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Infectious Disease EXAM 3 - UTI
Infectious Disease EXAM 3 - UTI
26
Pharmacology
Graduate
01/31/2011

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Term
uncomplicated UTI
Definition
15-45 years of age (child bearing age)
normal, healthy females
lack of structural or functional abnormalities
Term
complicated UTI
Definition
congenital abnormality
distortion of urinary tract:
obstruction - benign prostatic hypertrophy, stones or tumors, anticholinergic drugs
nerulogic defect (prevents patient from completely emptying their bladder): diabetes, stroke, spinal cord injury
can affect both genders
Term
Lower UTI = cystitis (bladder infection), urethritis (urethra), prostatitis (prostate), epididymitis (epididymis)
dysuria
urgency
frequency
suprapubic heaviness
nocturia
hematuria
discolored or cloudy urine
Definition
clinical presentation of lower UTI
Term
upper UTI = pyelonephritis (kidney)
flank pain
back pain
malaise
fever
N/V
Definition
clinical presentation of upper UTI
Term
altered mental status
change in eating habits
GI symptoms
Definition
clinical presentation of UTIs in elderly
Term
commonly will not have lower UTI symptoms
fever and flank pain
Definition
clinical presentation of UTIs from indwelling catheters or a neurologic disorder
Term
routes of infection:
ascending - urethra to bladder to kidneys
hematogenous (descending) - uncommon
lymphatic

UTIs more common in females than males b/c of anatomic differences in location and length of urethra

host defenses:
urine - inhibition and killing of microorganisms (low pH)
bladder - prevent bacterial adherence, colonization, and infection
Definition
pathophysiology of UTIs
Term
(PEKS)
Escherichia coli
Staphylococcus saprophyticus
Proteus
Klebsiella
Definition
common pathogens of Acute Uncomplicated Cystitis
Term
(EC GUNS)
Escherichia coli
Staphylococcus spp.
Chlamydia trachomatis
Neisseria gonorrhoeae
Gardenella vaginalis
Ureaplasma urealyticum
Definition
common pathogens of Symptomatic Abacteriuria
Term
(PEEKS)
Escherichia coli
Staphylococcus saprophyticus
Proteus
Klebsiella
Enterococcus faecalis
Definition
common pathogens of Asymptomatic Bacteriuria
Term
(PEKEP)
Escherichia coli
Enterococcus faecalis
Pseudomonas aeruginosa
Proteus
Klebsiella
Definition
common pathogens of Acute Pyelonephritis
Term
Pseudomonas aeruginosa
Enterococci
Definition
common pathogens of Nosocomial UTIs
Term
methods of urine collection:
midstream catch - preferred method for routine collection
catheterization - introduction of bacteria
suprapubic bladder aspiration - bypasses contaminating organisms; newborns, paraplegics, seriously ill patients

urine collection should meet specific criteria for significant bacteriuria

culture and sensitivities:
mid stream clean catch
pour plate technique - most accureate, $$ and time consuming
streak plate technique - most common, less costly

screening urine for bacteria:
DIPSTICKS - rapid screening
leukocyte esterase (LE) - found in PMNs, indicates presence of WBCs
nitrites - bacteria convert nitrates in the urine to nitrites; false negatives with Gram + or P. aeruginosa
proteinuria - found in presence of infection
pyuria - bacterial infection, presence of leukocytes
hematuria - non-specific
Definition
diagnosis of UTIs
Term
Treatment:
TMP/SMX: 3 days
OR
Levofloxacin or Ciprofloxacin: 3 days
OR
Nitrofurantoin: 7 days
OR
Beta-lactam: 3 days

Monitoring: urine cultures not routinely recommended, but is recommended if: symptoms persist during abx therapy or recur soon after therapy OR diagnosis is unclear based on medical history and physical exam
Definition
treatment, duration, and monitoring of Acute Uncomplicated Cystitis
Term
Treatment:
TMP/SMX: single dose
OR
TMP/SMX: 3 days
If STD suspected take one of the following in combination with TMP/SMX:
Azithromycin: single dose
OR
Doxycyclin: 7 days

Monitoring: if symptoms do not response or recur: obtain culture, consider treatment of concomitant STDs (Chlamydia trachomatis, Neisseria gonorrhoeae)
Definition
treatment, duration, and monitoring of Symptomatic Abacteriuria
Term
common in elderly, female, and *pregnant*
patient specific: treat pediatrics and pregnant women, don't treat non-pregnant adult females
Definition
treatment of Asymptomatic Bacteriuria
Term
Mild to moderate treatment:
TMP/SMX: 14 days (preferred)
OR
Levofloxacin: 14 days

Severe treatment:
IV fluoroquinolones
OR
Aminoglycoside +/- ampicillin
OR
Aminoglycoside +/- extended spectrum cephalosporin

Monitoring:
effective therapy should stabilize patient in 12-24 hours
reduction in urine bacteria in 48 hours
once patient is afebrile D/C IV therapy
follow up urine culture 2 weeks after completion of therapy
Definition
treatment, duration, and monitoring of Acute Pyelonephritis
Term
< 3 per year treat as separate infections
> 3 per year treat conventionally then prophylaxis for 6 months:
TMP/SMX: daily for 6 months
OR
Trimethoprim: daily for 6 months
OR
Nitrofurantoin: daily for 6 months
Definition
treatment and prophylaxis for recurrent UTIs
Term
Antipseudomonal agent (Ceftazidime, Piperacillin/Tazobactam, Aztreonam, Meropenem, Imipenem)
PLUS
Aminoglycoside
Definition
treatment of nosocomial UTI: hospitalized w/in last 6 months, urinary catheter, nursing home resident
Term
prolonged treatment = 10-14 days
follow up with culture and sensitivities at 4-6 weeks after completion of treatment
Definition
treatment of UTI in males
Term
Amoxicillin/Clavulanate: 7 days
OR
Cephalexin: 7 days
OR
Nitrofurantoin: 7 days
Definition
treatment of UTI in pregnancy: urinary stasis, reduced defenses, increased nutrients encourages bacterial growth
Term
signs and symptoms: sudden fever, chills, myalgia, localized pain, urinary symptoms
physical exam: swollen, tender, or indurated gland
labs: bacteriuria, bacteria in prostatic secretions
Definition
clinical presentation of acute prostatitis
Term
signs and symptoms: difficulty urinating, low back pain, perineal pressure
physical exam: indurated gland, enlarged gland
labs: bacteriuria, bacteria in prostatic secretions
Definition
clinical presentation of chronic prostatitis
Term
gram negative organisms:
E. coli (most common), other enterics from the GI tract (Proteus, Klebsiella)

infrequently gram positive organisms
Definition
organisms most likely to infect the prostate gland
Term
TMP/SMX: 4-6 weeks
OR
Levofloxacin or Ciprofloxacin: 4-6 weeks
Definition
treatment and duration of acute prostatitis
Term
TMP/SMX: 6-12 weeks
OR
Ciprofloxacin: 6-12 weeks
OR
Nitrofurantoin: 6-12 weeks
Definition
treatment and duration of chronic prostatitis
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