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66 Cards in this Set
- Front
- Back
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which is sterile
bladder and up bladder and down |
bladder and up= sterile
bladder and down= not sterile |
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when are uti more common in males
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-infancy
- age > 65 yo |
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when are uti more common in females
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preschool to age 65
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cystitis occus where
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limited to bladder and lower tract only
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Pyelonephritis:occurs where
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involvement of kidney(s) and upper tract
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def prostatitis
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Prostatitis: prostate infection
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uncomplicated uti
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- Normal GU tract with no prior instrumentation
- Not pregnant - No hx of recurrent UTI |
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complicated uti
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- Children
- Structural/functional abnormalities (pregnancy, obstruction) - Instrumentation - History of recurrent UTI - Males |
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3 proposed routes of infection
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-ascending
-lymphatic -hematogenous -reflux and sexual intercourse ( in prostatitis) |
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explain the ascending route of infxn
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- Bacteria are forced into bladder up through urethra
- Most likely d/t sexual intercourse or instrumentation - Gram negative enterics most common |
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what bac is usually involved in the ascending path
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gram -
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hematogenous route of infxn explaination
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Bacteremia or blood-borne pathogens deposit into kidney causing pyelonephritis
- Staphylococcus common, possibly Candida -- Gram negative bacilli rarely involved |
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Most important factor in causing infection
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-adherence/adhesive properties of bacteria
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bacterial virulence factors
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-Adherence/adhesive properties
- Most important factor in causing infection - Resistance to antibiotics - Presence of aerobactin - Helps sequester iron - Iron starvation needs to be overcome for bacteria to proliferate |
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what is aerobactin
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- Helps sequester iron
- Iron starvation needs to be overcome for bacteria to proliferate |
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host defenses vs uti
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-urine
-prostatic fluid -bladder flushing |
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predisposing factors for uti
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- pregnancy: physilogic alterations
-diabetes - inc age -structural abnormalities -obstruction (kidney stones) - instrumentation ( indwelling catheters) -sexual intercourse - previous uti episodes - neurogenic bladder |
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clinical presentation of cystitis
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- Dysuria, frequency, & urgency
- Possibly suprapubic tenderness & hematuria |
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clinical presentation of Pyelonephritis
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- Flank pain and/or tenderness with fever
- Also known as costovertebral angle (CVA) tenderness - Often with cystitis symptoms as well |
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clinical presentation of Asymptomatic Bacteriuria
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- Mostly seen in women & elderly
- Confirm Significant Bacteriuria by > 105 CFU/ml on 2 occasions 24 h apart - Therapy is indicated for select groups: Children Pregnant patients Presence of urologic obstruction |
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what groups do you have to treat for asymptomatic bacteriuria
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Children
Pregnant patients Presence of urologic obstruction |
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what are the 2 types of prostatitis
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-acute
-chronic |
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explain the clinical presentation of acute prostatitis
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- High fever with chills
- Perineal & back pain - Signs similar to cystitis - Prostate extremely tender & swollen |
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explain the clinical presentation of chronic prostatitis
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-May be asymptomatic
- Perineal discomfort, low back pain, dysuria - Most common cause of relapsing UTI in men - Acute episodes do not lead to chronic |
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urinalysis for uti will have presense of
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- nitrite
- leukocyte esterase |
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normal urinalysis will show
-clarity -protein -blood -nitrite -leukocyte esterase -wbc -bacterial count |
-clarity= clear
-protein= - -blood=- -nitrite= - -leukocyte esterase=- -wbc= 0-5 cells/mm3 -bacterial count= < 10 to the 5 bacteria / ml |
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abnormal urinalysis will show
-clarity -protein -blood -nitrite -leukocyte esterase -wbc -bacterial count |
normal urinalysis will show
-clarity= hazy/cloudy -protein= +/- -blood = +/- -nitrite = +/- -leukocyte esterase= trace to large -wbc= > 5-10 cells/mm -bacterial count= moderate to many > 10 to the 5 |
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do you treat asymptomatic pts with uti
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no, unless they are pregnant
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what level of bacteriuria will you always tx
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> 10 to the 5
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etiologic agents for community
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-ecoli= #1 cause
- staph saphrophyticus = 5-15% - entercoccus, klebsiella, p. mirabilis |
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etiologic agents for nosocomial
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- Escherichia coli: 75-90%
- Staphylococcus saphrophyticus: 5-15% - Enterococcus, Klebsiella, P. mirabilis - Rest of all episodes nosocomial - “community” pathogens PLUS -Pseudomonas aeruginosa - Enterobacter - S. aureus - inc in Proteus, Klebsiella, & Enterococcus know peck + enterbac + community pathogens |
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etiologic agents for prostatitis in acute
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Acute
- Gram-negative enterics - Neisseria gonorrhea now rarely the cause chronic - E. coli 80% - Klebsiella, P. mirabilis, Enterobacter & Enterococcus also common - Staphylococcus (both coag +/-) common in some |
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duration of therapy for
uncomplicated cystitis |
3 day course
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duration of therapy for
cystitis-complicated |
7-14days
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duration of therapy for
pyelonephritis |
14days
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duration of therapy for
asymptomatic bacteriuria |
children= 7-14days
pregnancy= 3-7 days |
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cystitis 1st line txs
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-bactrim ds bid x 3 days
- 1st infection, minimal ABX exposure, low R (<10%) - Single-dose therapy less efficacious - Longer therapy not shown to be more efficacious or nit macrocrystals 50-100 mg qid x 7-10 d nit monohydrate 100 mg bid x 7-10d - for younger females -sexual intercourse related - gram + suspected |
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cystitis 2nd line txs
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-Ciprofloxacin 250 mg BID -Levofloxacin 250 mg daily
- Concern for increasing Gram-negative resistance or tmp 100 mg bid -sulfa allergy |
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confirmatin of pyelonephritis
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Need UA, Gram stain, urine & blood cultures
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Pyelonephritis 1st line
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-3rd gen cephs iv
-cefotaxin -ceftriaxone - Mild cases can use PO (TMP/SMX or FQs) - Moderate to severe = hospitalization and IV; switch to PO once patient is stable |
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2nd line for pyelonephritis
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tmp/smx
cipro 400 mg iv bid levo 500 mg iv daily |
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cystitis in pregnancy when should you treat
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- ALL pregnant women with bacteriuria should be treated
- Even if asymptomatic, risk of pyelonephritis & premature delivery |
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cystitis in pregnancy 1st line for asymptomatic bacteriria/cystitis
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NIT 50-100 mg QID
NIT 100 mg BID (Macrobid) x 7-10 days |
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cystitis in pregnancy 2nd line for asymptomatic bacteriria/cystitis
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TMP/SMX DS BID =- Avoid in 3 trimester (and first?)
