Mcphs Genitourinary System Infections And Inflammatory Conditions

Front 1

What are the six types of urinary tract infections?

Back 1

Bacteriuria
Urethritis
Cystitis
Pyelonephritis
Intrarenal and Perinephric abscess
Prostatitis

Front 2

What are the lower urinary tract infections?

Back 2

Urethritis
Cystitis
Prostatitis

Front 3

What are the upper urinary tract infections?

Back 3

Pyelonephritis
Intrarenal and perinephric abscess

Front 4

What are four other categories, besides upper and lower, for urinary tract infections?

Back 4

Non-catheter associated (community acquired)

Catheter Associated (hospital acquired)

Any category may be Symptomatic or Asymptomatic

Front 5

What causes a urinary tract infection?

Back 5

Pathogenic microorganisms in urine, urethra, bladder, kidney, or prostate.

Front 6

What must you have for a diagnosis?

Back 6

From midstream "clean catch" urine sample.

Front 7

What is a sign from lab work that it is an infection?

Back 7

>10 to the fifth power, organisms per milliliter

Front 8

A urinary specimen can be significant with 10 to the second or 10 to the fourth power organisms per mL in what cases?

Back 8

If symptomatic or from catheter specimen

Front 9

What is the most common etiological agent class for urinary tract infection?

Back 9

Gram negative bacteria

Front 10

What gram negative bacteria is responsible for 80% of uncomplicated acute UTI?

Back 10

E. coli

Front 11

What two gram negative bacteria is associated with kidney stones?

Back 11

Proteus

Klebsiella

Front 12

What three agents besides E. coli, gram negative agents, are associated with UTI?

Back 12

Enterobacter

Serratia

Pseudomonas

Front 13

This gram positive cocci is responsible for 10-15% of cases of UTI causing acute symptoms of UTI in young females.

Back 13

Staphyloccocus saprophyticus

Front 14

This gram possitive cocci occasionally is the cause of acute uncomplicated cystitis.

Back 14

Enterococci

Front 15

This gram positive cocci is associated with renal stones, instrumentation, increased suspicion of bacteremic kidney infection.

Back 15

Staphylococcus aureaus

Front 16

Urethritis that is associated with acute symptoms in a female with sterile pyuria is caused by what?

Back 16

Often STD's - Chlamydia, Gonorrhea

Front 17

What are two non STD causes of urethritis?

Back 17

Ureaplasma urealyticum

Mycobacteria

Front 18

These agents usually causes urethritis associated with catheters or diabetes mellitus.

Back 18

Candida or other fungal species

Front 19

What are the three ways in which the pathogenesis of a UTI can occur?

Back 19

1. Usually ascent of bacteria from urehtra to bladder to kidney

2. Vaginal introitus, distal urethra, colonized by normal flora

3. Gram negative bacilli from bowel may colonize at introitus, periurethra.

Front 20

What are the predisposing conditions for a female to have a UTI?

Back 20

Short urethra, proximity to anus, termination beneath labia.

Sexual activity

Front 21

2-3% of these patients have a UTI, 20-30% with asymptomatic bacteriuria may lead to pyelonephritis.

Back 21

Pregnant patients

Front 22

Decreased ureteral tone, decreased ureteral peristalsis, temporary incompetence of vesicoureteral valves equal what?

Back 22

Increased risk of pyelonephritis

Front 23

Apart from just being a female and/or being pregnant, what are six other predisposing conditions for Urethritis/UTI?

Back 23

Neurogenic bladder dysfunction or bladder diverticulum (incomplete emptying)

Age

Vesicoureteral reflux

Bacterial virulence

Genetics

Change in urine nutrients, diabetes mellitus, gout

Front 24

In regards to age as a predisposing condition, what in particular about women and age are a predisposing condition for UTI?

Back 24

Postmenopausal women with uterine or bladder prolapse (incomplete emptying), lack of esrogen, decreased normal flora, concomitant medical conditions such as diabetes mellitus

Front 25

If you have acute dysuria, frequency, often need to suspect sexualy transmitted pathogens especially if symptoms persist more than 2 days, no hematuria, no suprapubic pain, new sexual partner, cervicitis.

Back 25

Urethritis in both male and female

Front 26

If you see frequency of urination, dysuria, ugency, suprapubic pain, cloudy malodorus urine, leukocyte esterase positive = pyuria, nitrite positive, and WBC with 2-5 of these symptoms and bacteria on microscopy in a female this means what?

Back 26

Cystitis in female

Front 27

These signs for this are fever, chills, N/V, diarrhea, tachycardia, general muscle tenderness with deep abdominal tenderness, possibly signs of gram negative sepsis.

Back 27

Pyelonephritis

Front 28

What three things can be seen in labs with pyelonephritis?

