Urinary Tract Infections

Question 1

What are the sxs of a lower UTI? upper UTI?

Answer 1

Dysuria, urgency, frequency, nocturia, and suprapubic heaviness

flank pain, fever, N/V, malaise

either can have gross hematuria

Question 2

PE finding in upper UTI?

Answer 2

CVA tenderness

Question 3

UTI lab findings?

Answer 3

pyuria (leukocytosis)

nitrite positive urine

leukocyte esterase positive urine

Question 4

Presenting sxs for elderly pt with UTI?

Answer 4

freq. NO urinary sxs

AMS, change in eating habits, GI sxs

Question 5

presenting sxs for UTI in patient with indwelling catheters or neuro disorders?

Answer 5

flank pain, fever

commonly will not have lower tract sxs

Question 6

What types of tests can you use to check for a UTI

Answer 6

common dipstick- checks for nitrites

leukocyte esterase dipstick

urine culture - most reliable!

Question 7

What can give you a false (-) for UTI on urine dipstick?

Answer 7

gram + organisms that do not reduce nitrate

low urine PH

freq voiding

dilute urine

Question 8

What are the goals of UTI tx?

Answer 8

• get rid of invading organism
• prevent/tx systemic consequences of infx
• prevent recurrence
• decrease potential for damage with too broad of abx therapy

Question 9

Most uncomplicated UTIs are caused by…

Answer 9

e. coli (75-95%)

Question 10

Besides e coli, what other organisms can cause UTI?

Answer 10

Staphylococcus saprophyticus

Klebsiella pneumoniae

Proteus spp.

Pseudomonas aeruginosa

Enterococcus spp.

Question 11

What can cause complicated UTIs?

Answer 11

gram (-) organisms

enterococcus faecalis

Question 12

Tx for uncomplicated UTIs?

Answer 12

Trimethoprim-sulfamethoxazole (Bactrim) x3 days

or

Fosfomycin x 1 dose

or

Nitrofurantoin x 5 days

Question 13

Fluroquinolones should be reserved for….. examples?

Answer 13

pyelonephritis or complicated infx

Ciprofloxacin
Levofloxacin
both x 3 d

Question 14

ADEs of trimethoprim-sulfamethoxazole?

Answer 14

Rash, Stevens–Johnson Syndrome, renal failure, photosensitivity, hematologic (neutropenia, anemia, etc.)

Question 15

What should you monitor on patient taking trimethoprim-sulfamethoxazole?

Answer 15

Serum creatinine, BUN, electrolytes, signs of rash, and CBC

Question 16

trimethoprim-sulfamethoxazole works well for most aerobic enteric bacteria except…

Answer 16

p. aeruginosa

Question 17

ADEs of Nitrofuratoin?

Answer 17

GI intolerance, neuropathies, and pulmonary reactions

Question 18

main advantage of Nitrofurantoin?

Answer 18

lack of resistance even after long courses of therapy

Question 19

ADEs of Fosfomycin trometamol?

Answer 19

diarrhea, HA, angioedema

Question 20

ADEs of Fluroquinolones: ciprofloxacin/levofloxacin?

Answer 20

Hypersensitivity, photosensitivity, GI symptoms, dizziness, confusion, and tendonitis (black box warning)

Question 21

When should you avoid fluroquinolones?

Answer 21

pregnancy and children

Question 22

What is the preferred penicillin for uncomplicated cystitis?

Answer 22

amoxicillin-clavulanate

Question 23

When should you avoid trimethoprim-sulfamethoxazole?

Answer 23

during 3rd trimester of pregnancy

Question 24

What pathogens cause prostatitis?

Answer 24

E. coli
K. pneumoniae
Proteus spp.
P. aeruginosa

Question 25

Tx for prostatitis?

Answer 25

Trimethoprim–sulfamethoxazole × 4-6wks Quinolone × 4-6 wks

Question 26

Presentation of stevens-Johnson syndrome?

Answer 26

begins with flu sxs facial/tongue swelling, hives, skin pain red/purple skin rash that spreads within hrs to days, blisters on skin, mm, eyes, nose, genitals shedding of your skin

Question 27

role of cranberry juice in UTIs?

Answer 27

lactobacillus potentially helps keep vag PH norm possible benefits in sexually active adult women with recurrent UTIs by decreasing adherence of bacteria to bladder epithelial cells

Question 28

What is Phenazopyridine HCL

Answer 28

urinary anesthetic/analgesic Azo dye, no antimicrobial properties brand: Pyridium, Uristat, Azo-standard

Question 29

Potential consequence to using Phenazopyridine HCL?

Answer 29

may mask s/s of UTI not responding to antimicrobial therapy

Question 30

ADEs of Phenazopyridine HC

Answer 30

red-orange discoloration of body fluids rash, anaphylaxis, rare hemolytic anemia, methemoglobinemia, acute renal failure

Question 31

When should you tx for UTI in pregnancy? What can you use?

Answer 31

if pt has significant bacteriuria, regardless of sxs 7 day course of one: Cephalexin Amoxicillin Amoxicillin/clavulanate