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GU: Clin Med IIA > UTIs > Flashcards

UTIs Flashcards

(56 cards)

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1
Q

UTIs are MC in who?

A

women

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1
Q

pathogen of UTIs?
how is the difference between acute and chronic?

A

Coliform bacteria, especially E. coli
Uncomplicated, community-acquired
Acute - usually one organism
Chronic - may be 2+ organisms

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2
Q

diagnostic evaluations and findings of UTIs

A
  1. Colony count - 105 cfu/mL (>100,000 cfu/mL is suggestive but not diagnostic
    - Up to 50% of women with UTIs have lower counts
    - asx bacteriuria is a thing, y’all
  2. Pyuria - helpful but not required
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3
Q

Presence of bacteria in the urine
what is this term

A

Bacteriuria

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4
Q

presentation of asx bacteriuria?
MC in who?
do you screen?

A
  • colony count of >105 cfu/mL
  • In women - 2 consecutive specimens
  • MC in women with increasing age
  • Recommended not to screen in children and women
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5
Q

failure to sterilize urinary tract during UTI tx
what type of bacteriuria?
cause?

A

Unresolved
Resistance, noncompliance with tx, mixed infections

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6
Q

urinary tract is sterilized, but bacteriuria recurs due to persistent source of bacteria
what type of bacteriuria?
causes?

A

Persistent
Infected stone, prostatitis, foreign bodies, fistulas

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7
Q

methods of UTI spread
which is MC

A
  1. ascending
  2. direct extension
  3. hematogenous
  4. lymphatic - rarest
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8
Q

why are women MC affected with UTIs compared to men?

A

Short urethra in women → much higher UTI incidence
men - longer urethra, takes more effort

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9
Q

from local infected tissue (e.g., intraperitoneal abscess)
what type of UTI spread?

A

direct extension

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10
Q

what pathogen is associated with hematogenous spread of UTI

A

staph aureus

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11
Q

general risk factors for UTI

A
  • Abnormal voiding (including vesicoureteral reflux)
  • Diminished renal blood flow
  • Intrinsic renal disease
  • Abnormal urine pH, osmolality
  • Deficient mucosal coating
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12
Q

risk factors for UTIs for females and males

A

females - Shortened urethra; Sexual intercourse (“Honeymoon Cystitis”)
males - prostatitis; foreskin

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13
Q

cause of acute cystitis?

A

bacterial
E. coli, Proteus, Klebsiella, Pseudomonas, Staphylococci, Enterococci

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14
Q

MC route of acute cystitis

A

ascent up urethra

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15
Q

acute cystitis is MC in who?

A

much MC in women
Rare in adult men - investigate possible underlying etiology

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16
Q
  • irritative voiding (dysuria, frequency, urgency), suprapubic pain, +/- gross hematuria, +/- malaise
  • Exam - suprapubic tenderness possible
  • Minimal/no signs of systemic toxicity

What is the probable dx?

A

acute cystitis
should NOT see flank pain

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17
Q

is imaging needed for acute cystitis?

A

not needed in uncomplicated cases (female)
Men - consider workup of suspected underlying cause

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18
Q

lab findings of acute cystitis

A

pyuria, hematuria, bacteriuria
* Leukocyte esterase, urinary nitrite
* Urine cx - (+) for causative organism
* obtain UA/UC with initial tx

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19
Q

Is a UA always necessary when diagnosing acute cytitis?

A

may skip (treat empirically) if no s/s of systemic illness and no risk factors for drug-resistant organisms
Otherwise should obtain UA/UC with initial tx

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20
Q

risks for MDR G- bacteria

A
  • MDR G- bacteriuria in the past 3 months
  • Inpatient stay (hospital, nursing home, LTC) in the past 3 months
  • Quinolone, TMP-SMZ, or ESβL antibiotics in the past 3 months
  • Travel to areas with ↑ MDR germs (Mexico, Spain, India, Israel)
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21
Q

first-line short-term antimicrobial therapy for uncomplicated acute cystitis

A

5 days - Nitrofurantoin (Macrobid) - 100 mg PO BID
3 days - TMP-SMZ (Bactrim DS) - 800/160 mg PO BID
Alternative - Trimethoprim 100 mg PO BID
Single dose - Fosfomycin (Monurol) - 3 g PO x 1 dose

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22
Q

second line abx for uncomplicated acute cytitis

Study These Flashcards
A
  • Amoxicillin/clavulanic acid 500 mg
  • Cephalosporins - cefpodoxime 100 mg, cefdinir 300 mg, cephalexin 250-500mg

