Exam 3- Genitourinary Infections

Question 1

What are the 5 types of genitourinary infections?

Answer 1

Pyelonephritis (kidney)
Cystitis (uncomplicated uti, bladder)
Urethritis (sti)
Prostatitis
Epididymitis (sti)

Question 2

What are the 6 factors that make a UTI complicated?

Answer 2

Anatomical abnormality of urinary tract

Recent urologic procedure or instrumentation

Immunocompromised patients

Recurrent infections despite appropriate treatment

Males

UTI in pregnancy

Question 3

What is an uncomplicated uti?

Answer 3

Patient who does not meet complicated uti criteria

Pre-menopausal women with normal anatomy

Question 4

What are the most common pathogens found in genitourinary infections?

Answer 4

E. COLI***

Question 5

What are the signs/symptoms of a UTI?

Answer 5

Dysuria (pain with urination)
Increased Urgency
Increased Frequency

Suprapubic “heaviness” and/or pain
Foul smelling/turbid urine
Hematuria

Question 6

What are the signs/symptoms of pyelonephritis?

Answer 6

Normal UTI symptoms plus:

-Systemic signs of infection (fever, chills, rigors, nausea, vomiting, diarrhea)

-Flank pain (costovertebral angle [CVA] tenderness) (palpating over the last rib can be very painful)

Question 7

What additional symptoms may be present with a complicated uti?

Answer 7

Symptoms may be atypical and non-specific:

Classic symptoms may or may not be present.

Also:
-Fever
-Malaise
-Altered mental status
-Urinary incontinence
-Change in appetite

Question 8

What symptoms may be present with catheter-associated uti?

Answer 8

Classic symptoms are often not present

-Pain over kidney + bladder
-Fever
-Lethargy and malaise

Question 9

What is the diagnostic criteria for uti/pyelonephritis?

Answer 9

Symptoms present
+
>/= 10^5 of >/= 1 bacterial species from a clean void

OR

> /= 10^3 of >/= 1 bacterial species from a catheter (placed in last 48-hr)

Question 10

What 2 tests can we perform to diagnose uti/pyelonephritis?

Answer 10

Urinalysis

Urine culture

*do both

Question 11

What are the 4 key components of a urinalysis relating to a UTI?

Answer 11

Bacteria present

WBC present (>/= 10 cells/hpf)

Leukocyte esterase present

Nitrite may or may not be present

Question 12

What does it mean nitrite is present in a urinalysis?

Answer 12

Enterobacterales are present

(convert nitrates to nitrites)

Question 13

What can a urine culture tell us?

Answer 13

Helps identify organisms and confirm antibiotic susceptibility

Question 14

What is the turnaround time for a urinalysis?

Answer 14

Hours

Question 15

What is the turnaround time for a urine culture?

Answer 15

2-3 days

Question 16

True or False: Repeat urine cultures after treatment are generally not recommended

Answer 16

True

Question 17

What is the treatment for asymptomatic bacteriuria?

Answer 17

This does not require treatment!!!

Except a few special cases: pregnancy

*note that asymptomatic bacteriuria is extremely common in catheterized patients and antibiotic use is normally unnecessary

Question 18

*What are the commonly used ORAL agents for UTI treatment?

Answer 18

Nitrofurantoin (uncomplicated)

Fosfomycin (uncomplicated)

Sulfamethoxazole/Trimethoprim

Fluoroquinolones (Ciprofloxacin, Levofloxacin)

Beta-Lactams
(Cephalexin, Cefadroxil, Cefpodoxime, Amox/Clav, Amoxicillin-not empiric)

Question 19

What are the oral beta-lactam options for UTI treatment (outpatient)?

Answer 19

Cephalexin
Cefadroxil
Cefpodoxime
Amoxicillin/Clavulanate
Amoxicillin (not empiric)

Question 20

What is the typical duration of complicated uti treatment?

Answer 20

7-14 days

Question 21

What is the typical duration of uncomplicated uti treatment?

Answer 21

3-7 days

Question 22

At what % resistance is an agent no longer recommended for empiric treatment?

Answer 22

20%

Question 23

What are the commonly used empiric antibiotic therapy options for inpatient uti treatment?

Answer 23

Ampicillin + Gentamicin*
Cefazolin +/- Gentamicin
Ceftriaxone
Cefepime
Gentamicin

Question 24

Which antibiotic does not cover enterococcus in uti’s?

Answer 24

any cephalosporins

*note that this is not the same as the nitrite producing enterobacterales

Question 25

What UTI patients are at risk of developing bacteremia (bacteria in the bloodstream)?

Answer 25

Complicated UTI Pyelonephritis

Question 26

True or False: If a patient develops bacteremia, we need to use antibiotics for a longer duration of time

Answer 26

False -use the same duration for complicated uti (7-14 days)

Question 27

What additional considerations must we make when treating prostatitis?

Answer 27

Need to consider antibiotic penetration into the prostate

Question 28

What are the treatment options for prostatitis?

Answer 28

Fluoroquinolones Sulfamethoxazole/ Trimethoprim Some Beta-Lactams (Cephalexin, Amox/Clav)

Question 29

What is the duration of treatment for prostatitis?

Answer 29

2-4 weeks (longer than any of the other urinary disease states)

Question 30

What is the definition of recurrent UTI?

Answer 30

3 or more infections in one year 2 or more infections in 6 months

Question 31

What are 3 potential causes of recurrent UTI's?

Answer 31

Sexual intercourse and diaphragm/spermicide use Postmenopausal women Urologic abnormality

Question 32

When may we consider uti prophylaxis?

Answer 32

If patient is experiencing recurrent uti's If no correctable cause is identified *note that you want to choose the narrowest spectrum option when choosing prophylaxis

Question 33

What are some options for uti prophylaxis?

Answer 33

Nitrofurantoin Trimethoprim/Sulfamethoxazole *avoid beta lactams

Question 34

When determining susceptibility of oral agents based on results from IV agents, for Cephalexin and Cefpodoxime, what would the reference IV drug be?

Answer 34

Cefazolin *Note that even though cefpodoxime is a 3rd gen cephalosporin, we would not use ceftriaxone