UTI

Question 1

UTI risk factors

Answer 1

aging, females, males (prostatic hypertrophy, bacterial prostatitis, anal intercourse), urinary tract obstruction (tumor, calculi), impaired bladder innervation

Question 2

Lower tract infection

Answer 2

urethritis, prostatitis, cystitis

Question 3

Upper tract infection

Answer 3

pyelonephritis, peri nephric abscess

Question 4

Trigone

Answer 4

• smooth triangular region of the internal urinary bladder formed by the two uretral orifices and the internal urethral orifice
• sensitive to expansion and when stretched to certain degree signals the brain it needs to empty

Question 5

Symptoms of UTI

Answer 5

• dysuria
• increased frequency
• hematuria
• fever (systemic)
• N/V (pyelonephritis)
• flank pain (pyelonephritis)
• pain with defecation

Question 6

CVA tenderness

Answer 6

pyelonephritis

Question 7

Urethral discharge

Answer 7

urethritis

Question 8

Tender prostate on DRE

Answer 8

prostatitis

Question 9

Labs (urinalysis)

Answer 9

+ leukocytes
+ nitrites (gram neg rods)
+ WBC
+ RBC

Question 10

Most valuable LAB diagnostic test for UTI

Answer 10

UA for pyuria

- presence of pyuria makes the dDx

Question 11

Most common pathogens

Answer 11

E. coli (80%) ; Staphylococcus saprophyticus (15%)

Question 12

Positive Urine Culture

Answer 12

Bacterial colony >10 (2) CFU/ml (symptomatic pt) or 10 (5) CFU/ml (Asymptomatic) + leukocytes

Question 13

Uncomplicated (Simple) Cystits

Answer 13

+ Dysuria - non- pregnant
+ Lower abd cramping - Healthy (> 12 y.o)
+ frequency - No N/V, flank pain
+ urgency

Question 14

How do you diagnose simple cystitis

Answer 14

Dipstick Urinalysis

Question 15

What is present in almost all pts with complicated UTI?

Answer 15

Pyuria

Question 16

What does white cell casts suggest?

Answer 16

Renal origin for pyuria

Question 17

Treatment for Uncomplicated (Simple) Cystitis

Answer 17

• Trimethroprim/Sulfamethoxazole for 3 DAYS
• TMP-SMX double strength 1 tab BID
• Given for 7-14 days in men
• May use fluoroquinolone (Ciprofloxacin/Levaquin) with sulfa allergies or areas of high bactrim resistance

Question 18

Risk fx for Uncomplicated Cystitis

Answer 18

Sexual Intercourse: may recommend post-coital voiding or prophylactic ABT use

Question 19

Definition of Complicated Cystitis

Answer 19

• female with comorbid medical conditions
• ALL MALE PATIENTS
• Indwelling foley cath
• Urosepsis/hospitalization

Question 20

How do you diagnose Complicated Cystitis?

Answer 20

UA/C&S

Question 21

Tx for Complicated Cystitis

Answer 21

• Fluoroquinolone (or another broad spectrum)
• 7-14 days tx
• May treat longer (2-4 weeks) in males with UTI

Question 22

Pyelonephritis (S/S)

Answer 22

fever, N/V, headache

Question 23

Pyelonephritis (Diagnosis)

Answer 23

UA, C&S, CBC, Chemistry

Question 24

Pyelonephritis (Treatment)

Answer 24

• 2 weeks of Bactrim or Fluoroquinolone

- Hospitalization and IV ABT if pt unable to take PO

Question 25

Perinephric / Renal Abscess

Answer 25

- suspect in pt who is not improving on ABT therapy | - Dx: CT with contrast, renal ultrasound, may need surgical drain

Question 26

Treatment of Pyelonephritis (Mild to Moderate)

Answer 26

- Ceftriaxone 1 g q 24 h - Cipro 400mg q 12 h - Levofloxacin 750mg q 24 h - Aztreonam 1 g q 8 to 12 h

Question 27

Treatment of Pyelonephritis (Severe)

Answer 27

- Cefepime 2 g q 12 h - Piperacillin-tazobactam 3.375g q 6 h - Ceftolozpne-tazobactam 1.5g q 8 h - Ceftazidime-avibactam 2.5g q 8 h - Meropenem 500mg q 8 h - Imipenem 500mg q 6 h - Doripenem 500mg q 8 h

Question 28

Prostatitis (S/S)

Answer 28

pain in perimeum, lower abd, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, sometimes blood in semen

Question 29

Prostatitis (Diagnosis)

Answer 29

- Clinical Hx: fever, chills, dysuria, malaise, myalgia, pelvic/perineal pain, cloudy urine - edematous and tender prostate on exam - Increased PSA - UA/C&S

Question 30

Prostatitis (Treatment)

Answer 30

Bactrim, fluoroquinolone, or other broad spectrum ABT for 4-6 WEEKS

Question 31

Urethritis (Chlamydia trachomatis)

Answer 31

- frequently asymptomatic in females - dysuria, discharge or PID - pyuria, (-) bacteria = suspect chlamydia - Chlamydia screening for females less than or equal to 25 yr - Tx: Azithromycin 1 g po x 1; Doxycycline 100mg po BID x 7 days

Question 32

Urethritis (Neisseria Gonorrhoeae)

Answer 32

- may present with dysuria, discharge, PID - Tx: Ceftriaxone 125mg IM x 1; Cipro 500mg x 1; Levofloxacin 250mg po x1; Ofloxacin 400mg po x 1, Spectinomycin 2g IM x 1