Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

bacteria shizz > IC13 UTI > Flashcards

IC13 UTI Flashcards

1
Q

Define ASB

A

ASB (asymptomatic bacteriuria) - significant colony counts in urine but w/o urinary symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define UTI

A

significant colony counts in urine w urinary symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In which patient populations should we screen for and treat ASB?

A
  1. pregnant women
    increased chance of pyelonephritis, preterm labor, infant low birth weight if left untreated
  2. undergoing invasive urologic procedure in which mucosal trauma/bleeding is expected
    bacteria in urine may enter bloodstream, causing bacteremia & urosepsis
    when treated, it is considered SAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do we screen for ASB in these 2 patient populations?

A

pregnant women: within 12-16 weeks of gestation
invasive urologic procedure: 2-3 days before procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does UTI present in elderly patients?

A
  1. altered mental status (delirium, falls, confusion)
  2. urinary symptoms (eg. dysuria, frequency)
  3. signs of systemic infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When do we treat UTI in elderly patients?

A

when they present with mental status changes + urinary symptoms OR signs of systemic infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the prevalence of UTIs across age groups

A

0-6 months: males > females
1-adult: females > males
elderly (>65): equal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the possible routes of infection of bacteria that results in UTI

A
  1. ascending route
    bacteria from colon/fecal matter colonise periurethral area/urethra –> ascend UP to bladder & kidney
  2. descending route
    bacteria from a distant primary infection site enters bloodstream and is transported to urinary tract, causing a UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the likely organisms involved in each route of infection?

A

ascending route: Enteric G(-) bacteria ie. Enterobacteriaceae, eg. E Coli, Klebsiella, Proteus

descending route: Staph aureus, MTb (bacteria unlikely to be found in GIT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some host defence mechanisms in our body that prevents UTIs?

A
  1. bacteria stimulates micturition
  2. anti-adherence mechanisms
  3. antibacterial properties of urine & prostatic secretion
  4. presence of phagocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the risk factors for UTI?

A
  1. females > males
  2. sexual intercourse
  3. pregnancy
  4. use of diaphragms & spermicides
  5. previous UTI
  6. positive family history
  7. DM
  8. catheterization
  9. abnormalities in urinary tract (eg. prostatic hypertrophy, kidney stones)
  10. neurologic dysfunction eg. stroke, DM, spinal cord injuries
  11. anti-cholinergic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to prevent more UTIs (non-pharmacological strategies)

A
  1. hydrate adequately
  2. urinate frequently/go whenever you have the urge
  3. urinate right after sex
  4. good toilet hygiene (females - wipe from front to back)
  5. wear cotton underwear, loose-fitting clothes to keep the area dry; avoid tight fitting clothes
  6. avoid spermicides & diaphragms & unlubricated condoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classification of UTI

A

complicated vs uncomplicated
- complicated: a/w serious outcomes, treatment failure, disease relapse
eg. UTI in men, children, pregnant women
- uncomplicated: none of the above
typically pre-menopausal woman of child-bearing age with no history of abnormal urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of lower UTI (cystitis)?

A

lower UTI (cystitis)
- dysuria (pain)
- hematuria (blood)
- urgency
- frequency
- nocturia
- suprapubic heaviness / pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of upper UTI (pyelonephritis)?

A

upper UTI (pyelonephritis)
- fever
- rigors
- headache
- N/V
- malaise
- flank pain
- renal punch positive
- abdominal pain
a/w systemic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the tests used to diagnose UTI?

A

urinalysis (UFEME)
urine dipstick
urine culture
lab values (WBC, RBC, CRP, procalcitonin, PMN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the possible urine collection methods?

A
  1. midstream clean catch
  2. catheterization
  3. suprapubic bladder aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does the UFEME report measure?

A
  1. WBC
  2. RBC
  3. microorganisms
  4. WBC casts
  5. squamous epithelial cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do these indicators tell us?

