Urinary Tract Infections

Front 1

difference between an uncomplicated and complicated uti

Back 1

uncomplicated=person with a functionally and anatomically normal urinary tract
Complicated UTI = any distortion of the normal physiology or anatomy

Front 2

Causative agents of UTI
1) Uncomplicated:

2) Complicated:

Back 2

1) E. coli – 80%
Others 20%
2) Gram negative enterobacteriaceae, Klebsiella, pseudomonas – 80%
E. coli 20%

Front 3

Groups at a higher risk for adverse outcome

Back 3

-infants and young children
-pregnant women
-comprised adults(diabetes, immunosuppressed, spinal cord patients

Front 4

Bacterial virulence factors(4)

Back 4

1) Adherence = most important factor
2) Toxins ( Hemolysins acquire iron to feed bacteria in iron-poor environment)
3) Capsule – evades host immune response
4) Urease production – precipitate formation of struvite stones

Front 5

Microscopic exam of the urine, describe findings in the following:
1) Pyuria
2) Hematuria
3) bacteriuria
4) squamous epithelial cells

Back 5

1)present in most cases of UTI
2)present in only 50%, but very specific
3) specific for UTI but not sensitive
4) contamination

Front 6

How do voiding symptoms differ between cystitis, urethritis, vaginitis?

Back 6

cystitis: abrupt, severe, multiple symptoms with increased urgency

urethritis: mild, gradual onset

vaginitis: burning of external genitalia not of urinary tract, no increased frequency or urgency

Front 7

How do other symptoms not related to uriary tract differ between cystitis, urethritis, vaginitis?

Back 7

cystitis: suprapubic/low back pain; hematuria

Urethritis: vaginal discharge or bleeding; lower abdominal pain

Vaginitis: vaginal discharge, odor, itching; pain on intercourse

Front 8

Diagnostic criteria for significant bacteriuria (3)

Back 8

1) If grow any amount of a significant uropathogen
2) Have to grow higher amounts of atypical bacteria (to rule out contamination)
3) Also have to grow high amounts in man or asymptomatic woman

Front 9

Indications of pretreatment cultures for UTI (4)

Back 9

1) Atypical symptoms
2) Pyuria can't be documented
3) Presence of risk factors for occult upper tract infection or compliccated UTI
4) Clinical features of pyelonephritis

Front 10

How does a lack of response to short course therapy for UTI used to localize illness?

Back 10

lack of response suggests upper tract infection

Front 11

antibiotics for acute cystitis (3)

Back 11

1) Trimethoprim/sulfamethoxazole (TMP/SMX, bactrim and septra) is the drug of choice
2) Fluoroquinolones (cipro) work well too, especially if resistant to TMP/SMX
3) Trimethoprim alone
o Nitrofurantoin good for use in pregnancy

Front 12

Duration of antibiotic therapy for UTI

Back 12

-3 days – uncomplicated cystitis with no risk factors for occult pyelonephritis
-7 days – those with risk factors (or if using something other than TMP/SMX or cipro)
-14 days – for men, because often have prostatitis as well

Front 13

Acute uncomplicated pyelonephritis in women:
1) most likely bug
2) most common sign
3) effective treatment time

Back 13

1) E.coli
2) pyuria
3) 2 weeks is as effective as 6 weeks

Front 14

Antibiotic therapy for pyelonephritis

Back 14

Don’t use bactrim unless you know it’s susceptible! Because the consequences of treatment failure (with resistance) are serious
1) Fluoroquinolones
2) Aminoglycosides (gentamicin)
3) Broad-spectrum cephalosporins (ceftriaxone)
4) Add ampicillin or vancomycin if gram-positive infection suspected

Front 15

Acute uncomplicated pyelonephritis in women:
1) when do you take urine cultures
2) image if

Back 15

1) urine cultures before and 1-2 weeks after completion of therapy
2) -Fever and pain > 72 hours
-More than 1 episode
-Atypical features suggesting anatomical abnormality

Front 16

atypical bacteriuria indications for treatment

Back 16

Neonates/young kids
Pregnant women
Anticipated instrumentation of urinary tract