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From Flashcardlet > SU2M - Infections of the GU tract > Flashcards

SU2M - Infections of the GU tract Flashcards

0
Q

9 Risk factors of UTIs?

A
  1. Female gender
  2. Sexual intercourse –> esp in females, or with use of spermacides
  3. Indwelling urinary catheters
  4. Pregnancy
  5. Personal Hx of recurrent UTIs
  6. Diabetes –> esp. upper UTIs
  7. Spinal cord injury
  8. Immunocompromised state
  9. Structural or functional abnormality that impedes urinary flow –> ex. incomplete voiding, neurogenic bladder, BPH, vesicourethral reflux, calculi
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1
Q

9 Most common organisms that cause UTIs?

A
  1. E.coli –> MOST common (80%)
  2. Staph saprophyticus
  3. Enterococcus
  4. Klebsiella
  5. Proteus spp.
  6. Pseudomonas
  7. Enterobacter
  8. Yeast –> esp Candida
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2
Q

3 Risk factors for UTIs in men?

A
  1. Uncircumcised
  2. Anal intercourse
  3. vaginal intercourse with a female colonized with uropathogens
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3
Q

6 Ssx of UTIs?

A
  1. Dysuria –> usually burning with urination
  2. Frequency
  3. Urgency
  4. Suprapubic tenderness
  5. Gross Hematuria
  6. Fever –> ONLY seen in upper UTIs
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4
Q

When should a urine culture be obtained with a UTI (5)?

A
  1. Patient > or 65 yrs old
  2. DM pt
  3. Recurrent UTIs
  4. Presence of sx for 7+ days
  5. Use of diaphragm
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5
Q

Asymptomatic bacteriuria: dx? tx?

A
  • dx: 2 successive + cultures (> or = to 10^5 CFU/mL)

- tx: ONLY tx in pregnancy or before urologic surgery

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6
Q

Most important finding on urinary analysis?

A
  • WBCs

- > or = to 10 WBCs = abnormal!

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7
Q

Dipstick urinalysis?

A
  1. Positive urine leukocyte esterase test = pyuria
  2. Positive nitrite test = enterobacteriaceae ONLY
    * *combining the 2 tests will increase sensitivity and specificity
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8
Q

Presence of epithelial cells in Urinalysis?

A
  • indicate vulvar or urethral contamination

- if contamination is suspected, perform a straight catheterization of the bladder

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9
Q

3 risk factors for upper UTI?

A
  1. Pregnancy
  2. DM
  3. Vesicourethral reflux
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10
Q

Recurrent infections: new or relapse? risk factors? consequences?

A
  • usually from a new organism, but can sometimes be a relapse if the original infection was not treated properly
  • risk factors: impaired host defense, pregnancy, vesicourethral reflux, sexual intercourse in women
  • consequences are usually not significant, unless the pt is at risk for upper UTIs
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11
Q

4 most common antibiotics given for an uncomplicated UTI?

A
  1. Oral TMP/SMX (bactrim) for 3 days
  2. Nitrofurantoin for 3-5 days –> DONT give if early pylonephritis is suspected
  3. Fosfomycin, singe dose –> DONT give if early pylonephritis is suspected
  4. Floroquinolones for 3 days –> alternative to above antibiotics
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12
Q

Phenazopyridine: use?

A
  • urinary analgesic

- can be given for 1-3 days for dysuria

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13
Q

3 Possible tx for UTI in pregnancy? What drug should be avoided? Why?

A
  1. Ampicillin
  2. Amoxicillin
  3. Oral Cephalosporins for 7-10 days
    * *Avoid fluroquinolones –> can cause fetal arthropathy
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14
Q

Tx of UTIs in men?

A
  • treat as an uncomplicated UTI in a female, but give tx for 7 days instead
  • do a work up if there are complications or recurrence
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15
Q

Tx for relapse of UTI within 2 weeks of the end of initial tx?

A
  • continue tx for 2 more weeks

- then get urine culture

16
Q

When should prophylaxis be given for recurrent UTIs? Tx?

A
  • when the pt has more than 2 UTIs per year
  • prophylaxis options:
    1. single dose of TMP/SMX after intercourse
    2. single dose of TMP/SMX at the first sign of UTI
    3. low-dose prophylactic antibiotics for 6 mnths
17
Q

8 Ssx of pyelonephritis?

A
  1. Fever/chills
  2. Flank pain
  3. Sx of cystitis –> may or may not be present
  4. GI sx: nausea, vomiting, & diarrhea –> sometimes present
  5. fever w/ tachy
  6. appear more ill than a pt with cystitis
  7. costovertebral angle tenderness –> unilateral or bilateral
  8. Abdominal tenderness on examination
18
Q

Pyelonephritis: definition?