A
  1. WBC
    - > 10 WBCs/mm3 = pyuria (pus in urine) = presence of inflammation, though not necessarily due to infection
    - no pyuria = very unlikely UTI
  2. RBC
    - > 5 RBC per high powered field (HPF) = hematuria
    - frequently occurs in UTI but non-specific
  3. microorganisms
    - bacteria, yeast
  4. WBC casts
    - formed in renal tubules
    - presence indicates upper UTI
  5. squamous epithelial cells
    - many = high levels of contamination = poor urine collection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does the urine dipstick measure?

A

presence of
1. nitrites
- detects presence of G(-) bacteria
- requires at least 10^5 bacteria/mL
2. leukocyte esterases
- detects presence of leukocytes in urine
- correlates w significant pyuria (>10 WBCs/mm3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When do we obtain urine cultures?

A

obtain pre-treatment cultures for complicated UTI (pregnancy, men, pyelonephritis, catheter-associated UTI) or recurrent relapse (relapse within 2 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do we not obtain urine cultures?

A

do not obtain for uncomplicated UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the likely organisms involved in uncomplicated UTI?

A
  • E Coli (80%)
  • Staphylococcus saprophyticus
  • Others (Proteus, Klebsiella, Enterococcus faecalis [PKE])
24
Q

What are the likely organisms involved in complicated UTI?

A
  • E Coli (50%)
  • PKE
  • Enterobacter
  • Pseudomonas aeruginosa
25
Q

What are the difference in the organisms involved in complicated and uncomplicated UTI?

A

TYPE of pathogens & STRAIN of pathogens (higher resistance in complicated/healthcare associated)

26
Q

What are the UNlikely organisms involved UTI?

A
  • Staph aureus: likely due to bacteremia (descending route)
  • Yeast, Candida: likely contaminant; can consider other infection sites (can cause infection via descending route)
27
Q

What is the thought process when trying to decide which abx to use for ASB/UTI?

A
  1. Do we need to treat this?
    - ASB (except 2 special pop): NO
    - Symptomatic: Yes
  2. Likely organism
    - Community acquired: E Coli, Staph saprophyticus
    - Healthcare-associated: E Coli, PKE, Enterobacter, Pseudomonas
  3. Type of UTI
    - cystitis VS pyelonephritis
    - complicated VS uncomplicated
    - community acquired VS healthcare-associated

possible scenarios:
- cystitis in women
- community-acquired pyelonephritis in women
- community-acquired UTI in men
- healthcare-associated UTI
catheter-associated UTI
- UTI in pregnancy

28
Q

Abx classes preferred for UTI in general according to SOA table

A
  1. beta lactams (penicillins, cephalosporins)
  2. fluoroquinolones
  3. co-trimoxazole
  4. others (nitrofurantoin, fosfomycin)
29
Q

First line empiric treatment options for cystitis in women [uncomplicated]

A

Likely pathogen: E Coli

FIRST LINE
1. PO Co-trimoxazole 960mg BD x 3/7
2. PO Nitrofurantoin 50mg QDS x 5/7
3. PO Fosfomycin 3g single dose*
RESERVED FOR CYSTITIS DUE TO ESBL PRODUCING G(-)

[nitrofurantoin & fosfomycin for ucUTI ONLY]

30
Q

Alternative empiric treatment options for cystitis in women [uncomplicated]

A

Likely pathogen: E Coli

ALTERNATIVES
1. PO Beta lactams x 5-7 days
- amoxicillin-clavulanate 625mg BD
- cephalexin 250-500mg QDS
- cefuroxime 250mg BD
2. PO Fluoroquinolones x 3/7
- cipro 250mg BD
- levo 250mg OD
*Avoid fluoroquinolones for ucUTI unless no other choice

31
Q

(if can’t rmbr previous slide)
How to remember which abx to use for ucUTI in women:

A

Likely pathogen to target: E Coli

First line: Co-trimoxazole, nitrofurantoin, fosfomycin

Alternatives:
Referring to SOA table, the abx that targets E Coli are
* BETA LACTAMS
- Amox-clav
- Pip-tazo
- All cephalosporins
* Carbapenems
* Aminoglycosides
* Fluoroquinolones

