Flashcards in UTI's Deck (37)
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How do bacteria get into the urinary tract?
1. Urethra -> Bladder -> Kidneys -> Blood
2. Bacteremia can result in seeding of the kidney
1
List some common uropathogens
1. Enterobacteriaceae (E. coli, Klebsiella spp., Proteus spp.)
2. Enterococcus spp.
3. CNS
4. GBS
2
What mechanisms does the healthy human host have to eliminate microbes from the urinary tract?
1. Normal flushing mechanism
2. pH
3. Chemical content of urine
3
What are some things that predispose someone to UTIs?
1. Kidney stones
2. Vesicourethral reflux
3. Neurologic problems (DM, spinal cord injury)
4. Prostate hypertrophy
5. Short urethra (women)
6. Urinary catheters
4
What is a major cause of nosocomial UTIs?
URINARY CATHETERS. Risk of UTI increases about 3% for each day of catheterization.
5
Guidelines for urinary catheters
1. Avoid it unless necessary
2. Remove it ASAP
3. Hand hygiene
4. Maintain drainage by gravity
5. IN and OUT is better than continuous
6
3 basic components taken together for the Dx of a UTI
1. Hx/physical
2. Urinalysis
3. Urine C/S
7
Signs and symptoms of a UTI
1. Frequency of urination
2. Dysuria
3. Urgency
4. Hesitation
5. New onset of incontinence (elderly)
6. Fever
7. Costovertebral angle tenderness (pyelonephritis)
8
Malodorous or cloudy urine is a definite sign of a UTI, T or F?
FALSE
9
List various methods of urine collection
1. Midstream
2. Foley catheter
3. Suprapubic aspiration
4. Ileal conduit
5. Nephrostomy tube
6. Cystoscopy
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Midstream urine collection
1. Clean periurethral area prior to providing sample
2. Difficult to collect from: bedridden pt's, the elderly, infants
3. Midstream urine allows for the initial stream to washout contaminating bacteria from lower urethra
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Foley catheter collection
1. Foley's in for > 24 hours are probably colonized
2. Try to collect from a newly inserted catheter (port)
3. NEVER collect from the bag
12
What 2 types of patients are likely to undergo suprapubic aspiration for a urine sample?
1. Pediatrics
2. Pt's with spinal cord injuries
13
Urine collected from an ileal conduit is also going to grow bacteria, T or F?
TRUE
14
When should a urine sample be transported to the lab?
Within 2 hours to avoid overgrowth. Can refrigerate for up to 18 hours.
15
What 2 macroscopic variables are assessed using a urine dipstick?
1. Leukocyte esterase - suggests WBCs are present
2. Nitrite - +ve if nitrate reducing bacteria are present
16
What can the presence of WBCs in the urine indicate?
Indicates inflammation from:
1. Infection
2. Cancer
3. Catheters
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What may the presence of RBCs in the urine indicate?
1. Infection
2. Kidney disease
3. Renal stone
4. Urinary tract cancers
5. Bleeding disorders
6. Contamination from menstrual blood
18
When is it ideal to collect urine cultures?
Before antibiotics are started
19
How soon might you receive the results from a urine culture?
18-24 hours. Susceptibility will come shortly after for pt's in hospital
20
Quantitative urine cultures apply to what type of sample?
Midstream urine
21
Quantitatively, what does significant bacteremia mean?
There is > 100,000 CFU/ml (pay attention to units)
22
What are some factors that may influence urine culture results?
1. Improper collection = contamination
2. Improper storage = overgrowth
3. Antibiotic Tx = decreased burden of susceptible bacteria
4. Fluid intake affects quantitative results
23
What is required to Dx a UTI?
1. Signs and symptoms present
2. +ve urinalysis
3. +ve urine culture
24
When would it be appropriate to draw blood cultures in a pt with a suspected UTI?
1. Fever
2. Pyelonephritis
3. UTI in immunocompromised
4. ALL pediatric pt's with fever
5. Sepsis
25
List some general principles for the Tx of a UTI
1. Look at local antibiogram
2. Use shortest duration possible
3. Change from IV to PO, ASAP
4. Reevaluate drug choice based on susceptibility report
5. Remove catheter if no absolute indication
6. Hydrate!
26
What 2 agents should no longer be used empirically for UTIs?
1. Ciprofloxacin
2. TMP/SMX
27
What antibiotics are still good empiric choices for cystitis?
1. Nitrofurantoin
2. Fosfomycin
3. For 1 and 2 - drug levels do not get high enough to treat pyelonephritis at the site of infection
4. Amoxicillin-clavulanate
28
What antibiotics should be avoided for the Tx of UTI in pregnant women?
1. TMP/SMX in 1st and 3rd trimester
2. Nitrofurantoin > 36 weeks (hemolytic anemic in neonate)
3. Quinolones
29
What Tx can be given for a pt that is septic from a UTI?
1. IV antibiotics
2. Piperacillin-tazobactam + gentimicin
30
Acute cystitis
1. May resolve spontaneously
2. Recurrence can be common in sexually active females
3. 1st episode in females -> screen for pyuria is adequate. Cultures not necessary if symptoms typical and respond to Tx
4. Recurrent cystitis in men -> investigate for prostatitis, prostate hypertrophy
5. Response to Tx should be seen by 48 hours
31
Tx for acute cystitis
1. Empiric = Nitrofurantoin or fosfomycin
2. Alternatives = Cefixime OR TMP/SMX, Ciprofloxacin
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Pyelonephritis
1. Kidney infection
2. Lower UT symptoms + fever and CVA tenderness
3. Recurrence can cause loss of renal function
4. May result in 2ndary bacteremia
5. Lasts 7-14 days
33
Tx for pyelonephritis
1. Not all pt's need hospitalization
2. Empiric outpatient Tx = Cefixime. Alt. = amoxicillin-clavulanate, ciprofloxacin, or TMP/SMX
3. In hospital Tx = Ceftriaxone IV or Gentamicin IV
34
Asymptomatic bacteriurea
1. Bacteria detected in urine +/- pyuria, but no symptoms
2. DOES NOT require antibiotics unless pt is pregnant or undergoing cystoscopy
3. This is common
35
Pregnancy and UTI
1. Asymptomatic bacteriuria needs Tx to prevent pyelonephritis, preterm labour, and low birthweight
2. Screen for bacteriuria at 12-16 weeks
3. Do post-Tx cultures and monthly cultures for remainder of pregnancy
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