A

-infection of the upper urinary tract

19
Q

Cystitis: definition?

A

-bladder infection

20
Q

3 Things to look for in urinalysis of pylenophritis?

A
  1. Pyuria
  2. Bacteriuria
  3. LEUKOCYTE CASTS
21
Q

3 Antibiotics for tx of pylenephritis? What to do if tx fails?

A
  1. TMP/SMX for 10-14 days (for gram-neg rods)
  2. Fluroquinolones for 10-14 days (for gram-neg rods)
  3. Amoxicillin (for gram-pos cocci –> enterococci or staph sapro)
    - single dose of ceftriaxone or gentamycin is often given initially before starting oral tx
    - repeate urine culture in 2-4 days, if sx are not resolving after 48hrs, then switch antibiotic according to the culture
    - failure to respond to tx = functional or structural abnormality –> workup needed!
22
Q

Which pts should be hospitalized for tx of pyleonephritis?

A
  1. very ill
  2. elderly
  3. pregnant
  4. unable to take oral meds
  5. significant co-morbidities
  6. suspected urosepsis
23
Q

Tx for hospitalized pts with pyelonephritis?

A
  • tx with antibiotics:
    1. ampicillin plus gentamicin
    2. ciprofloxcin
  • obtain blood cultures:
    1. if negative, tx with IV antibiotics until afebrile for 24 hrs, then give enough oral antibiotics to complete a 14-21 day course
    2. if positive, tx IV antibiotics for 2-3 weeks
24
Q

Tx for relapse of pylenophritis?

A
  1. If its the same organism, tx for 6 weeks

2. If it is from a new organism, tx with appropriate antibiotic for 2 weeks

25
Q

Acute bacterial prostatitis: who is it more common in?

A
  • younger men

- less common that chronic bacterial prostatitis

26
Q

Acute bacterial prostatitis: Pathophysiology?

A
  1. Ascending infection from urethra
  2. Reflux of infected urine
  3. After urinary catheterization
  4. Spread from rectum –> direct or lymphatic
  5. Hematogenous spread (rare)
    * *these all can also cause chronic prostatitis!
27
Q

Chronic bacterial prostatitis: who is it commonly seen in? pathophysiology?

A
  • more common than acute
  • most commonly sen in men ages 40-70
  • same routes of infection as acute prostatitis, can also develop from acute prostatitis
28
Q

6 Ssx of acute prostatitis?

A
  1. Fever/chills
  2. Dysuria
  3. Frequency
  4. Urgency
  5. Pain:
    - low back
    - perineal
  6. urinary retention
29
Q

Ssx of Chronic bacterial prostatitis?

A
  • patients are often asymptomatic, they do not appear ill
  • fever is uncommon
    1. Recurrent UTIs
    2. Irritative voiding sx
    3. Obstructive urinary sx
    4. Pain:
  • dull
  • poorly localized in the lower back, perineal, scrotal, or suprapubic region
30
Q

3 Tests for dx of acute bacterial prostatitis?

A
  1. DRE = boggy & very tender –> be careful not to cause bacteremia, may want to skip DRE if dx is obvious!
  2. Urinalysis = sheets of WBCs
  3. Urine cultures = almost always positive in acute
    * *obtain a CBC and blood cultures in a pt that appears toxic or if sepsis is suspected!
31
Q

Dx of Chronic prostatitis?

A
  1. DRE –> prostate is usually large and nontender
  2. Urine cultures –> may be positive or negative (nonbacterial prostatitis)
    * *obtain a CBC and blood culture in a pt that appears toxic or if sepsis is suspected
32
Q

Tx of acute prostatitis?

A
  • if severe and the pt appears toxic, hospitalize the pt and start IV antibiotics
  • if mild, tx outpatient with antibiotics for 4-6 wks:
    1. TMP/SMX
    2. Fluroquinolones + doxy
33
Q

Tx of Chronic bacterial prostatitis?

A
  • tx with fluorouinolones, prolonged course might be needed
  • hard to tx
  • recurrences are common!

From Flashcardlet (79 decks)

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