Flashcards in Renal infections Deck (20)
Cystitis vs urethritis
- inflammation of the bladder
- **can be infection or generalized inflammation causes
- also presents with frequency and urgency as well as possible suprapubic pain
- inflammation of the urethra
- **strongly consider with younger males with dysuria
- often STI caused (chlamydia/gonorrhea)
**both present with dysuria**
What symptoms are needed to make a diagnosis of a UTI?
Pyuria (presence of white blood cell)
Bacteriuria (presence of bacteria in urine)
Symptoms of infections (fever, sniffles, headache)
- is atypical in elderly or spinal cord injury
Dipstick analysis for UTI
- breakdown of active WBCs
- present when bacteria reduce dietary nitrates
- ***enterobacteriaceae is the most affecting agent showing these
Blood trace on dipstick
**microscopy looks for WBC/RBC hpf
- pyuria = 10 or > wbc/hfp
***need the triad of blood, nitrates and leukocyte esterase on dipstick***
What types of UTIs are seen in immunocompromised patients, but almost never in normal immune systems?
Gonorrhea, trichomonas, chlamydia
What two species of bacteria that produce UTIs dont show leukocyte esterase on dipstick?
- will show nitrates but no leukocyte esterase
- wont show either nitrates or leukocyte esterase
What is the classic number of CFUs/mL in order to 100% diagnosis someone with a UTI?
*this is starting to drop down to 10^3, but the classic teaching is 10^5*
Why are male patients almost always complicated UTIs?
Because they hardly ever get them due to longer urethra
What types of patients require cultures?
Pretty much everyone who doesnt present with a simple uncomplicated UTI and is symptomatic
- children, men and pregnant women are automatically complicated UTIs
How does one make the diagnosis of asymptomatic bacteria?
Is a normal appearing person that lacks typical signs and symptoms of UTI’s
- especially no fever or vomiting
However urinary dipstick shows signs of infection and culture will come back positive with >10^5 with some organism
***lack of treatment does NOT lead to injury to the patient, as compared to pyelonephritis***
- therefore, we DONT treat patients with this as long as they are asymptomatic and are not pregnant!!
**if patient is pregnant or the patient is undergoing urologic procedures and can likely bleed, must still treat since it can affect the child**
What are long term complications of untreated UTI
Renal scarring and GFR dysfunction
HTN (sometimes malignant)
Why is it important to ask patients who present with UTI symptoms if they have recently been using antibiotics?
If they say yes, it likely is a resistant organisms you are dealing with
Classic presentation of a UTI
A female who presents with:
-Urgency of urination without vaginal symptoms
**even higher chance if they state they have history of UTI/STD in the past**
***if the patient has all the above, especially the no-vaginal symptoms, then acute lower UTI = 90%***
First line therapies for uncomplicated UTI and cystitis
Nitrofurantoin (NO in pregnancy)
TMP-SMX (OK in pregnancy outside of the 3rd trimester)
Cephalosporins (3rd gen ceftriaxone/cefotaxime or 4th gen cefepime)
**second line = fluroquinolones**
***you don’t need imagining/cultures to diagnosis this and start treatment if the they have the classic triad of symptoms***
What is 1st line in VRE?
Carbapenems needed to be added
What is added to cover MRSA infections
When should you expect urinary tract infection obstruction with a UTI
If a patient is on appropriate antibiotics and they are not getting better (in fact often get worse)
When do you need to consider prostitis with a UTI?
Males who present with febrile UTIs
- requires 4-6 weeks of SMX-TMP or fluroquinolones
What is required to diagnosis sepsis?
SIRS criteria (need 2 of the 4) + infection = sepsis
- temperature > 38.0 C
- heart rate > 90 bpm
- Respiratory rate > 20 breaths
- WBC > 12,000
Treatment = start IV fluids. If it doesn’t solve hypotension, then start vasopressors (usually NE 1st)
Multiple organ dysfunction syndrome
Progressive organ dysfunction in acutely ill patients
- can be caused by infectious or non-infectious diseases
**will show multiple organ systems failing which are seen bellow with the respective lab abnormalities
- hematologic = low platelet count/INR
- liver = bilirubin high
- brain = low GCS and AMS
- renal = low creatinine and urine output
- cardiovascular = low blood pressure and height heart rate
- respiratory = oxygen requirements
- cellular metabolism = high lactate