Back 28

Leukocytosis

Pyuria with leukocyte casts, and bacteria and hematuria on microscopy

Front 29

What are complications associated with pyelonephritis?

Back 29

Sepsis, papillary necrosis, ureteral obstruction, abscess, decreased renal function if scarring from chronic infection, in pregnancy - may increase incidence of pre-term labor.

Front 30

10-15% of hospitalized patients with what develop bacteriuria?

Back 30

Patients with indwelling catheter

Front 31

What is the most significant complications of catheter induced UTI?

Back 31

Gram negative bacteremia

Front 32

What labs do you run when trying to diagnose UTI?

Back 32

Urinalysis with microscopic = WBC bacteria

Urine culture

Sensitivities of culture for tailord antibiotic therapy.

Front 33

You may diagnose acute uncomplicated cystitis based on what?

Back 33

history, PE and UA alone, no need for culture to treat.

Front 34

What is seen in the urinalysis of a patient with a UTI?

Back 34

Leukocyte esterase positive = Pyuria

Nitrite positive from urea producing bacteria (but not always)

Microscopic - WBC (even 2-5 in patient with symptoms)

Microscopic - Bacteria

Front 35

In the urine culture for UTI, what is considered the standard for diagnosis but misses up to 50% of the cases?

Back 35

When 10 to the fifth power, colonies per mL are seen.

Front 36

If a patient is symptomatic what numbers in urine culture are significant for UTI?

Back 36

10 to the second and 10 to the fourth power colonies per mL

Front 37

What three instances require a urine culture?

Back 37

In upper UTI

Complicated UTI

Failed Tx or re infections

Front 38

This allows for sensitivities for better tailoring of Tx for UTI.

Back 38

Urine culture

Front 39

What is the Tx for uncomplicated cystitis with less than 48 hours of symptoms, non-pregnant, usually 3 days Tx is sufficient?

Back 39

Bactrim DS, Septra DS
Cipro or other Fluoroquinolone
Nitrofurantoin (7 days)
Augmentin
Bladder analgesia, Pyridium

Front 40

Pyridium does what?

Back 40

reduces irritation of the bladder

Front 41

What uncomplicated cystitis drug txs should never be given during pregnancy?

Back 41

Cipro or other fluoroquinolone

Front 42

What is the Tx of uncomplicated cystitis in a pregnant patient?

Back 42

Requires longer Tx of 7-14 days

Cephalosporin, nitrofurantoin, augmentin, sulfonamides

Front 43

You do not use sulfonamides near term in pregnancy for the Tx of cystitis because?

Back 43

It increases the risk of kernicterus - hyperbilirubenemia causes this.

Front 44

You give empiric Tx for this in pregnancy screening at first visit?

Back 44

Asymptomatic bacteriuria

Front 45

If asymptomatic bacteriuria is left untreated it can cause what?

Back 45

Pre term delivery

Low Birth Weight

20-30% develop pyelonephritis

Front 46

You do a what in 2 weeks and each trimester with asymptomatic bacteriuria?

Back 46

TOC - Test of cure

Front 47

What do you screen each trimester, due to a two fold increases risk of asymptomatic bacteriuria?

Back 47

Sickle cell trait

Front 48

If you have a Tx failure with asymptomatic bacteriuria what do you do?

Back 48

Repeat Tx based on sensitivities for 1 week, then prophylactic therapy for the remainder of the pregnancy.

Front 49

What is used for prophylaxis in asymptomatic bacteriuria?

Back 49

Nitrofurantoin
Ampicillin
TMP/SMX

Front 50

This is if you have 3 or more episodes of UTI in on eyear, or 2 in six months.

Back 50

Recurrent uncomplicated UTI

Front 51

What is the Tx for recurrent uncomplicated UTI?

Back 51

Bactrim DS (or septra DS) QD for 3-6 months once infection eradicated, self admin. single dose at symptom onset or one DS tab post coitus.

Front 52

How do you prevent recurrent uncomplicated UTI?

Back 52

Voiding after intercourse, good hydration, frequent and complete voiding.

Front 53

How do you Tx uncomplicated nonpregnant pyelonephritis?

Back 53

Primary - any fluoroquinolone X 7 days, ie. cipro

Alternative - Augmentin, TMP/SMX, or oral CSP (cephalosporin) for 14 days.

Front 54

How do you Tx inpatient pyelonephritis?

Back 54

Treat IV until patient is afebrile 24-48 hours, then complete 2 week course with PO medication

Front 55

What PO meds do you use for Pyelonephritis Tx?

Back 55

Ampicillin/gentamycin or ceftriaxone or piperacillin

Front 56

If no improvement on IV, consider what in pyelonephritis?

Back 56

Consider imaging studies to look for abscess or obstruction

Front 57

All of these patients with pyelonephritis get inpatient Tx, appropriate IV antibiotics Immediately.

Back 57

Pregnant patients.