Term
|
Definition
15-45 years of age (child bearing age)
normal, healthy females
lack of structural or functional abnormalities |
|
|
Term
|
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
|
|
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
|
|
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 |
|
|