TMP 100 mg BID or TMP 200 mg daily =Avoid in 1st trimester |
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cystitis in pregnancy can you use fq or tetracyclines
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no
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tx for acute pyelonephritis in pregancy
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- IV, then PO to complete 14 day course if uncomplicated (no abscess)
- Follow-up urine cultures within 1-2 wks of completion of therapy and monthly for remainder of gestation |
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def treatment failure
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-no improvement 48-72 hrs after start of therapy
=> obtain culture & treat for 2 weeks - didnt get right abx on board --> chose another abx --> tx longer |
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def treatment relapse
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-infection 1-2 wks after therapy
- Same microorganism has persisted - Suggests upper tract involvement/GU abnormalities (i.e. renal calculi) or chronic bacterial prostatitis =>Obtain CX, look for source (obstruction) & treat for 4 – 6 weeks -treat more aggressively |
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def re infection
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>1 month after therapy
- Usually different microorganism but may also be the same -Treat like new infection |
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when do you prophylaxis for uti
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- 2 symptomatic infxns in 6 months OR
- 3 symptomatic infxns in 12 months - Clear relation between sexual intercourse and subsequent infection Acute infxns must be cured before starting prophylaxis An alternative to prophylaxis is intermittent self-treatment |
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what are the different types of dosing in recurrent uti prophylaxis
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- continuous
-post-coital -intermittent self dose |
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continous dosing for Recurrent UTI Prophylaxis
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TMP/SMX SS 1⁄2 tab Qhs or TIW
NIT 50-100 mg Qhs |
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post coital dosing for Recurrent UTI Prophylaxis
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TMP/SMX SS 1⁄2 - 1 tab
NIT 50-100 mg fluoroquinolones (last line) |
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intermittent self dosing for Recurrent UTI Prophylaxis
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Self-dose - Dosing same as acute infection - Only for those who can accurately diagnose
- Counsel pt to seek medical attention when symptoms don’t resolve within 48-72 hrs after initiating course |
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Recurrent UTI in Pregnancy
Postcoital single oral dose: |
- cephalexin 250mg
- nitrofurantoin macrocrystals 50mg |
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non specific agents for uti
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-methanamine
-phenazopyridine |
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what is methanamine
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Methenamine – protein denaturing agent (broad spectrum)
- Works at acidic pH only; hydrolyzes to formaldehyde - NOT for established UTI, pyelonephritis, presence of indwelling bladder catheter - May be helpful in prophylaxis - AVOID in hepatic or renal failure, gout, concurrent sulfonamides |
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what is phenazopyridine
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- urinary analgesic
- Used for urinary pain relief only - Relief of pain more responsive to appropriate antimicrobial treatment and analgesics (i.e. acetaminophen) |
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non pharm managment of uti
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-cranberry
- postcoital voiding -frequent voiding -adequate hydration |
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what does cranberry juice do
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Canberry
- Proanthocyanidins appear to inhibit bacterial attachment to uroepithelium - May reduce risk of recurrence by 12-20% 200-750 mL daily OR Cranberry-concentrate tabs daily (amt varies by product) |
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acute PROSTATITIS ANTIMICROBIAL SELECTION
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-3 generation CEPH + Aminoglycoside
-in acute, inflammed prostate allows good penetration of most abx -Fluoroquinolones (PO) - Less severe cases |
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Prostatitis Treatment Duration
-Acute |
- 14 days normally
- 10 days: less severe cases where pts started on PO abx |
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Prostatitis Treatment Duration
-Chronic |
- Difficult to cure
- Rx for 1 - 3 or more months |
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fungal uti usually occurs in what setting
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nosocomial infxn
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fungal uti risk factors include
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- Antibacterial therapy
- Indwelling catheters - Urologic procedures - Female sex - Diabetes - Immunosuppressive therapy |
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fungal uti tx
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Often requires antifungal treatment if symptomatic
- PO Fluconazole 100mg q24h x 7 – 14 d or - Ampho B bladder wash 50mg/L sterile water intermittent (q6h) or continuous irrigation |
