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Flashcards in UTIs Deck (25):
1

what are 2 main consequences of UTI

1. underTx
- many will develop pyelonphritis
2. over tX
- ABx resistance
- UTI most common reason for flouroquinolne Tx

2

3 steps of UTI patho

1. bacterial virulence factors
- fimbriae
- adehsins
2. ascending spread
- E. coli
- other enterobact.
3. hematogenous spread
- S. aureus
- candida

3

2 outcomes of asymptomatic bacteruria

1. resolution
2. acute cystitis

4

2 outcomes of acute cystitis

1. resolution
2. pyelo

5

4 protective factors

1. innate immunity (TLR -4)
2. high urinary area and low Ph
3. urinary tract epithelium derived protein factor
4. urinary flow and micturation

6

def. asymtomatic bacteruria

1. voided urinary sample with same species present above 10E5
- women 2 consecutive samples, men 1
- in cath - only 10E2
common in women

7

most common bact.

- E. coli
- Klebsiella pneumonia
- other enterobact.
- coag neg. staph
- group B strep

8

what are consequences in non-pregnant women

- more likely to dev. symptomatic UTI
- ABx reduced at 6 month, but not year

9

what are consequences in women with diabetes

- no increase in UTI
- no beneft for ABx

10

take home about non-symptomatic

- can have bacteria, but without Sx, there is not an issue

11

when is screening of benefit

only when it prevents adverse outcome
- preggers
- before URO procedures

12

2 risks in pregnant

1. 20-30x pyeloneph
2. increased with of premature
both decreases with ABx Tx

13

what is risk in people undergoing TURP

- 60% become bacteremic
- ABx the night before lowers risk

14

what is uncomplicated cystitis

- infection of bladder
- dysuria, freq, urgency
- bacteruria
- +ve leukocyte esterases, nitrites

15

3 principles for uncomp. cystitis

1. narrow spectrum
2. short course
3. proven efficacy

16

2 Tx reccomendations

1. nitrofuratoin
or
2. trimethoprim/sulfa

17

what are 3 reccomendations for reccurent acute uncomp. UTIs

1. behavioral mods
2. AB prophylaxis
>3/year
> confirmed by culture
- post-coital or bedtime dose
3. self-diagnosis and Tx

18

what makes pyelo uncomp. and comp.

uncomp
- healthy, pre-meno, non-preg
comp.
- perinephric abscess
- emphysematous pyelo
- papillary necrosis

19

what is Sx of pyelo

- flank pain
- N/V
- fever
- CVA tenderness
- sepsis possible

20

what is ABx outpatient therapy

- low fever, no dehydration
- fluroquinolone
- trimethoprim sulfa

21

what is in-patient therapy (4)

IV then switch to oral - all need 14 days
1. flouro
2. amplicillin+gentamicin
3. 3rd gen ceph
4. B-lactam

22

what are cath assoc. UTIs

- indwelling cath
- Sx of UTI
- no other source of infection
- > 10E3 cfu

23

Sx of cath. UTI

- fever, rigors
- flank pain, CVA tenderness
- urgency freq, suprapubic pain
- if SCI - spacticity, auto dysreflexia

24

3 princincples of cath. prevention

1. only place when needed
2. discontinue ASAP
3. consider automatic D/C times and MD reminders

25

4 Tx reccomnedations for caths

1. culture urine before ABs
2. change cath in 2 weeks
3. Tx based on culture
4. 7 days if prompt response, 10-14 otherwise

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