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Flashcards in dysuria/UTI Deck (26):
1

etiology of UTIs

E.coli (80-90%)
Other G-s (common in hospital, nursing home, immuen compromised, GU cath): proteus, klebsiella, pseudomonas
G+s: staph sapro, staph a., group B strep, enterococcus

2

renal parenchyma infection

pylenephritis

3

other causes of dysuria

menopausal: vaginal atrophy d/t loss of estrogen

4

fever
flank pain
CVA tenderness
nausea, vomiting

upper tract UTI

5

vaginal discharge
perineal pruritus
dysuria
reproductive age

vaginitis

6

if women has:
nocturia
cloudy
smelly urine
urinary frequency or urgency
dysuria
suprapubic discomfort

high confidence that it is a lower UTI

7

dysuria
urgency with decreased urine flow
tender and boggy prostate
hesitancy
+/- fever

prostatisis

8

high risk groups for UTI

-epithelium which e.coli adhere to
-uropathogens colonize vagina (d/t diaphgram, sponge, jelly)

9

complicated infection red flags

male
infant, geriatric
sx > 7 days
immunosuppresed
acute pyelonephritis in last year
anatomic abnormality
DM
fever
flank pain or tenderness

10

no fever or flank pain does/doesn't eliminate possiblity of UTI

doesn't
called occult pyelonephritis (just like lower UTI)

11

dipstick portion of a UA

blood
nitrite (50% UTIs, high FN rate, converted by bacteria over several hrs, except G+s and pseudomonas, if vegetarian won't have nitrates to convert)
luekocyte esterase (75% UTIs, WBCs, high FP rate)

12

dipstick results for a UTI

positive: either nitrite or LE positive
negative: both negative

13

dipstick shows blood

rule in UTI (but FP: myoglobin, bacteria producing peroxidase)

14

microscopy portion of UA

WBC count (women >2, men>5, kids >10)
RBC count
bacteria (if >10)
white cell casts

15

standard for UTI diagnosis

positive urine culture: >100 cfu of bacteria

16

use of urine culture only if

kid, men, older women, recurrent UTI in women
if healthy women: lack of prediction of response to Abx with culture

17

treatment of
acute uncomplicated lower UTI in healthy women

self-limited in 1 week: 40% but still treat with 3 days of Abx: TMP/SMX, TMX, nitrofurantoin (need 7 days), FQ (ciprofloxacin)

18

treatment of occult pyelonephritis

7 days of TMP/SMX or FQ

19

management of recurrent UTIs is women

don't need radiographic or urologic evaliuation
-urine cultures
-offer short course Abx when develop sx
-daily cranberry juice, increase fluid intake
-Abx after intercourse if 3 or more/year after intercourse

20

women with recurrent infections: behavior modifications (front to back, postcoital voiding, no pantyhose)

do not prevent UTIs

21

acute pyelonephritis in young women who is medically stable who maintains oral hydration

treat OP
-urine culture
-14 days antibiotics

22

acute pyelonephritis in hospitalized women (sepsis, abscess)

-blood culture before Abx
-IV FQ or pipercillin/tazobactam or 3rd gen cephalosporin
-continue until afebrile for 24 hrs
- 14 days antibiotics PO

23

test of cure for pyelonephritis

urine culture 2-4 wks after end of Abx

24

man with lower UTI or pyelonephritis

-urine culture
-7-10 days FQ if UTI or 14 days if pyelonephritis

25

imaging following pyelonephritis

women: if >1 pyelonephritis, postive urine culture after tx, childhood hx UTIs
men: 1 episode pyelo, >1 UTI

26

check for pyelo if

2 yo with recurrent UTI
>2 yo with pyelonephritis