Infectious Disease Exam 2 - UTIs

Question 1

Urinary Tract Infection - Presentation

Answer 1

Dysuria
Urgency
Frequency
Fever
Abdominal pain
May be asymptomatic

Question 2

Urinary Tract Infection - Diagnosis

Answer 2

Pyuria (white blood cells in urine)
Bacteriuria
Leukocyte ester (non-specific)

Question 3

Cystitis

Answer 3

Lower tract infection

Pyuria, dysuria, flank pain possible, or asymptotic

Question 4

Urinary Tract Infection - Pathogens

Answer 4

Gm(-) - most common
  -E. Coli -most common
  -Proteus
  -Providencia
  -Enterobacter
Gm(+)
  -Enterococci
  -MRSA
  -Staph. saprophyticus (common in young females)
Fungi
  -Candida

Question 5

Significant bacteriuria

Answer 5

> 100,000

>100 IF symptomatic w/ pyuria & if Gm(-) organism (nitrites present)

Question 6

Cystitis - Treatment

Answer 6

Outpatient therapy (3days)
Asymptomatic will self-resolve
-In pregnancy use 3-7 day treatment
-3-7 day treatment in DM

Question 7

Cystitis - Treatment (Bacterial)

Answer 7

Amoxicillin (might not cover)
TMP/SMX (might be best choice)
Fluoroquinolone (heavy duty)
Nitrofurantoin

Question 8

Cystitis - Treatment (Fungal)

Answer 8

Fluconazole

IF resistant/refractory Amphotericin B bladder irrigation

Question 9

Pyelonephritis

Answer 9

Upper tract infection/kidney infection
Unilateral/bilateral flank pain
Fever >102
Pyuria
Bacteriuria

Question 10

Pyelonephritis - Treatment (Inpatient)

Answer 10

Gm(-)
  -Ceftriaxone
  -Quinolone
Enterococcus (VSE)
  -Ampicillin
Enterococcus (VRE) 
  -Linezolid
MRSA
  -Vancomycin

Question 11

Pyelonephritis - Treatment (Outpatient)

Answer 11

Gm(-)
  -TMP/SMX
  -Quinolone
Enterococcus (VSE)
  -Ampicillin/amoxicillin

Question 12

Urosepsis

Answer 12

Sepsis originating in the urinary tract
Elevated WBC (>12,000) or depressed WBC (<4,000)
Organ dysfunction (reduced urine output)
Altered mental status
Cultures of blood and urine w/ same organism

Question 13

Urosepsis - Treatment (Community acquired)

Answer 13

Gm(-)
  -Cefriaxone
  -Quinolone
Enterococcus OR strep. 
  -Ampicillin

Question 14

Urosepsis - Treatment (Healthcare acquired)

Answer 14

Gm(-) - including psuedomonas
  -Ciprofloxacin
  -Cefepime and/or aminoglycoside
Gm(-) - Non-pseudomonas
  -Cefepime
  -Meropenem

Question 15

Chronic/Recurrent UTIs

Answer 15

> 3 per year

Question 16

Chronic UTI prophylaxis

Answer 16

TMP/SMX
TMP (preferred in men)
Nitrofurantoin (low dose over long time = resistance)