Cystitis in women is simple, uncomplicated = use oral abx
Therefore, the only options left are
- Amox-clav
- Cephalexin
- Cefuroxime
- Fluoroquinolones
Pip-tazo is IV only, cefazolin + 3rd-5th gen cephalosporins are all IV, carbapenems & aminoglycosides reserved for ESBL
Technically fluoroquinolones can be used, BUT not preferred for uncomplicated UTI as risks > benefits

and now, the whole list of abx is magically generated via elimination :)

32
Q

Empiric treatment options for cystitis in women [complicated]

A

same abx
longer duration of 7-14 days
fosfomycin dose for cUTI: PO 3g EOD x 3 doses

33
Q

Empiric treatment options for community-acquired pyelonephritis in women: OUTPATIENT TREATMENT (ie. not very severe)

A

Likely pathogen: E Coli

OUTPATIENT TREATMENT (oral)
1. PO fluoroquinolones
- PO cipro 500mg BD x 7 days
- PO levo 750mg OD x 5 days
2. PO Co-trimoxazole 960mg BD x 10-14 days
3. PO Beta lactams x 10-14 days
- amoxicillin-clavulanate 625mg TDS
- cephalexin 500mg QDS (not preferred)
- cefuroxime 250-500mg BD

generally higher dose + longer duration compared to cystitis

34
Q

Empiric treatment options for community-acquired pyelonephritis in women: INPATIENT TREATMENT (ie. severe)

A

Likely pathogen: E Coli

INPATIENT TREATMENT (IV)
considered for severely ill patients who require hospitalisation/unable to take oral drugs

  1. Amoxicillin-clavulanate 1.2g q8h
  2. Cefazolin 1g q8h
  3. Cipro 400mg BD
  4. IV/IM Gentamicin 5mg/kg

choose from 1, 2 or 3
add 4 if patient very severe = risk of ESBL strains

35
Q

When and how do we step down IV abx for severe community-acquired pyelonephritis?

A

switch to oral abx (ie. non-severe options) when patient improves
- follow duration stated for oral abx
- eg. if switching to PO co-trimoxazole, which has a stated duration of 10-14 days, and patient has been on ACTIVE IV abx for 3 days, then administer co-trimoxazole for another 11 days

36
Q

Empiric treatment options for community-acquired UTI in men

A

Likely pathogen: E Coli

concern for cystitis only: same treatment as complicated cystitis in women (co-trimoxazole, nitrofurantoin, fosfomycin for extended duration of 7-14 days)

concern for cystitis + ?prostatitis OR pyelonephritis:
1. PO co-trimoxazole 960mg BD
2. PO cipro 500mg BD
duration: 10-14 days
prostatitis confirmed: 6 weeks
why these 2 agents: concentrate well in all 3 organs (bladder, kidney, prostate) :O

37
Q

co-trimoxazole:
What are the difference in doses + duration when used for
1. uncomplicated cystitis VS complicated cystitis
2. cystitis VS pyelonephritis
3. CA-UTI in men

A

dose is always the same at 960mg BD
1. uncomplicated - 3 days
complicated - 7-14 days
2. cystitis: 3 days / 7-14 days
pyelonephritis: 10-14 days
3. 10-14 days

38
Q

Define nosocomial & healthcare-associated UTI

A

nosocomial: onset of UTI when hospitalised for >48h (2 days)

healthcare associated:
- hospitalised/underwent invasive urological procedures in the PAST 6 MONTHS
- indwelling urine catheter
- exposure to abx

39
Q

What are the microbes of concern for nosocomial/healthcare-associated UTI?

A
  1. Pseudomonas aeruginosa
  2. Resistant bacteria (eg. ESBL E Coli, Klebsiella)

*MRSA is also a healthcare associated pathogen, but not of concern as not usually in urinary tract (unless from descending route of infection)

40
Q

Empiric treatment options for healthcare-associated UTI for MORE sick patients

A

Likely pathogen: PA, ESBL

more sick = IV
1. IV Cefepime 2g q12h +/- IV Amikacin 15mg/kg/day
(if patient not doing well, add on aminoglycoside to cover potential ESBL strains)
(aminoglycoside may not be used in elderly due to concern of nephrotoxicity)
2. IV Carbapenem
- Imipenem 500mg q6h
- Meropenem 1g q8h

duration: 7-14 days

41
Q

Empiric treatment options for healthcare-associated UTI for LESS sick patients

A

Likely pathogen: PA

less sick = oral
1. PO Fluoroquinolones
- Cipro 500mg BD
- Levo 750mg OD
(the only oral agent for PA)

duration: 7-14 days

42
Q

What if a patient on PO abx for HA-UTI (ie. less severe) does not improve, or even worsens?

