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42 Cards in this Set
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- Back
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most common bacterial infx in humans?
Avg age of occurance? |
UTI
24-64 |
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young vs old pt UTI ratio?
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young: 30:1 f:m
old: 2:1 f:m |
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differentiating between cystitis and pyelonephritis?
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cystitis: dysuria, urgency, freq
pyelo: fever, flank pain, dysuria |
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Who are your complicated UTI pts?
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men, preg, hospitalized, kids, dm, structural abnormalties
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why is it important to distiguish between complicated and uncomplicated?
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because this may effect how long you tx the pt w/ abx. You want to keep down the rate of relapse and recurrence
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causative organisms in UTIs?
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E. coli, stap saprophyticus
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Host defenses against UTI?
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urine, urea, cytokines, IgA, normal flora
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Concerns in pregnant women and UTI?
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pH changes and urine stasis can result in more UTI and possibly pyelo. This can cause premature deliveries
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Behavioral risk associated with UTI?
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bacteria can enter the bladder during intercourse. Increased intercourse = increased UTI potential. spermicide kills natural flora.
important to urinate after intercourse |
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Why is some of the population more prone to UTI?
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they do not secrete ABH blood grp antigens that bind to bacteria and prevent the from adhering.
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other pathogens of UTI?
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klebsiella, proteus (high in hospital aquired, e coli still top)
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E. coli adherence?
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Type 1 pili = cystitis
Type2 pili = pyelonephritis |
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Other virulence factrors of E. coli?
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Capsule; K antigen (better attachment, harder to eat)
LPS = endotoxin gram - aerobactin hemolysin make more iron available |
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how does staph attach to the uroepithelium?
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lactosamine residues
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virulence factors of proteus?
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fimbrae, swarming capability (instrumentation), urease breakdown (urine more alk)
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Why can staph aureus be a troublesome bug in UTIs?
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MRSA forms, perinephric and renal abscess further blocks abx. Hard to find. Pts typically have DM
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If I have alot od epithelial cells does that mean a contaminated sample?
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yes
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characteristics of pt with acute, uncomplicated bacterial cystitis?
Tx? |
dysuria, frequency, urgency
fluids but only if there are no symptoms maybe one with a little bacteria |
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UA findings consistant with cystitis?
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cloudy, alk, + nitrates, +leukocyte esterase
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who will make a UTI Complicated?
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Male, elderly, preg, recent abx use, dm, 7 days of symptoms, indwelling cath, kids, immunosuppressed
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microscopic and UA findings consistant with pyelonephritis?
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same as cystitis, +/- ketones (fever)
casts |
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When should a culture and gram stain be performed in pts with UTI?
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According to the decision rule if they have only one criteria then culture if the have more than that tx empirically
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Tx for cystitis?
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3 day course of ab. check again if asymptomatic stop tx. if symptomatic do UA and UC
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Decision rule results?
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length of symptoms not useful
dysuria, + leuko, + nitrates were associated with pos culture |
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2 suggested tx patterns for cystitis?
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culture alone for women with non - 1 ctriteria
empiric tx for women with 2+ criteria |
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two viable tx for cystitis?
What should you not tx with? |
TMP-SMX, flouroquinilones
levofloxacin, moxifloxacin |
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Antibiograms and cystitis?
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you want to use this to determine regional resistance against TMP-SMX. don't apply (3 day clin approach). Use Flouro for longer course.
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Other abx use?
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Some employ beta-lactems (amox). bactrim Better choice. But increase adverse effects, recurrence.
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What is used for 5 day course?
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nitrofurantoin
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When to opt for the 7 day tx?
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prolonged symptoms, dm, diaphragm users, if infected with staph sapro (esp for women)
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What should you do if pt is syptomatic after 3 days of tx?
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do a U/A and U/C. Neg = observe, pyuria no bacteruria = tx for chlamydia, bacteruria = tx for 14 days
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preg women with cystitis have an increased risk of?
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bacteruria, pyelonephritis
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what can you tx preg when with cystitis with?
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nitrofurantoin, amoxicillin, cephalexin
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Tx for men over 50?
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TMP-SMX, flouro. 10-14 day course. increased risk of prostatitis
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what can you do for ppl with 3 or more UTI per yr?
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Void after intercourse
Avoid diaphragms and/or spermacides Cranberry juice Tx with pre/post prophylactic ab |
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what to do with they have 4 or more UTI per year?
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Continue things previously mentioned and do anti-microbe every other night at bedtime
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Symptoms of pyelonephritis?
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dysuria, frequency, urgency, fever, anorexia, malaise, N/V, flank pain, CVA tender
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When can use oral ab for pyelo?
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mild dz: no N/V, low fever, slight increase in WBC
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tx course to avoid recurrence?
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10-14 days
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When should you hospitalize someone with pyelo?
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dx uncertain, sever illness, preg, dm, liver/heart dz, non-compliant
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Pyelo tx?
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10-14 day tx for severe. 7 day for mild. tx mild with oral flouro (augmentin for gram +). for severe: IV then can switch to oral once afebrile.
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What are the indications for an UTI workup?
Options? |
pyelo not responding, fast recurrence, anatomic site unclear.
IVP, ultrasound, CT scan |
