UTI lecture

Question 1

Acute cystitis

Acute pyelonephritis

Answer 1

Uncomplicated UTIs

Question 2

UTIs in:
pregnancy
elderly
children
males
catheter pts

Answer 2

Complicated UTIs

Question 3

most common GU complaint

Answer 3

UTI

Question 4

female to male ratio for pyelonephritis

Answer 4

30:1

Question 5

Obstruction
Anatomic abnormality
Urologic dysfunction
Multi drug resistant uropathogen

Answer 5

Condition that may cause complicated UTI

Question 6

Females
Sexual intercourse (recent or frequent)
Diaphragm use
Spermicide use
Hx of UTI
Delayed post-coital micturation

Answer 6

UTI Risk factors

Question 7

develops when pathogens ascend to the kidneys via ureters

Answer 7

Pyelonephritis

Question 8

_______ accounts for 75-95% of uncomplicated UTIs

Answer 8

E. Coli

Question 9

Dysuria (or "burning")
increased urinary frequency
increased urinary urgency
suprapubic pain/discomfort
\+/- hematuria
voiding in small amounts
**AFEBRILE

Answer 9

Acute Cystitis

Question 10

\+/- cystitis signs PLUS
FEVER*
chills
flank pain
costovertebral angle tenderness
N/V

Answer 10

Acute pyelonephritis

Question 11

what MUST you think about if you have blood in urine without discomfort

Answer 11

urine cancer

Question 12

Pyuria
Bacteriuria
Varying degrees of hematuria
+ Leukocyte esterase (an enzyme released by leukocytes)
+ Nitrites (reflecting presence of bacteria which convert urinary nitrate to nitrite)
White cell casts – diagnostic for upper tract infx

Answer 12

Urinalysis in UTI

Question 13

Urine culture with more than 100,000 bacteria cfu/mL

Answer 13

UTI

Question 14

Hematuira
Leukocytes
Nitrites
WBCs

Answer 14

Can be seen in urinalysis of pt with UTI

Question 15

• TMP-SMX DS
• Nitrofurantoin
• Fosfomycin

Answer 15

First line agents for uncomplicated cystitis in women

Question 16

Bacteria convert urinary nitrate into…

Answer 16

nitrite

Question 17

Ciprofloxacin in acute cystitis

Answer 17

alternative agent for acute cystitis

Question 18

Pyridium in UTIs is used for…

Answer 18

pain! numbs bladder

**NO LONGER THAN 2 DAYS!!!

Question 19

Why should you not use Pyridium in UTIs for longer than 2 days?

Answer 19

Masks symptoms..should be starting to feel better after on antibiotics for 2 days

Question 20

Pyelonephritis with:
Mild to moderate illness
Stabilized with rehydration

treat with…

Answer 20

Outpatient oral antibiotics

Question 21

Pyelonephritis with..
Severe illness
High fever, pain
Marked debility
Inability to maintain oral hydration or take PO rx
Pregnancy
Concerns about compliance

treat with…

Answer 21

Inpatient IV antibitoics

Question 22

DOC for outpatient acute pyelonephritis

Answer 22

Ciprofloxacin

Question 23

FQ or AMP+gentamicin or ceftriaxone

Answer 23

IV acute pyelo tx

Question 24

UTIs usually respond to tx within….

Answer 24

48-72 hours

Question 25

``` Wipe from front to back Increase fluid intake Cranberry juice Void often Avoid irritants Change birth control method ```

Answer 25

UTI prevention

Question 26

``` Elderly Pregnant Children Men CAUTI ```

Answer 26

Special population UTIs

Question 27

Bladder and/or uterine prolapse Loss of estrogen causing change in vaginal flora Loss of lactobacilli in vaginal flora which results in periurethral colonization of E.coli Concomitant medical illnesses (i.e., diabetes)

Answer 27

causes of UTIs in postmenopausal women

Question 28

Benign prostatic hypertrophy can cause

Answer 28

UTIs in men

Question 29

asymptomatic bacteriuria

Answer 29

can be seen in pregnancy

Question 30

Up to 40% risk of developing UTI, including pyelonephritis, during pregnancy Associated with preterm birth, low birth weight & perinatal mortality Present in 4-7% of pregnancies Screen in 1st trimester with UC If UC positive, treat and then repeat q trimester Tx nitrofurantoin x 7 days Suppressive therapy after 2 or more courses antibx

Answer 30

asymptomatic bacteriuria

Question 31

Most common pathogen that causes UTIs in children

Answer 31

E coli

Question 32

Most common cause of nosocomial infections in US

Answer 32

CAUTIs

Question 33

advanced age, underlying illness & duration of catheterization

Answer 33

risk factors for CAUTIs

Question 34

screen urine how many hours after removing catheter?

Answer 34

48 hours

Question 35

asymptotic CAUTIs....

Answer 35

do NOT require antibiotics

Question 36

3 or more episodes per year (confirmed by UC) or 2 UTIs in last 6 months

Answer 36

recurrent UTIs

Question 37

vaginal estrogen in postmenopausal women

Answer 37

can help prevent UTIs

Question 38

Isolation of a single organism on UC from an individual without s/s of UTI * *Women – at least 2 occasions of 100,000 CFU/ml * *Men – at least 1 occasion of 100,000 CFU/ml

Answer 38

Asymptomatic bacteriuria

Question 39

Do you treat asymptomatic bacteriuria in: - Pregnant women - Prior to urologic procedures - After renal transplantation

Answer 39

YES

Question 40

What type of technique used to collect urine specimen?

Answer 40

Clean catch

Question 41

Diagnosis of ________ is often based on patient’s history alone (96% probability) in women presenting in outpatient setting with triad and no vaginal discharge

Answer 41

acute cystitis

Question 42

Should Pyridium be used as initial therapy?

Answer 42

NO!