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finals y3s1 > UTI > Flashcards

UTI Flashcards

1
Q

definition of asymptomatic bacteriuria (ASB)

A

urine got bacteria (bacteriuria) but X stymptoms

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2
Q

UTI

A
  • urine got bacteria + urinary symptoms
  • cystitis -> pyelonephritis -> UTI w bacteraemia/sepsis/death
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3
Q

what population is ASB especially common in?

A

old, women, long term indwelling urinary catheter

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4
Q

indication of screening/treatment of ASB

A

1) pregnant women

  • prevent pyelonephritis, preterm labour, infant low birthweight
  • screen at one of the visits (12-16 wk gestation period)
  • bacteriaemia -> treat w Abx according to AST for 4-7 days

2) pt undergoing urologic procedure where mucosal trauma/bleeding expected

  • prevent bacteriaemia & urosepsis
  • screen prior to procedure
  • bacteriuria -> active Abx as SAP
  • X include placement of urinary catheter
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5
Q

epidemiology of UTI

A

increases prevalence w age
1) 0 - 6 months: males > females
2) 1 - adult: females > males
3) > 65 yo: equal

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6
Q

pathogenesis of UTI - ascending

A
  • colonic/fecal flora colonise periurethra area/urethra -> ascend to bladder & kidney
  • factors that increase risk
    1) females (shorter urethra)
    2) use of spermicide & diaphragms as contraceptives
  • types of organisms: E.coli, Klebsiella, proteus
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7
Q

pathogenesis of UTI - descending

A
  • more rare
  • organism at distant primary site -> bloodstream (bacteriaemia) -> urinary tract -> UTI
  • types of organism: staph aureus, myco tb
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8
Q

what are the 3 factors determining development of UTI

A

1) competency of natural host defense mechanism
2) size of inoculum
3) virulence/pathogenicity of microorganism

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9
Q

factors determining development of UTI - competency of natural host defense mechanism

A
  • bacteria in bladder stimulate micturition w increased diuresis -> increase urge to empty bladder -> pee out urine
  • urine & prostatic secretion antibacterial properties
  • bladder anti-adherence mechanism: prevent bacterial attachment to bladder
  • inflammatory response w polymorphonuclear leukocyte (PMNs) -> phagocytosis -> prevent/control spread
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10
Q

factors determining development of UTI - virulence & pathogenicity of microorganism

A
  • bacteria w pili resistant to
    1) washout (E.coli)
    2) removal by anti-adherence mechanism of bladder
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11
Q

risk factors for UTI

A

1) females > males
2) sexual intercourse
3) abnormalities of UT

  • prostatic hypertrophy, kidney stone, urethral strictures, vesicoureteral reflux

4) neurologic dysfunction

  • stroke, DM, spinal cord injuries

5) anti-cholinergic drugs

  • 1st gen antihistamine, atropine
  • cause urinary retention

6) catheterisation & other mechanical instrumentation
7) DM
8) pregnancy
9) use of diaphragm & spermicide
10) genetic association

  • +ve family history, 1st degree female relative

11) previous UTI

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12
Q

lifestyle modification to prevent UTI

A

1) hydration to flush out bacteria
2) urinate frequently & go when first feel urge
3) urinate shortly after sex
4) women: wipe from front to back after bowel movement
5) cotton underwear & loose fitting clothes to keep area dry
6) if using diaphragm/spermicide: consider changing birth control method, unlubricated condoms/spermicidal condom increase irritation -> help bacteria grow

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13
Q

classification of UTI based on sypmtoms

A

1) complicated

  • associated w conditions that increase potential for serious outcomes/risk for therapy failure
    ** UTI in men, children, pregnant women
    ** presence of complicating factors: functional & structural abnormalities of urinary tract, genitourinary instrumentation, DM, immunocompromised host

2) uncomplicated

  • none of the above
  • healthy premenopausal, non-pregnant women w no history suggestive of abnormal urinary tract
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14
Q

subjective evidence for lower UTI

A

1) dysuria, urgency, frequency
2) nocturia
3) suprapubic (hypogastric) heaviness/pain
4) gross haematuria: pee blood

