Family Medicine - Urinary Tract Infections

Front 1

Do UTIs affect men or women more commonly?

Back 1

women - have shorter urethra's

Front 2

Is there bacteria in nl urine?

Back 2

NO
nl urine does NOT contain bacteria

Front 3

How does bacteria gain access to the bladder?

Back 3

via the urethra

Front 4

What are 3 lower urinary tract infections?

Back 4

1. urethritis
2. cystitis
3. prostatitis

Front 5

What are some upper tract infections?

Back 5

1. acute pyelonephritis
2. intrarenal and perinephric abscesses

Front 6

What is the most common bug to cause a UTI?

Back 6

E.coli - 70-80% of cases

Front 7

What are some other Gram (-) bacteria to cause UTIs?

Back 7

Proteus
Klebsiella
Enterobacter
Serratia
Pseudomonas

Front 8

How can you Dx a proteus infection?

Back 8

bacteria produces urease

Front 9

How can you Dx Klebsiella infection?

Back 9

extracellular slime layer
polysaccharides

Front 10

What 2 bacteria can commonly be associated with kidney stones?

Back 10

proteus and klebsiella

Front 11

What is a Gram (+) bacteria that can cause acute UTI in young women?

Back 11

Staph saprophyticus - 10-15%

Front 12

In what patients may staph aureus be found?

Back 12

in pts with renal stone or previous instrumentation

Note: isolation of Staph a from the urine should arouse suspicion for a bacteremia seeing the kidneys****

Front 13

What are some factors that increase the liklihood of UTI in women?

Back 13

sexual intercourse
use of a diaphragm
spermicide
vaginitis

Front 14

Are pregnant women more likely to get an upper or lower tract urinary infection?

Back 14

upper tract

20-30% asymptomatic bacteriuria develop pyelonephritis
Results from ureteral tone and peristalsis and temporary incompetence of the vesicoureteral valves

Front 15

What is the vesicoureteral reflex?

Back 15

Vesicoureteral reflux is the abnormal flow of urine from the bladder to the upper
urinary tract into the kidneys

can lead to upper UTIs and renal scarring

Front 16

A 53 yr old women complains of dysuria (painful urination), frequency, urgency, and suprapubic pain. You collect a clean catch urine sample and see that the urine is cloudy, has a foul odor, and appears to have a little blood in it. She has had a fever, chills, N/V, diarrhea, and complains of flank pain. What does she have?

Back 16

UTI

be sure to ask about previous UTI, renal disease, kidney stones, and recent surgical procedures or antibiotic use.

Front 17

What are symptoms of UTI in a child?

Back 17

irritability
fever
nausea
vomiting
bed-wetting
diarrhea

Front 18

What are symptoms of UTI in the elderly?

Back 18

mental status changes
malaise
incontinence
poor appetite

Front 19

What are 3 areas of the physical exam that must be performed when suspecting a UTI?

Back 19

temperature
abdominal exam
costovertebral tenderness

Front 20

You suspect your 53 yr old female has a UTI based on her symptoms listed previously....what would you list in the assessment of your SOAP note under differential?

Back 20

UTI
vaginitis
urethritis

Front 21

A 24 yr old college student female presents with frequency urinating, burning, and pyuria. You perform a urine collection and the lab results come back negative. What should your next step be?

Back 21

up to 30% of people with acute dysuria have midstream urine cultures with either no growth or insignificant bacterial growth.

these should be examined for STDs such as:
Chlamydia trachomatis
Neisseria gonorrhea
HSV

consider chlamydia or gonorrhea with a low onset of symptoms, no hematuria, no suprapubic pain, and more then 7 days of symptoms

Front 22

What are some conditions in men that may present like a UTI?

Back 22

younger men - urethritis

older men - 2nd to BPH

can also include:
Prostatitis
Epididymitis

Front 23

What are some NON-infectious causes of flank pain?

Back 23

renal stones
renal infarction
papillary necrosis

Front 24

What does the dipstick test evaluate on urine testing?

Back 24

leukocyte esterase

this is less sensitive then microscopy

Front 25

Where is the infection located if you find WBC casts present in the urine?

Back 25

upper UTI

Front 26

What is the requirement (quantity) for Dx of a UTI?

Back 26

growth of more than 100,000 organisms per mililiter

Front 27

What is the requirement (quantity) of organisms per millimeter if specimen is collected by suprapubic aspiration or catheterization?

Back 27

colony count of 100-10,000/mL generally indicate infection

Front 28

Does lower UTI or upper UTI need a longer course of antibiotics?

Back 28

Upper UTI - longer

Lower UTI - shorter

Front 29

What does it mean if a person has a reaccurance of a UTI after 2 weeks of Rx?

Back 29

represents reinfection with a new strain

Front 30

are most infections of UTI antibiotic sensitive or resistant?

Back 30

most are sensitive - which is good!

Front 31

If you Diagnose a person with cystitis (bladder infection) how should you treat them?

