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36 Cards in this Set

  • Front
  • Back
Define bacteriuria
Bacteria in urine
Define SIgnificant urine
WBC in urine. Sifnifican is greater than 100,000 cfu
Define pyelonephritis
bacterial nephriti involving renal parenchyma and collection system
What is the difference b.w acute and chronic pyelonephritis.
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
What are the two types of UTI's. (Test Q)
Complicates and Uncomplicated
Describe uncomplicated UTI (Test Q)
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.
Describe complicated UTI (test Q)
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.
What is the most commn cause of UTI (approx 85% of community acquires)
E. coli
What are some caused of hospital acquired UTI
Ecoli - 50%
- Other Causes of hospital acquired UTI’s include Enterococcus, Klebsiella, Citrobacter, Serratia, Pseudomonas (rarely treated with one antibiotics)and Providencia.
WHat is th emost common route od infection for an UTI
Ascending route: fecal--> uretha --> bladder --> ureters --> parenchyma of kidney
What are the two other route of getting a UTI?
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
What are the clinical manifestations of UTI.
Signs and symptoms: Associated with fever, chills, urgency, frequency and dysuria. If upper tract infection is suspected, flank pain may be added.
What is the key diagnostic for an UTI
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.
_____________ is found in over 90% of infections when colony count at least 100,000 cfu’s
Microscopic bacteriuria
_____________ is found in 40 to 60% of the time with acute cystitis.
Microscopic hematuria
How many cfu's do you need to have an infection
>100,000 cfu's
WHat is the rapid screen method to diagnose UTI?
Rapid screen methods: Use reagent strips to test for bacteriuria and pyuria as well as the presence of nitrates and leukocyte esterase.
When are imaging studies useful in diagnosing UTI
Only helpful in diagnosing complicated UTI where a structural problem might exist
What is a renal US good for and what are its limitation?
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])
WHat is the most complete study to evaluate GU tract?
CT scan
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.
Trimethoprim/Sulfamethoxazole aka: Bactrim or Septra.
Which antibiotic is the drug of choice for prophylaxis regimens but is ineffective tp Proteus and Pseudomonas
Nitrofurantoin aka: Macrodantin (excreted in urine  sterilizes urinary tract)
What are Cephalosporins aka Kefex, Ceftin, Rocephin all three generations, good for?
-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
What are Aminoglycosides aka gentamycin, tobramycin and vancomycin useful for?
–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
What is the DOC for pseudomonas infection
Floroquinolones aka ciprofloxicin and levofloxicin.
What two organisms are the cause if resistant UTI's
MRSA and VRE (exclusively nosocomial)
Define acute pyelonephritis
Acute pyelonephritis: Clinical syndrome ranging from cystitis, fever and flank pain to florid gram-negative sepsis.
What is the classic traid for acute pyelonephritis
fever, chills and flank pain
What is the most common organism to cause acute pyelonephritis
Wothin how many days should you treat an acute vs chronic pyelonephritis.
Acute: 10-14 days
Chronic: up to 21 days
What is the dru of choice to txt acute pyelonephritis?
ampicillin/gentamycin or quinolones
Renal abscess are confined to what area?
to the renal parenchyma
What are the most common cause of Renal abscess?
Usually gram - rods from ascending infection
•Most common causes are distal obstruction of the collecting system, urinary stasis, pregnancy, and diabetes mellitus. (underlying problems)
Perirenal abscess are confined to what area?
to the Gerota's fascia
What are the most common cause of Renal abscess?
•Usually arise from hematogenous seeding or from renal extension.
•most common organisms are E-coli and Proteus (important bacteria of stones).
What is the treatment for renal and perirenal abscess
• Aggressive antibiotic therapy based on the cultures.
• Relieve distal obstruction. (need to drain to prevent further infection)
• Percutaneous drainage in particular with perirenal abscesses.