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34 Cards in this Set

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  • Back
What is the scope/definition of urinary tract infections?
group of disorders that share similar clinical manifestations & causative agents
What is one of the most common indicaations for antibiotics?
How many episodes of UTIs are there per year & how many hospital admissions are there?
> 7 million episodes of UTIs/y

> 1 million hospital admissions
What are 4 ways to classify UTIs?
1) Site of Infection (bladder or kidney)
2) Presence or absence of symptoms (symptomatic vs asymptomatic)
3) Origin of infection (community vs hospital)
4) Uncomplicated vs complicated
What are 3 reasons why its important to classify UTIs?
Assists in the:
1) selection of antibiotics
2) route of administration
3) duration of therapy
What is the definition of an UNCOMPLICATED UTI?
CYSTITIS in nonpregnant young adult to middle-aged WOMEN w/out underlying anatomical abnormality or neurologic dysfunction
What is the risk for tx failure in uncomplicated UTI?
Low risk for tx failure in uncomplicated UTI
What makes up the largest single group of UTIs?
Uncomplicated UTI is the largest single group w/ UTI
What is the definition of COMPLICATED UTI?
PYELONEPHRITIS or URINARY TRACT W/ a structural or functional ABNORMALITY that would reduce the efficacy of antimicrobial therapy
What 4 types of people are always considered as having complicated UTIs?
1) Men
2) Children
3) Nosocomial Infections
4) Nursing Home
People w/ known a known lesion on prior dx are classified as having complicated UTIs. What are 8 examples of known lesions on prior dx?
1) Functional or structural urinary tract anomaly
2) Obstruction
3) Pregnancy
4) Diabetes
5) Spinal cord injury
6) Indwelling catheter
7)Comorbidities (ex. sickle cell disease, analgesic abuse, Pseudomonas spp infection)
8) Infection w/ an unusual organism (TB)
What are 4 examples of SUSPECTED LESIONS BASED ON HISTORY that would classify a patient as having a complicated UTI?
1) Unresolved UTI (failed response to therapy)
2) Recurrent UTI (w/ the same organism)
3) Urea-splitting organism (ex. P. mirabilis)
4) Recurrent febrile UTI as a child
What are 3 examples of SUSPECTED LESIONS BASED ON SYMPTOMS that would classify a patient as having a complicated UTI?
1) Febrile UTI (esp >3 days)
2) Renal colic
3) Gross hematuria
What 2 substances might you find in a Urine analysis that you could use to diagnose a patient w/ a UTI? What is the sensitivity/specificity?
1) PYURIA (WBCs in urine) sensitivity 95%,
specificity 71%
2) Presence of BACTERIA (function of # seen) sensitivity 40-70%, specificity 85 - 95%
What does a dipstick test w/ nitrite or leukocyte esterase look for? What is the sensitivity/specificity?
Nitrite test - tells you its a gm (-) organism (nitrates to nitrites)
Leukocyte esterase test - if (+), you have pyuria (WBCs in urine)
If a patient has a positive dipstick test, how much greater liklihood is it that the patient has an infection?
25% > pretest probability
What is the negative predictive value of nitrite & leukocyte esterase (dipstick) test? aka If dipstick is (-), how likely is it that you can rule out UTI?
negative predictive value = 97.5% for ruling out UTI
Is a urine culture necessary in uncomplicated cystitis, such as someone w/ symptoms + pyruia?
NO urine culture in uncomplicated cystitis
Name 4 situations that you should obtain a urine culture.
Complicated UTI such as:
1) pyelonephritis
2) complicated cystitis
3) fail to respond UTIs
4) Rucurrent cystitis
In what situation can a negative dipstick test NOT rule out a UTI?
When pretest likelihood is high
What percentage of blood cultures are positive in people w/ pyelonephritis?
30 - 40% patients w/ pyelonephritis have + blood cultures
In what type of patients who have pyelonephritis should blood cultures be obtained?
in hospitalized patients
What is a frequent complication of UTIs in the hospital?
For a urine culture, when during urination should the paient collect the urine? What # of bacteria is enough to make a URINE culture +?
Culture of MIDSTREAM urine
>10^5 bacteria/mL (sensitivity 50%, specificity very high)
>10^2 bacteria/mL in YOUNG WOMEN w/ CYSTITIS SYMPTOMS (sensitivity 95%, specificity 85%)
What is the overall most common bacteria that causes UTIs? What % of uncomplicated VS complicated UTIs are due to this bacteria?
E. Coli
What are the 3 most common Gm (-) bacteria that cause UTIs?
1) E. Coli
(U:70-90%, C:21-54%)
2) P. mirabolis: splits urease
(U: 1-2%, C: 1-10%)
3) Klebsiella
(U: 1-2%, C:2-17%)
What 4 other Gm (-) bacteria cause UTIs (more so complicated UTIs, only <1% Uncomplicated)?
1) Citrobactor spp
2) Enterobactor spp
3) P. aeruginosa
4) Other Gm (-) bacteria
What 4 Gram (+) bacteria can cause UTIs?
1) Coagulase (-) Staph (ex.
staph saprophyticus)
2) Enterococci
3) Group B Strep
4) S. Aureus
What Gm (+) bacteria causes many UTIs in sexually active females, so is the largest % Gm (+) cause of UNCOMPLICATED UTIs?
Staphlococcus saprophyticus (coagulase negative staph)
E. Coli has the largest resistance against what 2 antibiotics? What is the % of resistance?
E. Coli is 24% resistant to ampicillin & is
11% resistant to TMP/SMX
Should amoxicillin or ampicillin be used for 1st choice antibiotics for UTIs?
NO! E.Coli, which causes most UTIs is 24% resistant so only use amoxicillin or ampicillin when suseptibility shows organism is suseptable & you want to then switch to one of these
Is hydration therapy helpful in UTIs?
Hydration may or may not be helpful.
Crystalluria (precipitation in kidneys) can occur w/ sulfas so hydrate well if taking sulfa antibiotics.
What is the name of a urinary analgesia you might give a patient to reduce symptoms of dysuria? How long do they need it?
Phenazopyridine HCL (Pyridium)

Not usually needed beyond 1-2 days
What are 2 things to know when prescribing phenazoyridine HCL?
1) colors urine red/orange
2) not in pregnancy, breast feeding