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3124 ca2 > uti > Flashcards

uti Flashcards

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1
Q

what is cystitis

pyelonephritis

A

cystitis- inflammation of bladder
what is pyelonephritis - infection of kidney
begins in urethra or bladder and travels to one or both kidneys

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2
Q

0-6 months prevalent in males or females

A

males

- more functional and structural abnormalities in males

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3
Q

1- adult prevalent in males or females

A

females , bc urethra shorter
- easier access to bladder
males have additional protection by antibacterial substance from prostate

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4
Q

in elderly describe the prevalence

A

equal in both genders

  • more comorbidities
  • obstruction or retention of urine
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5
Q

explain how benign prostatic hypertrophy can lead to uti

A

prostate bigger
= urinary retention
= more urine and bowel incontinence due to muscular dysfunction or stroke

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6
Q

explain ascending route of infection and who is at greater risk

A

colonic / fecal flora colonise periurethra area/ urethra
-> ascend to bladder and kidney

females greater risk of bc shorter urethra , use of spermicides, and diaphragm contraceptives

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7
Q

organisms causing ascending route of infection

A

ecoli
klebsiella
proteus
usually gram neg

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8
Q

explain hematogenosu ( descending route of infection)

A

organism @ distant primary site like heart value, bone

-> goes to blood stream -> urinary tract then uti

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9
Q

organisms causing descending/hematogenous route of infection

A

staph aureus
mycobacterium tubercolosis
( staph not common unless from somewhere else )

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10
Q

describe the 4 host defence mechanisms

A
  1. bacteria in bladder stimulates micturition w inc diuresis
    = emptying of bladder which gets rid of bacteria thru the urine
  2. urine and prostatic secretion have antibacterial properties
  3. bladder has anti-adherence mechanisms , prevent bact attaching to bladder
  4. polymorphonuclear leukocytes ( PMNs) have inflammatory response
    = phagocytosis
    = prevents and controls spread
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11
Q

which bact is resistant to washout or removal by bladder mechanisms

A

pili bact

eg ecoli

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12
Q

what are some risk factors

A 
gender 
sexual intercourse 
abnormalities of urinary tract
neurological dysfunction stroke, diabetes, spinal cord injuries => malfunction of UT
- anti cholinergic drugs 
- catheterisation 
- pregnancy 
- diaphragms & spermicides 
- genes 
- prev UTI
-vesicoureteral reflux
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13
Q

non pharmaco advice

A

lots of fluid to flush out bact , 6-8 glasses ( if allowed)
urinate frequently
urinate shortly after sex
wipe from front to back
cotton, loose fitting clothes, keep area dry
- modify birth control methods if using diaphragm or spermicide as they inc bacterial growth

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14
Q

uncomplicated uti normally in which grp of patients

A

premenopausal and non pregnant women with no history of abnormal UT

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15
Q

complicated uti in which grps of patients

A

anything besides premenopausal women without history of abnormal urinary tract

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16
Q

subjective symptoms of lower UTI ( cystitis)

A 
dysuria- pain on urinartion 
urgency 
frequency - bladder not emptied 
- nocturia 
- suprapubic heaviness or pain 
gross hematura ( blood in urine )
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17
Q

subjective symptoms of upper UTI ( pyelonephritis)

A 
fever 
rigors 
HA 
nausea, vomitting 
malaise 
flank pain ( pain on each lower back side ) 
costovertebral tenderness ( renal punch !!!!) 
abdominal pain
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18
Q

what are some signs and symptoms for elderly bc their symptoms usually arent specific

A

altered mental status, less alert, changes in eating habits etc

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19
Q

what are the objective vital signs indicating infection

A

fever > 38 deg
( would be reduced when taking with antipyretics )
inc in total white count
normal 4-10x10^9/L
inc neutrophil count normal 45-75%
CRP protein inc > 40 infection < 10 normal
ESR - indicative of bone/joint infection
procalcitonin levels

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20
Q

is cystitis or pyelonephritis more likely to show signs of general infection

A

pyelonephritis > cystitis

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21
Q

3 methods of urine collection

A

midstream clean catch
catheterisation
subrapubic bladder aspiration ( needle to bladder to collect)

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22
Q

UFEME criteria and what its for

UFEME- urine formed elements and microscopic examination

A
  1. WBC
    >10WBCs/mm3 = pyuria ( pus in urine )
    - signifies inflammation but may or may not be due to infection
    if patient symptomatic , pyuria correlates with significant bacteuria
  2. RBC
    microscopic>5 / HPF or gross = hematuria
    shows blood in urine , common but not specific
  3. identification of bacteria or yeast using gram-stain
  4. WBC cast cells
    - indicates upper UTI
    / kidneys involved
    ( masses of cells and proteins formed in renal tubes and kidneys )

note for WBC and RBC if > 225 no longer counted

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23
Q

describe chemical urinalysis ( dipstick ) - objective diagnosis tool

A

nitrite

  • positive test shows gram neg bacteria present
  • requires 10^5 bacteria/mL
  • only gram neg reduces nitrate to nitrite

