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POCKET > UTI > Flashcards

UTI Flashcards

1
Q

Anatomical classifications of UTI

A

Lower vs Upper
Lower = urethritis, cystitis (superficial infection of bladder)
Upper = pyelonephritis (inflam process of renal parenchyma), renal or perinephric abscess, prostatitis

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2
Q

Clinical classifications of UTI

A

Uncomplicated vs Complicated
Uncomplicated - Cystitis in immuno-competent, non-prego woman w no underlying structural or neurologic dz
Complicated - Upper tract infection in women; OR, any UTI in men or prego women; OR UTI w underlying structural dz or immunosuppression

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3
Q

Pathogens causing uncomplicated UTI

A

E. coli (80%)
Proteus
Klebsiella
S. saprophyticus

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4
Q

Pathogens causing complicated UTI

A 
E. coli (30%)
Enterococci (20%)
Pseudomonas (20%)
S. epidermidis (15%)
Other GNR (gram-neg rods)
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5
Q

Pathogens causing catheter-assoc’d UTI

A 
Yeast (30%)
E. coli (25%)
Other GNR
Enterococci
S. epidermidis
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6
Q

Genital pathogens causing Urethritis

A 
Chlamydia trachomatis
Neisseria gonorrhea
Ureaplasma urealyticum
Trichomonas vaginalis
Mycoplasma genitalium
HSV
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7
Q

S. aureus and UTI

A

S. aureus is NOT a common primary urinary pathogen in absence of catheter or recent instrumentation
So, if you get S. aureus, consider bacteremia with hematogenous seeding

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8
Q

Clinical manifestations of cystitis in UTI

A 
Cystitis = 
dysuria
urgency
frequency
hematuria
chg in urine color/odor
suprapubic pain
usu NO fever.
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9
Q

Clinical manifestations of Urethritis in UTI

A

May be identical to cystitis except urethral discharge may be present

Cystitis = 
dysuria
urgency
frequency
hematuria
chg in urine color/odor
suprapubic pain
usu NO fever.
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10
Q

Clinical manifestations of prostatitis in UTI

A

Chronic: like cystitis except + sx of obstruction (hesitancy, weak stream)

Acute: Perineal pain, fever, tenderness on prostate exam

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11
Q

Clinical manifestations of Pyelonephritis in UTI

A

Pyelonephritis - inflam process of renal parenchyma
Fever, shaking, chills
Flank/back pain
Naus/Vem/Drh

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12
Q

Clinical manifestations of Renal Abscess in UTI

A

Abscesses can be intrarenal or perinephric
Identical to sx of pyelonephritis except persistent fever even despite appropriate abx.
(Fever, shaking, chills
Flank/back pain
Naus/Vem/Drh)

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13
Q

What does urinalysis show in UTI (general)?

A

Pyuria + Bacteriruria
+/- hematuria
+/- nitrites (if + nitrites, means it’s GNR- prob Ecoli. Bacteria has enz that converts endogenous nitrates to nitrites)

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14
Q

What is shown on Urine Cx in UTI (significant bacterial counts)?
(Cx = culture)

A

Take from clean-catch or straight-cath specimen.
Significant bacterial counts =
>10,000 CFU/ml in asx women
>100 CFU/ml in men
>100 CFU/ml in sx or catheterized pts (hydration may falsely dilute counts)

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15
Q

Pyuria & negative Urine Cx

A

Means sterile pyuria (contains WBCs but not bacteria)

Can be d/t urethritis, nephritis, renal TB, foreign body.

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16
Q

When should you screen for asx bacteriuria?

A

Pregnant women

Pts undergoing urologic surgery

17
Q

When should you take blood cultures when dx’g UTI?

A

In febrile UTIs, possibly complicated UTIs

18
Q

When should you used DNA detection/culture when dx’g UTIs? and what for?

A

Use to check for C. trachomatis and N. gonorrhea in high-risk pts or in sterile pyuria

19
Q

What kinds of urine specimens are used in cases of suspected prostatitis?

A

1st-void and midstream specimens
Prostatic expressage specimens
Post-prostatic massage specimens

20
Q

When and why should you do abd CT in dx’g UTI?

A

To r/o abscess in pts w pyelonephritis who fail to defervesce (get rid of fever) after 72hrs (3 days)

21
Q

What is a urologic workup and when should you do it when dx’g UTI?

A

Renal US w PVR, Abd CT, voiding cystography

Do it for recurrent UTIs in men

22
Q

Rx for cystitis (UTI)

A

FQ or TMP-SMX PO for 3 days (if uncomplicated) or 10-14 days (if complicated)

If asx bacteruria in prego or before urologic surgery: abx for 3 days

23
Q

Rx for UTI in catheterized pts

A

Remove or exchg catheter, plus

FQ or TMP-SMX PO for 3 days (if uncomplicated) or 10-14 days (if complicated)

24
Q

Rx for urethritis

A

Treat for both Neisseria and Chlamydia
Neisseria: Ceftriaxone 125mg IM x1
Chlamydia: Doxy 100mg PO bid (twice a day) x7days OR Azithromycin 1g PO x1

25
Q

Rx for Prostatitis

A

FQ or TMP-SMX PO x 14-28days (acute) or 6-12 wks (chronic)

26
Q

Rx for Pyelonephritis

A

Outpt: FQ or oral ceph PO x 14d
In-pt: Ceftriaxone IV or FQ PO or aminoglycoside or ampicillin/sulbactam x 14d
Change from IV to PO when pt has improved clinically and when pt is afebrile for 24-48hrs, and then complete 14d course

27
Q

Rx for renal abscess

A

Drainage + abx same as pyelonephritis
which is..
Outpt: FQ or oral ceph PO x 14d
In-pt: Ceftriaxone IV or FQ PO or aminoglycoside or ampicillin/sulbactam x 14d
Change from IV to PO when pt has improved clinically and when pt is afebrile for 24-48hrs, and then complete 14d course

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