UTIs- Male

Question 1

uncomplicated UTI: pt does not have a ___________ factor that would affect microbio, incidence, or recurrance rates. typically what type of person?

Answer 1

predisposing; young healthy person with no comorbidites and no hx of recurrent UTIs

Question 2

what patients are considered to have complicated UTIs?

Answer 2

elderly, DM, recurrent UTIs, CA, comorbidites, and hx of known resistance

Question 3

most UTIs are caused by what?

Answer 3

bacteria entering through the urethra

Question 4

pyelonephritis develops when __________ ascend to the __________ via the __________. it can also be caused by _________ of the kidneys from ________

Answer 4

pathogens; kidneys; ureters; seeding; bacteremia

Question 5

what is acute simple cystitis?

Answer 5

acute UTI that is confined to the bladder AND doesnt have normal symptoms (fever, flank pain, CVA tenderness, chills. pelvic/perineal pain)

Question 6

what are two main categories of pts that require unique management of UTIs

Answer 6

pregnant women and renal transplant recipients

Question 7

what is an acute complicated UTI?

Answer 7

acute UTI accompanied by signs or symptoms (fever, chills. flank pain, CVA tenderness, pelvic/perineal pain) that suggest infection beyond the bladder

Question 8

what bacteria is the most common cause of uncomplicated UTIs?

Answer 8

E coli

Question 9

E coli has ____ that help the bacteria adhere to _______ __________ in order to cause infection. ________ helps prevent E coli from adhering

Answer 9

pili (protein filaments); urinary structures; cranberry

Question 10

what are four organisms that can cause complicated UTIs?

Answer 10

proteus, klebsiella, entercoccus, pseudomonas

Question 11

what bacteria is more common in patients with health care exposures/instrumentation?

Answer 11

pseudomonas

Question 12

____________ __________ is an occasional cause of pyelonephritis in young healthy women

Answer 12

staph saprophyticus

Question 13

three risk factors for UTI with resistant organisms

Answer 13

1) . recent broad spectrum antimicrobial use
2) . health care exposures
3) . travels to parts of the world where multidrug resistant organisms are prevalent

Question 14

uncomplicated UTI signs/symptoms (4)

Answer 14

urinary frequency, lower abd or back pain, cloudy and foul smelling urine, +/- fever

Question 15

how to diagnosis uncomplicated UTI

Answer 15

based on hx, PE, and labs (PE is usually unremarkable)

Question 16

what does UA show for uncomplicated UTI? (3) what test is usually not needed?

Answer 16

positive for nitrites, WBC esterace, and blood; culture is not done

Question 17

what are three ABX options for uncomplicated UTI tx?

Answer 17

bactrim DS BID 3 days, keflex 500 mg BID 5-7 days or cipro 250 mg BID for 3 days

Question 18

presence of ______ with or without pyuria in the absence of any UTI symptom is called _________ ___________. describe tx for this

Answer 18

bacteriuria; asymptomatic bacteriuria; does warrant tx in nonpregnant patients who arent undergoing urologic surgery

Question 19

pt populations of people at increased risk of UTI (and could present with complicated UTIs) 8 things

Answer 19

CA, recurrent UTIs, urinary obstructions, neurogenic bladders, sexually active women (with STD or recurrent UTIs), postmenopausal women, men with prostate dz, and elderly

Question 20

____________ and ________ ___________ are the most common predisposing factors for nosocomial UTIs

Answer 20

instrumentation and urinary cath

Question 21

_____ ______is the most common cause of gram neg septicemia in hospitalized pts

Answer 21

urinary cath

Question 22

________ pts are at an increased risk of UTIs; ______ pts often have complicated UTIs

Answer 22

diabetic; elderly

Question 23

presentation signs and symptoms for complicated UTI

Answer 23

may present with typical UTI symptoms but elderly/comorbidly ill pts will have altered mental status, anorexia, fatigue, weakness, and vague symptoms

Question 24

UA will show what for complicated UTI? what other test will you run compared to not doing in an uncomplicated UTI

Answer 24

positive for nitrites, WBC esterace, blood (may have elevated WBC on CBC); DO a culture

Question 25

tx of complicated UTI: base off ______, may require __________ for IV ABX if unstable or septic (______ = ABX)

Answer 25

culture; hospitalization (Rocephin)

Question 26

recurrent UTIs are more than ____ per year (with ________ testing)

Answer 26

4; positive

Question 27

common causes of recurrent UTIs (5)

Answer 27

menopause, poor hygiene, frequent diarrhea, sex, spermicide use

Question 28

eval for recurrent UTI includes what tests (6)

Answer 28

UA, microscopy positive urine cultures, pelvic exam, cystoscopy, urodynamics, renal US

Question 29

tx for recurrent UTI

Answer 29

acute- complicated type ABX for at least 7 days prophylaxis- macrobid, trimethoprim, or keflex ABX as needed

Question 30

_______ for prevention of recurrent UTIs in premenopausal women

Answer 30

fluids

Question 31

uncomplicated cystitis ABX: best for pregnancy? other good one but requires renal monitoring

Answer 31

macrobid- preg | keflex- renal dose adjustment

Question 32

complicated cystitis: tx may require ________. initial ABX therapy is _______ and then step down PO is ______

Answer 32

culture; ceftriaxone 1-2 weeks and then keflex 10-14 days

Question 33

uncomplicated pyelonephritis ABX for initial and step down therapy

Answer 33

initial- ceftriaxone 10-14 days and then keflex 10-14 days (OBTAIN cultures)

Question 34

after 50, __________ ________ becomes more common which can cause obstruction and increased risk of ______

Answer 34

prostatic hyperplasia; UTI

Question 35

UTI is the ____ most common infection in the elderly

Answer 35

2nd

Question 36

UTIs in elderly are more common for those living where or with what?

Answer 36

living in nursing home/extended care and who have indwelling cath

Question 37

elderly people with UTI present with what four things that are different than normal UTI symptoms?

Answer 37

altered mental status, fatigue, weakness, anorexia

Question 38

tx for UTIs in elderly

Answer 38

IV or PO ABX, removal of cath if possible

Question 39

some elderly pts with ________ ______ may have chronic asymptomatic bacteria which does or does not need ABX?

Answer 39

indwelling catheters; does not

Question 40

the ______ fluid in men has antimicrobial properties

Answer 40

prostatic fluid

Question 41

on a culture, a true UTI is presented when there are >_________ colony forming units of bacteria per mL of urine

Answer 41

greater than 100,000

Question 42

send culture on ____, _______ women, people with __________ UTIs

Answer 42

kids; pregnant; complicated

Question 43

if the patient has progressed to _______, figure out the cause and fix it, plus add ____ and _____

Answer 43

urosepsis; IVFs and ABX

Question 44

fluoroquinolones have black box warning for ___ ______

Answer 44

CNS toxicity