Term
| What are the host defenses against UTIs? |
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Definition
1.Normal flora- lactobacilli
2.Urine- antibacterial; antiadherance; physical voiding
3.Urothelium- mucin secreted by umbrella cells |
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Term
| Describe modes of infection for UTIs. |
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Definition
1.GI flora
2.Ascending pathogens
3.Binding to mannose residues; fimbriae; correlates with virulence and disease severity
4.bladder infections spread quickly |
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Term
| Factors that predispose people to have UTIs? |
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Definition
1.Age
2.Increased organism entry
3.Incomplete bladder emptying
4.Change in flora(menopause, spermicides)
5.Impaired immune function(DM, immunosuppression) |
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Term
| Incomplete bladder emptying happens because of 3 reasons. What are the reasons and describes ways they occur. |
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Definition
1.Obstruction: prego, kidney stones, prostate enlarged, renal calculi, etc
2.Neurologic: stroke, DM, spinal injury
3.Anticholinergic Drugs |
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Term
| What symptoms characterize upper vs lower UTI? What are the more scientific names for these? |
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Definition
Upper(pyelonephritis)-fever, epigastric pain
Lower(cystitis)-frequency, urgency |
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Term
| When is a UTI considered complicated? |
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Definition
1.structural/fxnl abnormalities
2.DM
3.prego
4.immunosuppression
5.catheter/instrumentation
6.children
7.>65yo
8.males |
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Term
| Common Pathogens of UTIs? |
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Definition
1.E.Coli(G-)
2.Staph saprophyticus(G+)
3.Other G-(Proteus, Klebsiella, Pseudomonas, Enterobacter)
4.Enterococci(G+)
**Elderly have more G-
**Younger normally have S.saprophyticus |
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Term
| Lower(cystitis) UTI presentation |
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Definition
dysuria(freq urination)
strangury(painful urine)
urgency
hematuria
suprpubic pain uncommon
no vag discharge
fever uncommon |
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Term
| Upper(pyelonephritis) UTI presentation |
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Definition
*bladder/kidney infection
*fever, chills, flank pain, tender, NV, costo-vertebral angle
*may or may not also have lower UTI sx too |
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Term
| What kind of sx will older patients with UTIs present with? |
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Definition
altered mental status
urinary incontinence |
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Term
| UTI diagnostic tests? How many of each kind do you need to diagnose? |
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Definition
Sensitive Tests:
*Pyuria(leukocyte esterase and/or WBC>10
*>5 RBCs
Specific Tests:
*Nitrite
*Bacteria
**Need at least one specific and one sensitive to diagnose! |
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Term
| What is the supportive care for UTI treatment? |
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Definition
1.fluid hydration
2.urinary analgesics(debated though, bc this could mask treatment failure) |
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Term
| Empiric Therapy for Uncomplicated Lower UTIs? |
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Definition
1st Line
*Bactrim 3d BID - C
*Nitrofurantoin 5d BID - B (ineffective against Proteus; avoid in G6PDH defic; NOT in CrCl<50
*TMP if Sulfa allergy 3d BID - C
2nd Line
*FQs (Cipro, Levo, Nor 3d BID - C)
Other(these less effective)
*fosfomycin - single dose
*BL - 7d |
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Term
| Empiric Therapy for Complicated Lower UTI? |
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Definition
*FQs first line
*Bactrim second line
*Duration 7-10 days
*May add Aminoglycoside if need to cover G-(Pseudomonas)-7days |
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Term
| Empiric Therapy for Upper UTI? |
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Definition
*FQ first line
*Bactrim second line
*Add Amoxicillin or similar BL to cover G+(Enterococci) with or without BLI
*Duration 7-14 days
*May add Aminoglycoside if need to cover G-(Pseudomonas)-7days |
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Term
| What are the Common G+ coverage used in UTIs? |
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Definition
Amoxicillin (+/- BLI)
Ampicillin +/- BLI
Ceftriaxone
Cefotaxime
Aztreonam
*All duration 10-14 days
*caution BL in upper UTI |
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Term
| What is the duration of treatment for UTIs in males? |
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Definition
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Term
| What are the two classifications of prostatitis in males and characteristics of these? |
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Definition
1.Acute: sudden fever, suprapubic pain, tenderness, sacral/perineal pain
Tx for 4 weeks
2.Chronic: fever, less sever sx; difficulty urinating, low back pain, perineal pressure
Tx for 6 weeks |
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Term
| What are the male choice of antibiotics? |
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Definition
1st line- FQs
2nd line- Bactrim |
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Term
| Which FQ is not used in any of the UTI groups? |
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Definition
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Term
| What are the only reasons we would treat asymptomatic bacteriuria? |
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Definition
*pregnancy
*invasive urologic procedures |
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Term
| What are the treatments for UTIs in pregnancy? |
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Definition
Nitrofurantoin, cephs, fosfomycin
*sulfonamides in 1st and 2nd trimester only
*avoid TMP in 1st trimester
*avoid TCs and FQs! |
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