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15
Q

subjective evidence for upper UTI

A
  • more serious
  • fever, headache, N/V, malaise, flank pain, costovertebral tenderness (renal punch), abdominal pain
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16
Q

additional subjective symptoms elderly face for UTI

A

altered mental status (more drowsy, less alert), small GI symptoms, change eating habits

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17
Q

urine collection method

A

1) midstream clean-catch
2) catheterisation
3) suprapubic bladder aspiration

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18
Q

when to get urine culture

A

1) pregnant women
2) recurrent UTI (relapse within 2 wks/frequent)
3) pyelonephritis
4) catheter-associated UTI
5) all men w UTI

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19
Q

what is done during urinalysis

A

UFME, chemical analysis

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20
Q

UFME components

A

1) WBC

  • pyuria: > 10 WBC/mm^3
  • presence of inflammation but may/may not be cuz of infection
  • symptomatic pt: correlate w significant bacteriuria
  • absence of pyuria = unlikely UTI

2) RBC

  • presence = haematuria (microscopic > 5/HPF or gross)
  • frequent in UTI but non specific

3) microorganism: gram stain

4) WBC cast

  • mass of cell & protein that form in renal tubule
  • indicate upper tract infection/disease (kidneys X involved)
21
Q

chemical urinalysis through dipstick components

A

1) nitrite

  • +ve test = gram -ve bacteria present cuz only gram -ve reduce nitrate to nitrite
  • at least 10^5 bacteria/mL
  • possible false positives
    ** gram pos, Pseudomonas
    ** low urinary pH
    ** frequent voiding
    ** dilute urine

2) leukocyte esterase (LE)

  • +ve test = esterase activity of leukocyte in urine
  • correlate w significant pyuria
22
Q

likely pathogen for uncomplicated/community acquired UTIs

A

E.coli, staph sacrophyticus, enterococcus faecalis, klebsiella pneumoniae, proteus spp

23
Q

likely pathogen for complicated/hospital acquired UTIs

A

E.coli, enterococci, proteus spp, klebsiella spp, enterobacter spp, pseudomonas, drug resistant strain (ESBL producing E.coli)

24
Q

when to consider other site of infection for UTI

A

staph aureus, yeast/candida possible contaminant

25
Q

determining need to treat for UTI

A

X treat if X symptoms of UTI (ASB) unless pregnant women & urologic procedure in which mucosal trauma/bleeding expected

26
Q

types of UTI

A

1) cystitis in women
2) community acquired pyelonephritis in women
3) community acquired UTI men
4) nosocomial/healthcare associated UTI
5) catheter-associated UTI
6) UTI in pregnancy

27
Q

cystitis in women - 1st line

A

1) PO cotrimoxazole
2) PO nitrofurantoin

28
Q

cystitis in women - alternatives if allergic

A

1) PO beta lactam for 5-7 days

  • cefuroxime, augmentin

2) PO fluoroquinolone 3 days

  • ciprofloxacin, levofloxacin
  • X use if possible because associated w disabling effect
29
Q

complicated cystitis in women

A
  • longer treatment (7-14 days)
  • consider fosfomycin
    ** X 1st line cuz high rate of resistance
    ** used for cystitis caused by ESBL producing E.coli
30
Q

community acquired pyelonephritis in women - normal

A

1) PO fluoroquinolone (ciprofloxacin, levofloxacin)
2) PO cotrimoxazole
3) PO beta-lactam (cefuroxime, augmentin)