Leukocyte esterase ( LE)

  • positive test shows esterase activity of leukocytes in urine which is wbc activity
  • correlates with significant pyura or wbc >10 wbc/mm3
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24
Q

what could cause nitrate test false negative results

A 
gram pos 
p.aeruginosa 
low urinary pH 
frequent voiding and
dilute urine
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25
when to obtain urine culture
``` complicated uti -preg , recurrent if 2 weeks or frequent - pyelonephritis - catheter associated uti - uti in men ```
26
likely pathogen for uncomplicated or comm-acquired UTI
- ecoli >85% ( more common in females and not so much in males ) - staphyloccus saprophyticus ( 5-15% ) - common coloniser of uti others - enterococcus faecalis klebsiella penumoniae proteus spp
27
likely pathogen for complicated or healthcare-associated UTI
- ecoli abt 50% - enterococci ( gram pos ) - proteus spp, klebsiella spp, enterobacter spp, p. aeruginosa
28
other likely pathogens for UTI which would require other considerations
s.aureus commonly due to bacteremia , so consider other sites of infection - come thru bloodstream and isolated in urine yeast or candida - could be a possible contaminant so consider other sites of infection, but normallly dont need to treat
29
when to treat UTI | positive urine culture
- if symptomatic dont need to treat if patients not symptomatic UNLESS - pregnant - children - patient undergoing invasive urologic procedures w mucosal trauma eg TURP , cystoscopy with biopsy
30
why must treat pregnant women
dec risk of developing pyelonephritis , risk of preterm labour and low birth weight infant
31
why must treat patients going for invasive urologic procedures with mucosal trauma whats turp and cytosocopy with biopsy and how
- prophylaxis to prevent postoperative bacteremia and sepsis Turp - trans urethral resection of prostate cytoscopy - scope of bladder with tissue sample - culture @ start then start ab based on culture and sensitivity 12-24 hrs before procedure
32
empiric 1st line ab for uncomplicated cystitis in women | + dosing
cotrimoxazole 800/160mg bid 3d nitrofurantoin 50mg qid 5d fosfomycin 3g single dose ALL PO
33
empiric alternatives for uncomplicated cystitis in women
blactams 3-7 days cefuroxime 250mg bid cephalexin 500mg bid augmentin 625mg bid ``` fluroquinolones x 3 days ciprofloxacine 250mg bid levofloxacin 250mg daily ( but risk of collateral damage ) ALL PO ALSO ```
34
for complicated cystitis in women, or uncomplicated cystitis in men with no concern for prostatitis whats the dosing adjustment
treat for a longer duration from 7-14 days for fosfomycin eg every other day x 3 doses
35
why is fosfomycin not recommended even tho 1st line and when to use it
tendon joint muscle pain , cns side effects also reported use if no other alternative
36
empiric ab for comm-acquired pyelonephritis in women
``` cipro 500mg bid x 7 days levo 750mg od x 5 days co-trimoxazole 800/160mg bid x 14 days po cephalexin 500mg bid 10-14 days po augmentin 625mg tds 10-14 days ``` IV options - for hospitalised or severely ill unable to take oral eg nausea, vomitting cipro 400mg bid cefazolin 1g q8h augmentin 1.2g q8h and or iv/IM gentamicin 5mg/kg ( added for esbl producing ecoli and klebsiella) not needed in community acquired switch to oral when can streamline when urine culture avail
37
what to note about the duration of treatment for ab
total duration so if total is 14 days empiric for 3 days then remaining 11 days even if negative urine test
38
empiric ab for comm acquired uti in men with concern for prostatitis OR pyelonephritis in men
ciprofloxacin 500mg bid co-trimoxazole 800/160mg bid treat po for 10-14 days will need longer duration if prostatitis is confirmed ( 6 weeks )
39
s&s of prostatitis ( 2 )
localised pain or | pain upon ejaculation
40
nosocomial meaning and most common cause of nosocomial uti
onset of uti 48hr post admission CA uti- most common cause
41
healthcare associated meaning
patients hospitalised or underwent invasive urological procedures in last 6 months , indwelling catheter etc
42
for nosocomical, Healthcare acquired pyelonephritis whats the possible organism what kind of ab spectrum coverage to use
possibility of p.aureug and other ESBL ecoli and klebsiella - use broad spectrum b lactam
43
empiric ab for nosocomial/healthcare associated pyelonephritis
for less sick - po ciproflocaxin 500mg bid levofloxacin 750mg bid iv cefepime 2g q12h w/wo amikacin 15mg/kg for better coverage iv imipenem 500mg q6h iv meropenem 1g q8h duration for 7-14days