all options BID x 5-7 d

23
Q

third line abx for uncomplicated acute cytitis

Study These Flashcards
A

Fluoroquinolones - ciprofloxacin 250 BID, levofloxacin 500 QD

all options x 3 d

24
is a repeated UA necessary for uncomplicated acute cystitis
* not necessary if s/s resolve in simple cases * May consider repeating if concern about unresolved bacteriuria
25
CI of Phenazopyridine (Azo)
Renal insufficiency; known hypersensitivity
26
SE of Phenazopyridine
HA, dizziness, GI cramps, **discolored urine** * NOT for chronic/long-term use * Interferes with in-office UA dip * Rare - AKI, hemolytic anemia, methemoglobinemia
27
what Urinary analgesics/antimicrobial Metabolizes into formaldehyde and ammonia in urine
Methenamine (Hiprex)
28
which methenamine are additives to acidify the urine or provide pain relief
Cystex, Phosphasal
29
CI of methenamine
Renal or severe liver insufficiency; known hypersensitivity; severe dehydration; current tx with sulfonamides
30
DDI of Methenamine
sulfa drugs
31
SE of Methenamine
rash, nausea, dyspepsia * Only use long-term if instructed to do so by provider * Rare - elevated LFTs
32
other supplemental tx for uncomplicated acute cystitis
* Sitz baths * Increased PO fluid intake * Cranberry juice or supplement * Probiotics * Vaginal estrogen
33
non-pharm prevention of acute cystitis
* Voiding - Voiding after intercourse; Minimizing urinary retention * Other Patient Habits - Adequate PO fluid hydration; Avoiding causative meds; Wiping “front to back;" “Breathable” undergarments * Supplements - Probiotics; Cranberry juice/supplement; D-mannose supplement
34
pharm prevention for acute cysititis
Low-dose abx QHS or PRN with coitus * TMP-SMZ 40/200 mg/d * Trimethoprim 100 mg/d * Nitrofurantoin 100 mg/d * Cephalexin 250 mg/d * Methenamine 500-1000 mg BID
35
who is a good candidate for pharm tx for acute cystitis prevention
* In women with 3+ UTIs in a 12-month period * Prior to starting tx - r/o correctable etiology, more serious causes (Fistulas, infected stones, etc.)
36
what is the "kidney infection"
Acute Pyelonephritis
37
what pathogen can be seen in Acute Pyelonephritis
**G- bacteria most common** E. coli, Proteus, Klebsiella, Pseudomonas May see G+ - Enterococci, Staphylococci
38
MC route of acute pyelonephritis
ascent up urethra
39
Acute Pyelonephritis is MC in who?
women less common than acute cystitis
40
irritative voiding , suprapubic pain, +/- gross hematuria, fever, chills, N/V/D, flank pain Exam - fever, tachycardia, CVA tenderness what is the dx?
Acute Pyelonephritis
41
is imaging needed for acute pyelonephritis? is there a preferre method?
* may not be indicated in uncomplicated cases * **CT - preferred** - can show renal inflammation, abscess * US - can show hydronephrosis, may show abscess
42
labs of Acute Pyelonephritis
* pyuria, hematuria, bacteriuria, +/- **WBC casts** * Leukocyte esterase, urinary nitrite possible * Urine CX - (+) heavy growth of causative organism * CBC - leukocytosis with left shift * Blood cx - may or may not be +
43
outpatient tx for acute pyelonephritis if they are:
* Able to tolerate PO fluid and abx intake * mild-moderate s/s, uncomplicated, compliant
44
abx for outpatient acute pyelonephritis
_oral (+/- initial IV treatment)_ _Initial IV options_: * ceftriaxone (Rocephin) * ciprofloxacin (Cipro) * gentamicin _Oral Tx options_: (non FQ options need IV first) * levofloxacin (Levaquin) * ciprofloxacin (Cipro) * trimethoprim-sulfamethoxazole (Bactrim DS) * (not 1st line) - amoxicillin/clavulanate (Augmentin)
45
CI abx for acute pyelonephritis
nitrofurantoin, oral fosfomycin they dont stay in the kidney!!
46
Unable to tolerate PO fluids/meds, severe illness, complicated case (sepsis, obstruction), non-compliant would this pt need inpatient or outpatient tx?
inpatient
47
inpatient tx for acute pyelonephritis
* No risk for MDR G-: IV ceftriaxone, IV piperacillin-tazobactam, IV ampicillin/gentamicin, or IV/oral fluoroquinolones * If MDR G+ suspected - add on vancomycin, linezolid or daptomycin * 1+ risk factors for MDR G- : IV carbapenem (imipenem, meropenem, or doripenem) * If highly resistant - IV extended-spectrum cephalosporin + BL inhibitor * If MDR G+ suspected - add on vancomycin, linezolid or daptomycin May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx
48
complications with acute pyelonephritis | include tx for one of the complications
* Sepsis/Septic shock * Scarring and nephron loss * Chronic pyelonephritis- Requires abx tx for 3-6 mo; Similar rx to acute pyelonephritis * Major renal abscess formation * May necessitate surgical drainage
49
cause of acute urethritis MC route? | pathogen
* #1 cause **Neisseria gonorrhoeae**, #2 cause Chlamydia trachomatis , #3 cause - Mycoplasma genitalium * Trichomonas vaginalis also emerging as etiology * gonococcal urethritis or non-gonococcal urethritis (NGU) * MC route - **ascent up urethra**
50
acute urethritis is MC in who?
**men** * Young, sexually active males * Occurs in women, but usually also occurs with another dx (PID, vaginitis, cystitis, etc.)
51
irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge probable dx?
Acute Urethritis
52
difference between discharge seen in Acute Urethritis
from scanty/thin/watery to thick/purulent/copious **thick = gonococcal**
53
can acute urethritis asx?
Up to 10% of gonococcal urethritis and 42% of NGU
54
PE findings include +/- inflammation at urethral meatus; urethral discharge what is this dx
**Acute Urethritis** May not see discharge without “milking” of urethra Thick, purulent, copious discharge - more suggestive of gonorrhea
55
tx for Acute Urethritis
* Gonorrhea - ceftriaxone (Rocephin) 500 mg - 1 g IM x 1 dose * Chlamydia - azithromycin 1 g PO x 1 dose / doxycycline 100 mg PO BID x 7 days * Directed Therapy - culture and sensitivity * All sexual partners must also be treated * Reportable disease

GU: Clin Med IIA (13 decks)

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