UTI/pyelonephritis

Question 1

asymptomatic bacteriuria

Answer 1

significant bacteria but no symptoms

Question 2

pyelonephritis

Answer 2

infection of the kidney

Question 3

uncomplicated UTI

Answer 3

infections to pts who are healthy and have no structural or functional abnormalities of the urinary tract

Question 4

complicated UTI

Answer 4

infections to pts who have abnormalities of their urinary tract, a stone, a catheter, obstruction, or neurologic deficit affecting flow

Question 5

signs and symptoms of acute simple cystitis

Answer 5

dysuria
urinary incontinence
uinary urgency
urinary frequency
foul smelling urine
hematuria

Question 6

signs and symptoms of complicated UTI/ pyelonephritis

Answer 6

sign and symptoms of ASC
chills
fever
flank plain
costovertebral angle tenderness
N/V
abdominal pain

Question 7

diagnosis

Answer 7

get a UA
if positive w s/sx proceed with a urine culture

Question 7

gold standard

Answer 7

culture with sensitivities

Question 7

no UTI symptoms
not at risk population

Answer 7

no culture

Question 8

no UTI symptoms
at risk population

Answer 8

culture

Question 9

any UTI symptom
at risk population

Answer 9

culture

Question 10

any UTI symptoms
not at risk

Answer 10

evaluate pyuria and contamination

Question 11

any UTI symptoms
NOT at risk
pyuria (>10 WBC)
no contamination (<100 squamous cells)

Answer 11

culture

Question 12

any UTI symptoms
at risk
no pyuria

Answer 12

no culture , strong predictor of no infection

Question 13

any UTI symptoms
at risk
pyuria and contamination (>100 squamous cells)

Answer 13

no culture

Question 14

two clinical instances where a pt with ASBU should be screened

Answer 14

pregnant women
-pyelonephritis
-premasture delivery
-low birth weight infant

prior urologic procedure
-risk of mucosal bleeding
-post bacteremia
-sepsis

Question 15

duration of therapy for pregnant women

Answer 15

4-7 days, shortest effective course

Question 16

abx in pregnancy
asymptomatic bacteriuria

Answer 16

cephalexin
amoxicillin
cefdinir
amoxicillin-clave
nitrofurantoin
Trim/sulf
fosfomycin

Question 17

duration of therapy for urologic procedure with mucosal bleeding risk

Answer 17

1-2 dose short course

Question 18

uncomplicated UTI management
first line

Answer 18

Nitrofurantoin x 5 days
–avoid in CrCl <30m ml/min

Trimethoprim/sulfamethoxazole x 3 days

Fosfomycin single dose

Question 19

uncomplicated UTI management
second line

Answer 19

oral bet lactam x 5-7days
– cephalexin, cefdinir

Flurooquinolones x 3 days
–cipro or levo

Question 20

cather-associated UTI are grouped within

Answer 20

complicated UTI

Question 21

complicated UTI management
first line

Answer 21

Trim/sulf (bactrim) x 7days

Levo 5-7 days

Question 22

complicated UTI management
second line

Answer 22

Nitrofurantoin 7-10 days
—avoid in pyelonephritis and Crcl <30

oral beta lactam x7days
–cephalexin, cefdinir

Question 23

Inpatient management of complicated UTI first line

Answer 23

ceftriaxone 1 g daily ertapenem 1 g daily if history of ESBL producing org piper/tazo if pt has history of pseudomonas

Question 24

Inpatient management of complicated UTI stepdowm/ second line

Answer 24

Nitrofurantoin 7day total cours including initial IV --avoid in pyelonephritis of Crcl < 30) trimethoprim/sulfamethaxazole 7days oral beta lactase 7 days --cephalexin, cefdinir, amoxicillin-clav

Question 25

inpatient management CAUTI mild/moderate - treat as complicated UTI

Answer 25

Levo BID TMP/SMX BID alt; oral 3rd gen cephalorsporin ceftriaxone

Question 26

inpatient management CAUTI suspicion for more serous infections

Answer 26

PIPeracillin-lazobactam cefrpime ertapenem alternative: aminoglycoside

Question 27

management of pyelonephritis non-hospitalization

Answer 27

Ceftriaxone 1g one due to high e.coli resistance --levo or cipro 5-7 days TMP/SMX 10-14 days

Question 28

management of pyelonephritis hospitalized

Answer 28

no MDR= ceftriaxone 1g q24hr risk for MDR= piperacillin-taz cefepime ertapenem (esbl history) ahminoglycosides vancomycin

Question 29

duration of the management of pyelonephritis

Answer 29

7 day course is considered effective when the bacteremia but ups to 14 days total may be needed w oral abx depending on agent