A

if worsens after 2 days/no improvement, switch to IV

43
Q

Define catheter-associated UTI

A
  1. Signs & symptoms of UTI
  2. No other sources of infection
  3. at least 1 bacterial species in a single catheter urine specimen present in at least 10^3 cfu/mL

for patients that
- has been on catheter for 2 days
- within 2 days of removal of long term catheter

44
Q

What are the symptoms of catheter-associated UTI?

A
  1. new-onset/worsening fever
  2. rigors
  3. altered mental status
  4. malaise
  5. lethargy
  6. no other identified cause (for the 5 above)
  7. flank pain
  8. costovertebral angle tenderness
  9. acute hematuria
  10. pelvic discomfort
45
Q

Risk factors for catheter-associated UTI

A
  1. duration of catheterization
  2. colonisation of drainage bag, catheter, periurethral segment
  3. DM
  4. female
  5. impaired renal function
  6. poor quality of catheter care, incl insertion
46
Q

What is the difference in the microbes identified from short term VS long term catheterization?

A

short term: UTI due to single microbe
long term: UTI due to multiple microbes (polymicrobial)

47
Q

Scenario: Results of urine culture of patient with catheter showed presence of bacteria. What do you do?

A

asymptomatic –> NO NEED TO TREAT W ABX (similar to ASB)
1. remove catheter
2. if catheter is needed, replace

symptomatic –> TREAT
1. take urine +/- blood culture
2. start empiric abx
*if patient has low grade fever but is stable –> observe

48
Q

Empiric treatment for moderate to severe symptomatic catheter-associated UTI

A

Likely pathogens: PA, ESBL

moderate to severe = IV
1. Carbapenems
- Imipenem 500mg q6h
- Meropenem 1g q8h
2. Cefepime 2g q12h +/- Amikacin 15mg/kg (1 dose or daily) (same as HA-UTI)

duration:
- 7 days (if fever goes down within 3 days)
- 10-14 days (if delayed response)

49
Q

Empiric treatment for mild symptomatic catheter-associated UTI

A

Likely pathogen: PA, E Coli???

mild = oral
1. PO/IV levo 750mg OD x 5 days
2. PO Co-trimoxazole 960mg BD x 3 days

50
Q

How to prevent catheter-associated UTI?

A
  1. avoid unnecessary catheter use
  2. use for minimal duration
  3. long term indwelling catheters should be changed before blockage occurs
  4. use of closed system
  5. ensure aseptic insertion technique
51
Q

What is not recommended to prevent cather-associated UTI?

A
  1. topical antiseptic/antibiotic in urinary tract
  2. prophylactic abx
  3. chronic suppressive abx
52
Q

What antibiotics should be avoided in pregnancy for UTI?

A
  • fluoroquinolones
  • co-trimoxazole
  • nitrofurantoin at 38-42 wks
  • aminoglycosides
53
Q

What are the choice of abx & duration for UTI in pregnancy?

A

beta lactams
fosfomycin

54
Q

What is the duration of treatment of UTI in pregnancy?

A
  • ASB, cystitis: 4-7 days
  • pyelonephritis: 14 days
55
Q

What are some adjunctive therapy for symptoms experienced during UTI (pain, fever, vomiting)?

A

pain, fever - paracetamol, NSAIDs
vomiting - rehydration
pain - phenazopyridine 100-200mg TDS (topical analgesic effect) avoid in G6PD deficiency

56
Q

How long will the abx take to show effect?

A

patient should feel better the next day (won’t completely be cured the next day, but should feel better)

bacteria shizz (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions