UTI Flashcards
(20 cards)
What defines “bacteruria”?
Presence of over 100,000 crus/ml bacteria in the urine –> less is NOT significant
Symptomatic –> clinical levels + cystitis or pyelonephritis
ASYMPTOMATIC –> clinical without symptoms –> USUALLY DO NOT TREAT
When DO we treat asymptomatic bacteruria?
PREGGOS!!!!!!
Transurethral resection of the PROSTATE –> surgery can lead to urethral trauma and predispose to infections
Patients getting any urological procedures where bleeding is anticipated
Presence of neutrophils (pyuria) is NOT an indication to treat asymptomatic individuals
RISK FACTORS FOR UTI - Being a woman
WOMEN! 30:1 F:M ratio –> MUCH SHORTER URETHRAS so bacteria have a shorter path to get from the rectum to the urethra to the bladder
Urethra is also at risk during intercourse! This trauma can damage it, predisposing to UTI
Intercourse with SPERMICIDES or DIAPHRAGMS significantly increase risk
Women with RECURRENT UTIs
Other RIsk Factors
Being OLD –> in general we lose the ability to control SPHINCTERS –> incontinence, stool/urine spread, increases risk of UTI
PREGGO – as fetus grows, uterus compresses bladder and ureters –> decreased flow, STAGNANT urine –> allows for bacteria to replicate and cause infection
STONES - increase risk of developing UTI (obstruct –> low flow –> stagnant) –> also, bacteria can get INSIDE STONE and be protected! Recurrent UTI despite treatment could indicate a stone
Vesico-urethral REFLUX –> backflow, can bring bacteria with it
Incomplete bladder emptying –> leaves some urine in the bladder for long periods; allows bacteria to grow in the stagnant urine
Instruments –> major cause of HAI! Foley Catheters!!!!!!!!
Age and gender incidence
NEONATES –> primarily male, 1% prevalence
School age –> 1-2% –> F 30 : M 1
Reproductive age –> 2-4% –> F 30 : M 1
Pregnancy –> 4-10%
Old age –> 10-20% –> F 3 : M 2
Cystitis vs. Pyelonephritis
CYSTITIS –> UTI only involving the BLADDER –> bacteria makes its way to bladder but does NOT ascend through the ureters –> 3 symptoms (dysuria - painful pee, urgency, frequency)
PYELO –> UTI has ascended the ureters and affects the KIDNEYS –> same symptoms PLUS FLANK PAIN, FEVERS/CHILLS, N/V –> much more serious, longer course of antibiotics
Vaginal discharge?
NOT A UTI
UTI and Urinalysis
Urinalysis –> FRESH specimen (less than an hour at room temp, fridge less than 4); only do urinalysis on COMPLICATED UTIs (those that aren’t sexually active females of reproductive age)
Uncomplicated cystitis –> NO URINALYISIS OR CULTURES
What is complicated? MEN, symptoms of pyelo, preggos, patients with an obstruction, recurrent UTIs
UTI and Disptick analysis
Can do these for UNCOMPLICATED; easy, cheap, quick
Checks for 2 relevant markers –> LEUKOCYTE ESTERASE (surrogate marker for pyuria –> indicates INFECTION, not UTI)
NITRITES –> gram negatives convert dietary nitrAtes to nitrItes –> unlikely in patients who pee a lot because it takes 4 hours for the bacteria to convert
WHO NEEDS TO BE SCREENED AND TREATED FOR BACTERURIA, no matter if symptomatic or not?
PREGGOS!
Transurethral resection of prostate!
Before any urological procedure with bleeding risk
Patients who are consumed/febrile/unable to describe symptoms
ALL SYMPTOMATIC patients
Who does NOT need screening/treatment for ASYMPTOMATIC?
Premenopausal, non-preggos
Diabetics
Patients in nursing homes
Elderly
People with spinal cord injuries
People with catheters in place
Don’t want to overuse antibiotics!!!!
Bacterial Causes of UNCOMPLICATED UTI?
Bacteria that cause UTI mostly come from our OWN RECTAL FLORA –> E. Coli causes 90%!!
Remaining 10% of uncomplicated = Klebsiella and STAPH Saphroticus
Just assume it’s E. Coli (won’t change decision making, just cover for Klebsiella and Staph)
Treating Uncomplicated UTI
FLUOROQUINOLONES –> CIPROFLOXACIN or LEVOFLOXACIN (but save for more resistant infections)
Patients with UNCOMPLICATED CYSTITIS should GENERALLY be treated with NITROFURANTOIN, FOSFOMYCIN, BACTRIM
instead
Women with ACUTE PYELO
Fever, nausea, FLANK PAIN –> do URINALYSIS and CULTURE
Typical sexually active female –> still use BACTRIM (not nitro or fosfo)
Ciprofloxacin or Levofloxacin have good penetration and activity in the urine (NOT MOXIFLOXACIN, don’t use!)
Treating MEN with UTI
All considered COMPLICATED
Can be hard to differentiate CYSTITIS from PROSTATITIS (P tends to occur in young/middle aged and C tends to occur in older men, secondary to BPH b/c it obstructs urethra)
Perineum pain, abdominal pain, testicular/penile pain
Blood in semen and pain on ejaculation rare
MOST LIKELY E COLI!!!!
Treat acute prostatitis with BACTRIM, LEVO or CIPRO (chronic with NSAIDs)
Treat CYSTITIS with drugs that can penetrate the PROSTATE (in case patient actually has prostatitis!!!) –> BACTRIM, LEVO, CIPRO (nitro or fosfo DONT cross prostate)
How do recurring UTIs occur?
REINFECTION (second infection after 1 or more months) –> considered to have been successfully treated first time around, just got a second infection); usually due to a DIFFERENT bacterial species this time! Or a diff serotype
RELAPSE – patients infection was NEVER fully eliminated and instead the bacteria was suppressed while on the antibiotics - but once treatment stopped, bacteria reproduced causing symptoms –> anything WITHIN A MONTH is considered relapse, usually happens 1-2 weeks after –> need to consider RENAL infection, structural abnormality, obstruction or chronic bacterial prostatitis!
CHILDREN AND UTI
Under 2 y.o. –> more generalized and nonspecific (febrile, crying) –> these kids get recurrent UTIs frequently, so if the child has a history, suspect another!!!!
Uncircumsized boys have higher risk
Any kid with signs and symptoms AS WELL AS fever, needs to have an ULTRASOUND TO CHECK FOR MALFORMATIONS (only do ultra on adults with relapsing infections)
VCUG?
UTI + fever –> voiding cystourethography (VCUG) —> used to be recommended to all kids with a UTI
NOW only for recurrent, or in children where an ULTRASOUND shows: hydronephrosis, scarring, high grade vesicouretral reflux, or obstructive uropathy
Vesicouretral Reflux
Backflow of urine up ureters
COMMON CAUSE OF STIs in KIDS
Many grades of severity, many children grow out of it
Children NOT given prophylactic antibiotics for this anymore (used to think that chronic infection led to scarring and kidney damage)
Hospital Acquired UTI
FOLEY CATHETERS
Most common nosocomial infections!
80% are associated with indwelling catheters, so remember to get them out WHENEVER possible!
Always need to CULTURE these patients’ urine - likely a gram negative, but could also be resistant or rarer bacteria!
