Repro Elisco- Urinary Tract Infection; Nv

Front 1

Define bacteriuria

Back 1

Bacteria in urine

Front 2

Define SIgnificant urine

Back 2

WBC in urine. Sifnifican is greater than 100,000 cfu

Front 3

Define pyelonephritis

Back 3

bacterial nephriti involving renal parenchyma and collection system

Front 4

What is the difference b.w acute and chronic pyelonephritis.

Back 4

Acute: characterized by fever, cholls, flanck pain that is associated with UTI (always positve culture)
Chronic: shrunken, scarred kidney caused by prior infection with perminent changes to kidney

Front 5

What are the two types of UTI's. (Test Q)

Back 5

Complicates and Uncomplicated

Front 6

Describe uncomplicated UTI (Test Q)

Back 6

Uncomplicated: Describes infection in a patient with a structurally and functionally normal urinary tract.
–Bacterial cystitis
–Acute pylonephritis in females. (responds to Antibiotics)
–Narrow spectrum of infecting pathogens.
–Eradicated by a short course of abx.

Front 7

Describe complicated UTI (test Q)

Back 7

Complicated: Comprises infection in a patient with structural (stricture blockage) or functional impairments that reduce the efficacy of antimicrobial therapy.
–All male patients with urinary tract infections
–Multi-drug resistance
–Prolonged courses of abx.
–Require urologic evaluation and treatment
–Usually have an anatomic or functional
–Abnormality of the GU tract.

Front 8

What is the most commn cause of UTI (approx 85% of community acquires)

Back 8

E. coli

Front 9

What are some caused of hospital acquired UTI

Back 9

Ecoli - 50%
- Other Causes of hospital acquired UTI’s include Enterococcus, Klebsiella, Citrobacter, Serratia, Pseudomonas (rarely treated with one antibiotics)and Providencia.

Front 10

WHat is th emost common route od infection for an UTI

Back 10

Ascending route: fecal--> uretha --> bladder --> ureters --> parenchyma of kidney

Front 11

What are the two other route of getting a UTI?

Back 11

Two other routes of infection: 1. Hematogenous route: kidney is secondarily infected. usually associated with Staph Aureus or Candida .
2. Lymphatic route: direct extension usually from severe bowel infection or abcess

Front 12

What are the clinical manifestations of UTI.

Back 12

Signs and symptoms: Associated with fever, chills, urgency, frequency and dysuria. If upper tract infection is suspected, flank pain may be added.

Front 13

What is the key diagnostic for an UTI

Back 13

Urinary collection is key:
–Men: voided mid stream specimen.
–Women: Mid stream “clean catch” urine or urethral cath specimen after appropriate cleaning of the vaginal area.

Front 14

_____________ is found in over 90% of infections when colony count at least 100,000 cfu’s

Back 14

Microscopic bacteriuria

Front 15

_____________ is found in 40 to 60% of the time with acute cystitis.

Back 15

Microscopic hematuria

Front 16

How many cfu's do you need to have an infection

Back 16

>100,000 cfu's

Front 17

WHat is the rapid screen method to diagnose UTI?

Back 17

Rapid screen methods: Use reagent strips to test for bacteriuria and pyuria as well as the presence of nitrates and leukocyte esterase.

Front 18

When are imaging studies useful in diagnosing UTI

Back 18

Only helpful in diagnosing complicated UTI where a structural problem might exist

Front 19

What is a renal US good for and what are its limitation?

Back 19

Renal US: Very good at evaluating solid vs. cystic lesions, hydronephrosis, and the architecture of the kidneys.
–Limitation: Only provides “static” images. (Just architecture, shows nothing about function [unlike contrasted study])

Front 20

WHat is the most complete study to evaluate GU tract?

Back 20

CT scan

Front 21

WHat antibiotic is very effective in uncomplicated infections, inexpensive and minimal effects on fecal flora. Its disadvantages include skin rashes and GI complains. It is not effective against Pseudomonas and Enterococcus.

Back 21

Trimethoprim/Sulfamethoxazole aka: Bactrim or Septra.

Front 22

Which antibiotic is the drug of choice for prophylaxis regimens but is ineffective tp Proteus and Pseudomonas

Back 22

Nitrofurantoin aka: Macrodantin (excreted in urine  sterilizes urinary tract)

Front 23

What are Cephalosporins aka Kefex, Ceftin, Rocephin all three generations, good for?

Back 23

-As a group very good against Enterbacter and very poor against enterococci.
–First generation good against gm+ bacteria.
–Second generation good against anaerobes.
–Third generation good against gm- bacteria and nosocomial infections

Front 24

What are Aminoglycosides aka gentamycin, tobramycin and vancomycin useful for?

Back 24

–Gentamycin and tobramycin only effective on gm- bacteria.
–Vancomycin only effective on gm+ bacteria. Drug of choice against MRSA.
oUseful in patients with penicillin allergies
oDisadvantages include nephrotoxicity, and no oral route. Must be given IV

Front 25

What is the DOC for pseudomonas infection

Back 25

Floroquinolones aka ciprofloxicin and levofloxicin.

Front 26

What two organisms are the cause if resistant UTI's

Back 26

MRSA and VRE (exclusively nosocomial)

Front 27

Define acute pyelonephritis

Back 27

Acute pyelonephritis: Clinical syndrome ranging from cystitis, fever and flank pain to florid gram-negative sepsis.

Front 28

What is the classic traid for acute pyelonephritis

Back 28

fever, chills and flank pain

Front 29

What is the most common organism to cause acute pyelonephritis

Back 29

E.coli

Front 30

Wothin how many days should you treat an acute vs chronic pyelonephritis.

Back 30

Acute: 10-14 days
Chronic: up to 21 days

Front 31

What is the dru of choice to txt acute pyelonephritis?

Back 31

ampicillin/gentamycin or quinolones

Front 32

Renal abscess are confined to what area?

Back 32

to the renal parenchyma

Front 33

What are the most common cause of Renal abscess?

Back 33

Usually gram - rods from ascending infection
•Most common causes are distal obstruction of the collecting system, urinary stasis, pregnancy, and diabetes mellitus. (underlying problems)

Front 34

Perirenal abscess are confined to what area?

Back 34

to the Gerota's fascia

Front 35

What are the most common cause of Renal abscess?

Back 35

•Usually arise from hematogenous seeding or from renal extension.
•most common organisms are E-coli and Proteus (important bacteria of stones).

Front 36

What is the treatment for renal and perirenal abscess

Back 36

• Aggressive antibiotic therapy based on the cultures.
• Relieve distal obstruction. (need to drain to prevent further infection)
• Percutaneous drainage in particular with perirenal abscesses.