Urinary tract Infections

Question 1

Define :
bacteruria
UTI
Cystitis
Pyelonephritis
Funguria

Answer 1

Bacteriuria presence of bacteria in urine
UTIS -presence of microbes in urine that can Invade structures and tissues of urinary tract and surrounding areas
Cystitis-inflammation of bladder d/t infection
Pyelonephritis-affect kidneys and upper urinary tract
Funguria-presence of fungi/yeast in urine

Question 2

Define uncomplicated , complicated UTIs, relapse , reinfection,recurrent

Answer 2

Uncomplicated- occur in healthy men and women with completely normal genitourinary systems
Complicated- infections interfere with normal urine flow can be due to stones, catheter
Recurrent UTI->3 episodes /year with asymptomatic periods in between
Relapse -same pathogen
Reinfection-different pathogens

Question 3

Examples of lower urinary tract infections

Answer 3

Cystitis , urethritis, prostatitis

Question 4

Etiology of uncomplicated UTIs (pathogens)

Answer 4

E.Coli (80-90%)
K. Pneumonia
Proteus mirabili
Pseudomonas aeruginosa
Enterococcus
Staph saprophytic

Question 5

Etiology of complicated UTI

Answer 5

E.coli
K.pneumonia
Proteus
Enterobacter
P. Aeruginosa
Enterococcus

Question 6

What pathogens are patients with vancomycin resistant enterococci( VRE)

Answer 6

E.faecalis
E.faecium

Question 7

Pathophysiology uti

Answer 7

Results from normal flora from bowel can gain entry into urinary tract by ascending up urinary tract , hematogenous route , lymphatic system

Question 8

Diagnostic and treatment plan depends on (uti)

Answer 8

Location of UTI
Comorbidities such as diabetes
Complications such as nephrolithiasis
Resistance of organisms

Question 9

Clinical presentation of Lower and upper UTIs

Answer 9

Lower-dysuria, nocturia, supra pubic tenderness, haematuria, urinary urgency

Upper -flank pain, fever , chills , N/V , malaise

Question 10

What are some treatment concerns utis

Answer 10

Resistance to fluoroquinolones
Cotrimoxazole increased
Resistance of E.coli, E. Faecalis, proteus mirabilis

Question 11

Diagnosis uti

Answer 11

Dipstick diagnosis- cost effective, use midstream urine culture asses elevated nitrites and wbc
Urine culture - for elderly women, cystitis in Immunocompromised, exposure to antibiotics
Bacteremia associated with pylenephritis
Urinalysis-proteinuria

Question 12

Dipstick testing

Answer 12

Glucose, protein ,blood,nitrite , leukocyte esterases help screen UTIS

Question 13

Speak on urine culture

Answer 13

Not needed in uncomplicated UTI(cystitis)
Criterion standard for diagnosis of UTIs
Especially for complicated UTIs, and failing initial /empiric therapy

Question 14

What does it mean when patient has had UTI within month of treatment

Answer 14

Relapse probably due to treatment failure, obtain urine culture and perform gram stain for sensitivity

Question 15

Characteristics sign of pyelonephritis

Answer 15

Fever
Severe flank pain
In elderly women cases of cystitis involve upper tracts

Question 16

Physical examination uti

Answer 16

Dry mucous membrane ,tachycardia, symptomatic orthostasis is suggestive of poor vascular tone due to gram negative bacteremia

Question 17

Why should pelvic exam be done(uti)

Answer 17

To exclude vaginitis, pelvic tenderness, cervicitis

Question 18

Compare acute urethritis and cystitis

Answer 18

Urethritis-urethral discharge, fever , acute dysuria and urinary hesitancy
Cystitis-inflammation of bladder cause dysuria, polyuria,,incomplete voids with low back pain

Question 19

Catheter-related infection signs

Answer 19

Fever and leukocytosis
Significant pyuria
Polymicrobial infections

Question 20

What are infections of pregnant patients
(UTIs)

Answer 20

Asymptomatic bacteruria(ASB)
Predispose to preterm labor, anemia, hypertensive disorders

Question 21

Risk factors for ASB(utis)

Answer 21

Sexual activity
Diabetes
History of UTIs

Question 22

Complications UTIs patient with DM

Answer 22

Papillary necrosis
Fungal infections
Renal and perirenal abscess

Question 23

Differentials utis

Answer 23

Herpes simplex
Vaginitis
Pelvic inflammatory disease
Bladder cancer

Question 24

Non pharmacological management utis

Answer 24

Cranberry
Hydration
Diet

Question 25

Indication for hospital admission for patients with complicated UTI

Answer 25

Complicated pyelonephritis Metabolic disease(DM) Immunocompromised Structural abnormalities ie indwelling catheter

Question 26

1st choice agents for treatment of uncomplicated acute cystitis

Answer 26

Nitrofurantoin TMP-SMX Fosfomycin Alternative-beta lactams FQ-complicated cystitis

Question 27

Treatment of UTIs for uncomplicated Give 1st, second line and alternative

Answer 27

1st line :1.cotrimoxazole DS 1 tab PO q12h for 3 days Nitrofurantoin 100mg q12h 5-7 days Fosfomycin 3g PO with 125 ml of water Second line : levofloxacin 250mg PO q24h for 3 days Alternative -cefuroxime 200mg q12 7-10 days Amox/clav 500/125mg q12 for 3-7 days

Question 28

Treatment for complicated 1st line and for patient who can’t tolerate oral therapy or possible resistance

Answer 28

1st- levofloxacin 750mg q24 for 5 days Parenteral for pt can’t tolerate Levofloxacin 750 mg IV for 5 days Pip-tazo 3.375 g IV q6h Imipenem-cilastin 500mg IV q6h for 7-14 days

Question 29

Fungal infections

Answer 29

Replace catheter Amphotericin B, 0.3mg/kg IV for 1 dose to provide sustained and systemic response

Question 30

Discuss monitoring parameters utis

Answer 30

Clinical presentation ie fever FBC ie TMP-SMX cause hematologic disturbance Adr: Nitrofurantoin-hepatotoxicity, peripheral neuropathy Cotrimoxazole - anemia, neutropenia, allergic rxn,

Question 31

Speak on nitrofurantion

Answer 31

MOA: interfere cell wall synthesis, by interfering with bacterial enzymes involved in metabolism of pyruvate Spectrum: gram +/- , e.coli, S.saprophyticus Admin:oral Side effects: pulmonary toxicity, peripheral neuropathy, GIT , peripheral neuropathy Good for uncomplicated UTIs

Question 32

Fosfomycin

Answer 32

MOA: inhibits cell wall synthesis by interfering with peptidoglycan formation Spectrum : gram+/- , resistant strains , E. Coli Dosing orally/IV Side effect : well tolerated , git symptoms Decreased resistance, good for uncomplicated UTIs

Question 33

Cotrimoxazole

Answer 33

MOA: inhibit sequential steps for bacterial folic acid synthesis, inhibit DNA synthesis Spectrum: broad spectrum, gram +/- , E.coli , S. Aureus Admin: orally S/E : neutropenia, anemia, Steven Johnson , allergic rxn, neutropenia Good for prophylaxis, used in management both complicated and uncomplicated UTIs including prostatitis Drink with lots of water