44
definition of catheter associated uti
s&s compatible w UTI but no other identifiable source of infection + 10^3 cfu/mL of at least 1 or more bacterial species in single catheter urine specimen in patients with indwelling urethral, indwelling suprapubic or intermittent catheterisation or in a midstream voided urine specimen from patient whose catheter removed in prev 48 hrs
45
risk factors for CA uti
duration of catheterisation , every day catheter used 3-5% inc in risk of having ca uti - colonisation of drainage bag, cathether or periurethral segment - dm - female - impaired renal func - poor catheter care and insertion
46
organisms causing uti in short terms catheterisation <7 days
single organisms 85% those prevailing in environment eg ecoli and klebsiella
47
organisms causing CA UTI in long term catheterisation >28 days
95% is polymicrobial including 2-3 organisms | eg ecoli, klebsiella and pseudomonas
48
when to treat ca uti
- treat w ab only is symptomatic Or prior traumatic urological procedure - <10% febrile causes - usually low risk - always consider removal of the catheter , if >2 weeks and theres still an indication for CA-UTI then replace the catheter
49
what symptoms of CA uti then start ab
``` new onset fever worsening fever rigors alt mental status malaise lethargy w no other cause flank pain costovertebral angle tenderness , acute hematuria pelvic discomfort ``` if stable and low grade fever consider observing first
50
should urine and blood culture be taken before ab given for CA uti
yes mUST
51
why high threshold for treatment of ca uti
usualy always have positive urine culture | so if low threshold and treat right away can develop resistance
52
empiric ab for ca uti
IV imipenem 500mg q6h iv meropenem 1g q8h iv cefepime 2g q12h +/- amikacin 15mg/kg ( 1 dose ) po/iv levofloxacin 750mg x 5d ( for muld ca-uti ) po co-trimoxazole 960mg bid x 3d ( for women 65 or less with cauti without upper uti symptoms after indwelling catheter removed ) duration - 7 days for prompt resolution of symptoms / afebrile in 72 hrs 10-14 days if delayed response
53
chronic suppressive therapy & prophylactic why is it not recommended for ca uti
bc ca uti q common so only given chronic suppressive if frequent life threatening infection then risk to benefit ratio is better - must be given long term
54
ca uti prevention
- dont use if not needed - minimise duation - change before blockage - closed system - antiseptic techniques - topical ab not reco - prophylactic ab not reco
55
abs to avoid for uti in pregnancy
avoid cipro - fetal cartilage damage - arthropathies in animals avoid co-trimoxazole in 1st trimester & close to term - folate antagonism of TMP can cause neutral tube defects - avoid close to termbc risk of kernicterus due to comp binding between bilirubin and sulfonamides to plasma albumin - concern for fetus being g6pd deficient nitrofurantoin at term - g6pd deficiency concern amingolycosides - toxicity
56
which ab for pregnnacy is okay | and treat for how long
blactams 7 for asymptomatic bacteriuria or cystitis 14 days for pyelonephritis
57
additional adjunctive therapy for uti
for pain and fever give antipyretics eg paracetemol and nsaids for vomitting - rehydration phenazopyridine ( urogesic ) - topical analgesic effect on ut, symptomatic relief urine alkalisation - relief discomfort for mild uti of
58
``` phenazopyridine ( urogesic ) dose duration caution adr ```
``` 100-200mg tds limited for duration of symptoms avoid in g6pd deficiency adr : - nausea - vomitting - orange red discolouration of urine and stool ```
59
non pharmaco for avoiding uti
cranberry juice - inhibits adherence of ecoli to UT epithelial cells intravaginal estrogen cream - dec incidence of uti in postmenopausal women - restores vaginal flora preventing ecoli colonisation lactobacillus probiotics - restore normal vaginal flora , prevent ecoli colonisation - recent small controlled trial showed reduction in uncomplicated cystitis
60
monitoring
resolution of symptoms by 24-72 hrs after initiating effective ab if failure after 48-72 hrs, investigate is resistance, obstruction, abscess or other disease - absence of adr and allergies - bacteriological clearance but repeat culture not needed for patients who respond
61
need to do culture to document clearance of infection for who
pregnant women

3124 ca2 (5 decks)

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