Lecture 7: UTIs Flashcards by Enoch Koo

What is the MC organism to cause an UTI?

E. Coli

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How does the etiology of an acute UTI vs a chronic UTI differ?

Acute UTI: typically one organism.
Chronic UTI: 2+ organisms

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What two diagnostic tests are suggestive of an UTI?

Colony count > 10^5 cfu/mL
Pyuria

Both are not diagnostic of UTI.

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What is considered asymptomatic bacteriuria in women?

2 consecutive specimens with colony counts > 10^5

MC in women of increasing age.

Not recommended to screen in women or children.

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What could result in unresolved bacteriuria?

Resistance
Noncompliance
Mixed infections

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What is a persistent bacteriuria?

Sterilized urinary tract but still recurs due to persistent sources of bacteria.

Infected stones
Prostatitis
Foreign bodies
Fistulas

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What is the most common spreading method of UTIs?

Ascending via the urethra.

Women have higher incidence due to a much shorter urethra.

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If an UTI has a hematogenous source, what is the most likely bacteria to cause it?

Staph Aureus

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What are some general risk factors for UTIs?

Abnormal voiding
Diminished renal blood flow
Intrinsic renal disease
Abnormal urine pH or osmolality
Deficient mucosal coating

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What is the primary etiology of acute cystitis?

Bacterial (E. coli)

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What is the MC route for contracting acute cystitis?

Ascent up the urethra

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What are the S/S of acute cystitis?

Irritative voiding
Suprapubic pain
+/- hematuria
+/- malaise
Suprapubic tenderness

Systemic symptoms should NOT BE SEEN.

CVA tenderness would be more suggestive for pyelo.

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What is the triad that makes up irritative voiding?

Dysuria
Frequency
Urgency

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What imaging should we use for acute cystitis?

None needed unless male or complicated.

Could consider US for a male

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What are the expected lab results for acute cystitis?

Pyuria, hematuria, bacteriuria.
Leukocyte esterase, urinary nitrite
Urine culture

UA is NOT required unless risk factors or systemic symptoms present.

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What are the risk factors that would make an MDR G- bacteria more likely to be the underlying etiology for acute cystitis?

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Infection in 3 months with MDR G-
Inpatient stay
International travel
Quinolone, TMP-SMZ, or ES-beta lactam abx in 3 months.

What is the empiric therapy for acute cystitis?

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5 days of macrobid 100mg BID
3 days of bactrim DS 800/160mg BID
1 dose of fosfomycin 3g

Can choose any of these.

Macrobid only works on bacteriuria specifically.
DS = double strength

What are the second-line empiric therapies for acute cystitis?

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Augmentin or cefdinir/cephalexin for 5-7days BID

What are the 3rd line therapies for acute cystitis?

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Fluoroquinolones

What would prompt us to order a repeat UA for acute cystitis?

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Only if we are concerned it is unresolved.

What drug/dye can be given as a urinary analgesic and its main concerns?

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Phenazopyridine (dye)
Not for chronic use
Affects UA
Can cause AKI, hemolytic anemia, or methemoglobinemia

Can make urine bright orange! (prob a test question)

Should not use past 2 days!!!!!!!!!

What drug can double as a urinary analgesic and antimicrobial? What is its MOA?

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Converts parts of urine to formaldehyde and ammonia.
Methenamine

Usually short-term

What are the SEs/CIs associated with methenamine?

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Sulfa allergy
Rash
Nausea
Dyspepsia
CI in renal/liver insufficiency

What is a sitz bath?

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Sitting in a shallow basin filled with warm water.

What are the non-pharmacologic interventions for acute cystitis?

* Pee after sex * Pee when you can * Drink enough water so you pee * Wipe your pee front to back * Probiotics, cranberry juice, D-mannose ## Footnote SGLT2 inhibitor could increase incidence of UTIs! (anything that ends in gliflozin?)

What would prompt us to use abx prophylaxis for acute cystitis and the options?

* 3+ UTIs in a 12-month period with no correctable etiology. * Bactrim, TMP, Macrobid, Keflex, Methenamine (BID) | All other abx are daily.

What is the primary difference between acute cystitis vs pyelo?

Pyelo is more referred to as a kidney infection, rather than an UTI. | Same etiology, same route, same demographics ## Footnote It is rare than acute cystitis (since it is essentially a more advanced version of it)

What S/S are more unique to pyelo vs cystitis?

* Fever * CVA tenderness * N/V/D * Flank pain * Tachycardia

What is the preferred imaging modality for pyelo if imaging is desired?

CT, because it can show inflammation. | Overall, imaging is not required to diagnose. ## Footnote Both US and CT can show abscess.

What are the expected labs for pyelo?

* Pyruia, hematuria, bacteriuria * WBC casts can appear * Leukocyte esterase, urinary nitrite * CBC will show leukocytosis with left shift (DIFFERENT FROM CYSTITIS) | Generally labs appear the same as they do in cystitis

For OP tx of pyelo, what are the primary abx options?

* Initial IV of rocephin, cipro, or gentamicin * Oral ABX: Levofloxacin, cipro, Bactrim DS * 5-7 days for fluoros, 14 days for others. | Augmentin is second line. ## Footnote DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!

For IP empiric tx of pyelo, what are the primary abx options?

* If no MDR G- risk: rocephin, zosyn, unasyn, or fluoroquinolones * 1+ MDR G- risk: carbapenems * For highly resistance MDR G-: ES cephalosporin + BL inhibitor * For MDR G+: vanco, linezolid, or daptomycin | 14d of tx ## Footnote DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Zosyn has a z, so its pip/taZo Unasyn has a u, so its amp/sUl

What are the complications associated with pyelo?

* Sepsis/shock * Scarring and nephron loss * Chronic pyelo (3-6 months of abx) * Abscess formation (might need I&D)

What are the primary etiologies for acute urethritis?

1. N. gonorrhea 2. Chlamydia 3. Mycoplasma genitalium 4. Trichomonas vaginalis | Usually either gonococcal or non.

What is different about demographics between urethritis vs cystitis/pyelo?

MC in men because urethra is long enough to become infected. | In women, urethra is short so infection goes to bladder asap.

What are the S/S of acute urethritis?

* Irritative voiding * Pain/itching at meatus * Urethral discharge

If a patient has thick, purulent, copious discharge from their urethra, what is the more likely causative organism?

Gonorrhea | Will usually require milking the urethra. (awk)

What are the labs that would suggest urethritis?

* Gram stain * > 2WBC/hpf = presumptive * G- intracellular diplococci: presumed gonococcal * NAAT - diagnosing gono/chlamydia * UA: WBC esterase, pyruia, possible hematuria (need first-stream sample) ## Footnote AKA you do not want them to pee out the first bit into the toilet. Different from a clean catch!!

What is the empiric tx for acute urethritis?

* Gono: rocephin * Chlamydia: azithromycin, but doxy is preferred (but it is 7 days only) | MUST TREAT ALL PARTNERS AND REPORT TO HEALTH DEPARTMENT ## Footnote If very low risk for STI, should do a C&S in case.

Lecture 7: UTIs Flashcards

(39 cards)