Exam 4 - UTI

Question 1

1 bacteria of UTI?

Answer 1

E Coli

Question 2

Risk factors in UTI?

Answer 2

Spermicide, new sex partner <12mo, sex >3x/week, hx UTI, maternal UTI

Question 3

2 definitions of recurrent UTI?

Answer 3

2+ in 6 months, or

3+ in 12 months

Question 4

Sx of UTI?

Answer 4

Dysuria, frequency & urgency, hesitancy, hematuria, suprapubic pain

Question 5

Dx UTI with no labs?

Answer 5

Yes, if PT has new dysuria, frequency, and hematuria. No vag discharge and no complicating factors.

Question 6

What does Urine Dipstick check?

Answer 6

• Leukocyte esterase

- Nitrites (enterobacc bacteria)

Question 7

What is Pyuria? Which test can detect it?

Answer 7

WBCs in urine. Urine Microscopy.

Question 8

Urine Microscopy tests for?

Answer 8

Pyuria (WBCs in urine), hematuria, WBC casts

Question 9

What do positive WBC casts on urine microscopy signify?

Answer 9

Kidney inflammation

Question 10

What two tests combine to Urinalysis?

Answer 10

Dipstick + Microscopy

Question 11

What is gold standard for testing urine? When not to use?

Answer 11

Urine Culture. Don’t use in uncomplicated UTI.

Question 12

Is there a single best tx for uncomplicated UTI? Goal of tx?

Answer 12

No single best test!

Goal=less collateral dmg, less ecological effect

Question 13

Tx options for uncomplicated UTI?

Answer 13

• Bactrim DS x3 days (not if resist >20% or had in 3-6 mo)
• Nitro (Macrobid) x5 days (caution if CrCl <30)
• Fosfomycin x1 day

Alt: Cipro, B-Lactam

Question 14

Definition of complicated cystitis?

Answer 14

Preggers, urologic abnormal, immunocompromised, men, DM (?), preadolescent, post-menopausal.

Question 15

Tx of UTI if preggers?

Answer 15

Macrobid (nitrofurintonin). NOT Bactrim!

Question 16

Recurrent UTI prophylaxis options?

Answer 16

Bactrim SS 40/200

Nitro 50-100

Question 17

Dx for Complicated Cystitis

Answer 17

Urine Culture TOC. Follow up with another culture 1 week after tx.

Question 18

When to follow-up with urine culture?

Answer 18

1 week after tx

Question 19

Which drug to avoid in pregnant UTI?

Answer 19

Bactrim. Use Macrobid (Nitrofurintonin).

Question 20

When to screen pregnant women for UTI?

Answer 20

In 1st trimester and periodically after

Question 21

Who to screen for UTI?

Answer 21

Pregger women, urologic surgery PT

Question 22

Who to treat if ASx UTI positive?

Answer 22

Pregnant women, urologic surgery PT, renal transplant, neutropenic PT

Question 23

Tx for Recurrent UTI?

Answer 23

Nutrofurintonin or Bactrim

Question 24

If treat PT with recurrent UTI and they have another < 6 months what to do?

Answer 24

Use different agent than before

Question 25

When to prophylaxis for recurrent UTI?

Answer 25

After 2nd in 6 months or 3rd in 12 months with culture on record.

Question 26

2 major S/Sx in Acute Pyelonephritis?

Answer 26

1. Fever >38C/100.4F | 2. CVA tenderness

Question 27

Dx for Acute Pyelonephritis

Answer 27

Urine Culture!!!

Question 28

When to order imaging for Acute Pyelonephritis?

Answer 28

- If severe or worsening after appropriate abx in for 48-72h - ≥2 episodes - Persistent hematuria, stone, abscess, or obstruction

Question 29

First-line emperic tx for Acute Pyelonephritis? What caution?

Answer 29

Fluoroqinolones IV or PO 5-7 days. Caution with >10% resistance.

Question 30

Other abx tx or Acute Pyelonephritis

Answer 30

- Bactrim DS BID x14 days | - PO Beta-lactam

Question 31

When to admit Acute Pyelonephritis PT?

Answer 31

Hemodynamically unstable, DM, renal stones, preggers, PO meds not tolerated d/t severe nausea & vomiting

Question 32

Urine culture shows entercoccus in the urine, even if the person is asymptomatic and non-pregnant, treat?

Answer 32

Yes!!!

Question 33

Treatment options for Urine culture shows entercoccus in the urine, even if the person is asymptomatic and non-pregnant?

Answer 33

Nitrofurantonin. Amoxicillin/Ampicillin if Nitrofuratoin is not available.

Question 34

Tx for Complicated UTI?

Answer 34

1. Fluoroquinolones | 2. Aminoglycosides

Question 35

Tx for Recurrent UTI and Uncomplicated UTI?

Answer 35

1. Fosfo 3g x1 2. Nitro 100mg BID x5 days 3. Bactrim DS x3 days

Question 36

What are the two most accurate indicators of Uncomplicated UTI?

Answer 36

Nitrites and Leukocytes on dipstick

Question 37

When to treat women with catheter-acquired bacteruria after removal?

Answer 37

At least 48 hours

Question 38

When to treat PT with chronic indwelling catheter?

Answer 38

When symptomatic

Question 39

Should screen older ASx PTs for UTI?

Answer 39

No. Only if symptomatic.

Question 40

How to screen pregger women for UTI? When?

Answer 40

Urine cultures at end of first trimester. "Leukocyte esterase and nitrite tests have low sensitivity for identifying bacteriuria in women who are pregnant, these patients should be screened with urine cultures."

Question 41

Routine screening of ASx women w/DM?

Answer 41

Not supported

Question 42

ABX for ASx UTI preggers?

Answer 42

Amoxicillin, (Augmentin), Ampicillin, Cefuroxime (Ceftin), Cephalexin (Keflex), Nitrofurantoin (Furadantin)