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Therapeutics V > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

(43 cards)

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1
Q

Types of UTIs

A

-Pyelonephritis
-Prostatitis
-Cystitis

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2
Q

Which gender are UTIs more common?

A

Female

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3
Q

Risk factors for UTI

A

-Urologic instrumentation
-Urinary tract obstruction
-Neurogenic bladder
-Renal transplantation

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4
Q

Characteristics of complicated UTIs

A

-Anatomical abnormality of urinary tract
-Recent urologic procedure or instrumentation
-Immunocompromised patients
-Recurrent infections despite appropriate treatment
-Male sex
-UTI in pregnancy

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5
Q

Examples of an anatomical abnormality in urinary tract

A

-Obstruction (commonly due to calculi (stone))
-Hydronephrosis (fluid swelling around kidney)
-Renal tract calculi
-Colovesical fistula (connects the bladder to the colon)

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6
Q

Examples of a recent urologic procedure or instrumentation

A

-Placement of nephrostomy tubes (tube above an obstruction to drain urine)
-Ureteric stenting (increases the flow of urine if there is no obstruction)
-Suprapubic catheter
-Foley catheter

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7
Q

What is an uncomplicated UTI?

A

-Patient not meeting criteria for complicated UTI
-Pre-menopausal women with normal anatomy

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8
Q

Most common pathogen seen in UTIs

A

E. Coli

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9
Q

What other pathogens are seen in complicated UTIs, catheter-associated UTIs and prostatitis?

A

-Enterococcus spp.
-Pseudomonas
-Other enteric GNRs

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10
Q

Signs and symptoms of a UTI

A

-New onset of dysuria, increased urinary urgency and increased urinary frequency
-Suprapubic heaviness sensation and/or pain
-Urine may be foul smelling or turbid (not correlated with infection)
-Hematuria can occur in some cases (alone does not mean complicated infection)

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11
Q

Signs and symptoms of pyelonephritis

A

-Same as UTI
-Systemic signs of infection - chills, fever, rigors, nausea, vomiting, diarrhea
-Flank pain - costovertebral angle (CVA) tenderness

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12
Q

Clinical presentation of a complicated UTI

A

-Classic UTI symptoms commonly present, but not always
-Fever
-Malaise
-Altered mental status
-Urinary incontinence
-Change in appetite

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13
Q

Clinical presentation of catheter-associated UTI

A

-Classic UTI symptoms often not present
-Pain over kidney and bladder
-Fever
-Lethargy and malaise

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14
Q

If a patient has altered mental status, does that mean they have a UTI?

A

NO, altered mental status alone does not automatically mean UTI is present

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15
Q

What are the microbiologic criteria that must be met to diagnose a UTI?

A

-10^5 or more of 1 or more bacterial species from a clean void
-10^3 or more of 1 or more bacterial species from a catheter (placed in last 48 hours)

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16
Q

How do you diagnose cystitis?

A

Cystitis symptoms must be present and microbiologic criteria must be met

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17
Q

How do you diagnose pyelonephritis?

A

Pyelonephritis symptoms must be present and microbiologic criteria must be met

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18
Q

What are the four key components of a urinalysis that are related to UTI?

Study These Flashcards
A

-Bacteria present (depends on how lab reports it)
-WBC present (10 or more cells)
-Leukocyte (WBC) esterase present
-Nitrite may or may not be present (enterobacterales convert nitrates to nitrites)

19
Q

How quickly can a urinalysis be completed?

20
Q

Why do you get a urine culture in a UTI?

Study These Flashcards
A

Assists with identification of organism and confirm susceptibility to antibiotic selection

21
Q

Would you repeat a urine culture after treament?

22
Q

How quickly can a urine culture be completed?

23
Q

What are the two tests that can be done to diagnose a UTI or pyelonephritis?

Study These Flashcards
A

-Urinalysis
-Urine culture

24
Q

When do you treat asymptomatic bacteruria?

Study These Flashcards
A

Only in pregnant patients

25
The four characteristics of an ideal oral antibiotic for UTI
-Medium to high bioavailability (50% and above) -Medium to high renal excretion (50% and above) -Low risk of "collateral damage" (tendency to cause bacterial resistance) and adverse effects -High likelihood of susceptibility
26
Commonly used oral agents for outpatient UTI treatment
-Nitrofurantoin (uncomplicated only) -Bactrim -FQs - cipro, levo -Fosfomycin (uncomplicated only) -Beta-lactams
27
What beta-lactams are commonly used for the treatment of UTI?
-Cephalexin -Cefadroxil -Cefpodoxime -Augmentin -Amoxicillin (only after susceptibility is confirmed) (not used empirically because E. Coli resistance is high)
28
Outpatient treatment duration for uncomplicated UTI
3-7 days
29
Outpatient treatment duration for complicated UTI
7-14 days
30
What is the percent resistance where an agent is no longer recommended for empiric treatment?
20%
31
Which drugs have a resistance rate of over 20%?
-Bactrim -Cipro
32
Do beta-lactams have less effectiveness and have more side effects than other UTI antimicrobials?
No, those studies sucked
33
Commonly used empiric therapies for UTI in hospitalized patients
-Ampicillin 2 grams IV Q6H + gentamicin 5 mg/kg (AdjBW) IV Q24H (first-line at IU Health but almost everywhere else uses ceftriaxone first line) -Cefazolin 1-2 grams IV Q8H +/- gentamicin 5 mg/kg (AdjBW) IV Q24H -Ceftriaxone 1-2 grams IV Q24H -Cefepime 1 gram IV Q8-12H -Gentamicin 5 mg/kg (AdjBW) IV Q24H
34
What percent likelihood is ampicillin + gentamicin to cover all organisms in a UTI?
91.6%
35
What percent likelihood is ceftriaxone to cover all organisms in a UTI?
72.2%
36
Considerations for UTI treatment in hospitalized patients
-Bacteremia can occur in patients with complicated UTI and pyelonephritis -De-escalate to narrowest antibiotic option once urine culture with susceptibilities return
37
How would you change treatment duration when treating a patient with urosepsis?
Do not lengthen treatment duration, treat for 7-14 days
38
What must you consider when selecting an antibiotic to treat prostatitis?
-Must consider antibiotic penetration into the prostate -No active transport of antibiotics into the prostate tissue -Need an option with high level of free drug, low protein binding
39
Recommended treatment options for prostatitis
-FQs -Bactrim -Some beta-lactams (cephalexin, Augmentin)
40
Treatment duration for prostatitis
2-4 weeks
41
Definition of recurrent UTI
-3 or more infections in 1 year -2 or more infections in 6 months
42
Potential causes for recurrent UTIs
-Sexual intercourse and diaphragm/spermicide use -Postmenopausal women -Urologic abnormality
43
How do you treat recurrent UTI?
-May consider prophylactic antibiotic if no correctable cause identified -Select narrowest spectrum possible

Therapeutics V (52 decks)

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