31
Q

community acquired pyelonephritis - initial IV therapy

A
  • severely il pt who require hospitalisation
  • pt X tolerate oral
  • types
    1) IV ciprofloxacin
    2) IV cefazolin
    3) IV augmentin
    4) +/- IV/IM gentamicin (work for gram -ve ESBL, X work for bacteriaemia)
  • switch to oral after improve/can tolerate oral
32
Q

community acquired UTI for men - cystitis wo prostatitis concern

A
  • same as complicated cystitis in women
33
Q

community acquired UTI for men - cystitis w prostatitis/pyelonephritis concern

A

1) PO ciprofloxacin
2) PO cotrimoxazole

  • 10-14 days
  • 6 wks if prostatitis confirmed
34
Q

what is nosocomial UTI

A

onset of UTI > 48h after hospitalisation

35
Q

possible causes of nosocomial/healthcare-associated UTI

A

pseudomonas, other resistant bacteria

36
Q

empiric therapy for nosocomial/healthcare-associated UTI

A

broad spectrum beta lactam

1) IV cefepime +/- IV amikacin
2) IV imipenem or IV meropenem
3) PO levofloxacin, PO ciprofloxacin

  • duration 7-14 days
  • consider oral for less sick pt
37
Q

definition for catheter-associated UTI (CAUTI)

A

UTI S&s + X identified source of infection + 10^3 cfu/mL of ≥ 1 bacterial species

38
Q

catheter-associated UTI (CAUTI) Risk factors

A

1) duration of catherisation
2) colonisation of drainage bag, catheter, periurethral segment
3) DM
4) female
5) impaired renal function
6) poor quality of catheter care (insertion)

39
Q

causative organism for catheter-associated UTI

A

short term (< 7 days): single organism
long term (> 28 days): polymicrobial

40
Q

symptoms for CAUTI

A

new/worsen fever, rigor, altered mental status, malaise, lethargy w no identified cause, flank pain, costovertebral angle tenderness, acute haematuria, flank pain, change lab values

41
Q

general treatment for CAUTI

A
  • X treat asymptomatic
  • consider remove catheter
  • if CAUTI occur when IDC > 2 wks & still indicated then replace catheter
  • Abx only for symptomatic
42
Q

empiric treatment for CAUTI

A

1) IV imipenem or IV meropenem
2) IV cefepime +/- IV amikacin
3) PO/IV levofloxacin
4) PO cotrimoxazole (women ≤ 65 w CAUTI wo upper urinary tract symptoms after indwelling catheter removed)

  • 7 days, 10-14 if delayed response
43
Q

CAUTI prevention

A

1) avoid unnecessary catheter
2) use for minimal duration
3) change long-term indwelling before blockage likely to occur
4) use of closed system (X a lot of fiddling, X introduce microorganism)
5) ensure aseptic insertion technique
6) x recommend topical/prophylactic antiseptic/Abx & chronic suppressive Abx

44
Q

what to avoid for pregnant UTI

A

1) ciprofloxacin

  • potential fetal cartilage damage & arthropathies in animal studies

2) cotrimoxazole

  • 1st trimester: folate antagonism of TMP -> neural tube defect
  • 3rd trimester: kernicterus in newborn
  • foetus maybe G6PD deficiency

3) nitrofurantoin

  • X at term (38-42 wks)
  • concern about G6PD deficiency
45
Q

what to use w caution for pregnant UTI

A

1) aminoglycosides (neural tox)

46
Q

what is safest to use for pregnant UTI

A
  • beta lactams
  • 4-7 days asymptomatic bacteriuria/cystitis
  • 14 days pyelonephritis
47
Q

monitor response

A
  • resolution by 24-72 hrs
  • if X respond within 2-3 days/persistently positive culture -> reinvestigate to exclude bacterial resistance, possible obstruction, renal abscess, other disease process
48
Q

adjunctive therapy for UTI

A

1) fever & pain

  • paracetamol & NSAID

2) vomiting

  • rehydration

3) urinary symptoms

  • phenazopyridine
    ** topical analgesic on urinary tract mucosa -> symptomatic relief
    ** treatment limited to duration of symptoms
    ** X G6PD
    ** N/V, orange-red discolouration
49
Q

nonpharmaco for UTI

A

1) cranberry juice
2) intravaginal estrogen cream
3) lactobacillus probiotics

finals y3s1 (10 decks)

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