Back 31

usually a shorter course of antibiotics

single dose of fosfomycin and short courses of fluoroquinolones (3days)

Front 32

What are 3 examples of fluoroquinolones?

Back 32

norfloxacin
ciprofloxacin
ofloxacin

Front 33

For the following categories of UTIs in adults what is:
1. Diagnostic criteria
2. Pathogens
3. 1st line Rx
4. Additional comments

Back 33

Table 55-1 pg 187

Front 34

acute uncomplicated cystitis
Dx?
pathogens?
1st line Rx?
additional comments?

Back 34

Dx - urinalysis for pyuria and hematuria (culture NOT required)

pathogens - E.coli, Staph saprophyticus, Proteus mirabilis, Klebseiella pneumonia

1st line Rx? - TMP/SMX (bactrim, spectra); nitrofurantomin; Ciprofloxacin (cipro); Ofloxacin (floxin); Norfloxacin (Noroxin)

additional comments - quinolones, fosofomycin and nitrofurantoin are 1st line agents*** in areas of TMP/SMX resistance or in pts who cannot handle sulfa drugs

Front 35

recurrent cystitis in young women
Dx?
pathogens?
1st line Rx?
additional comments?

Back 35

Dx - symptoms and a urine culture with a bacterial count of more than 100,000 CFU/mL of urine

pathogens - same as for acute uncomplicated cystitis

1st line Rx? - if the pt has >3 cystitis episodes/yr, treat prophylactically with postcoital, or continuous daily therapy.

additional comments - repeat therapy for 7-10 days based on culture results and then use prophylatic therapy

Front 36

acute cystitis in young men
Dx?
pathogens?
1st line Rx?
additional comments?

Back 36

Dx - urine culture with a bacterial count of 1000-10,000 CFU/mL of urine

pathogens - E.coli, staph sap, proteus mirabilis, klebsiella pneumonia

1st line Rx - TMP/SMX (bactrim, spectra); nitrofurantomin; Ciprofloxacin (cipro); Ofloxacin (floxin); Norfloxacin (Noroxin)

additional comments - treat for 7-10 days

Front 37

acute uncomplicated pyelonephritis
Dx?
pathogens?
1st line Rx?
additional comments?

Back 37

Dx: urine culture with a bacterial count >100,000 CFU/mL

Pathogens - same as for acute uncomplicated cystitis

1st line Rx: If gram negative organism - oral fluoroquinolone

If gram + amoxicllin

If parenteral administration is required use ceftriaxone (rocephin) or a fluoroquinolone

If enterococcus species add oral or IV amoxicllin

Additional comments: swith from IV to oral administration when the patient is able to take medication by mouth; complete a 14 day course

Front 38

For complicated urinary tract infection what is:
Dx criteria?
Principle pathogens?
1st line Rx?
Comments?

Back 38

Dx criteria - urine culture with a bacterial count of more than 10,000 CFU/mL

Principle pathogens - E.coli, klebsiella, Proteus mirabilis, enterococcus, Pseudomonas aeruginosa

1st line Rx - If gram (-) give oral fluoroquinolone
If enterococcus species, ampicillin or amoxicillin with or without gentamicin (Garamycin)

Comments - treat for 10-14 days

Front 39

For an asymptomatic bactiuria in pregnancy:
Dx criteria?
Principle pathogens?
1st line Rx?
Comments?

Back 39

Dx criteria - urine culture with a bacterial colony count of more than 100,000

Principle pathogens - same as for acute uncomplicated cystitis

1st line Rx - amoxicillin, nitrofurantoin (macrodantin), Cephalexin (keflex)

Comments - avoid tetracycline and fluoroquinolones
treat for 3-7d

Front 40

Catheter-associated UTI
Dx criteria?
Principle pathogens?
1st line Rx?
Comments?

Back 40

Dx criteria - symptoms and a urine culture with a bacterial count of more than 100

Principle pathogens - depends on duration of catheterization

1st line Rx - If gram (-) = fluoroquinolone
If gram (+) = ampicillin or amoxicillin, plus gentamicin

Comments - remove catheter if possible and tx for 7-10 days
for pts with long term catheters and symptoms treat for 5-7days

Front 41

How long should a male be treated for a UTI?

Back 41

should recieve a 7-14 days course of antibiotics

Front 42

You have a 34 yr old pregnant women present with a UTI. What are your tx options?

Back 42

amoxicillin
nitrofurantoin
cephalosporin

Front 43

what should you do if you have continuous UTI in a pregnant women?

Back 43

low-dose prophylaxis with nitrofurantoin is indicated

Front 44

men or women presenting with acute infection and signs or symptoms suggest an obstruction or stones. What should you do next?

Back 44

US or CT scan to confirm

Front 45

What are the doses given for frequent symptomatic infections?

Back 45

daily or 3x/wk
single dose TMP/SMX (80/400mg)
TMP (100mg)
Nitrofurantoin (50mg)

Front 46

What is it important to tell sexually active people?

Back 46

always void after intercourse to clear the urethra