UTIs

Question 1

what are 2 main consequences of UTI

Answer 1

1. underTx
   - many will develop pyelonphritis
2. over tX
   - ABx resistance
   - UTI most common reason for flouroquinolne Tx

Question 2

3 steps of UTI patho

Answer 2

1. bacterial virulence factors
   - fimbriae
   - adehsins
2. ascending spread
   - E. coli
   - other enterobact.
3. hematogenous spread
   - S. aureus
   - candida

Question 3

2 outcomes of asymptomatic bacteruria

Answer 3

1. resolution

2. acute cystitis

Question 4

2 outcomes of acute cystitis

Answer 4

1. resolution

2. pyelo

Question 5

4 protective factors

Answer 5

1. innate immunity (TLR -4)
2. high urinary area and low Ph
3. urinary tract epithelium derived protein factor
4. urinary flow and micturation

Question 6

def. asymtomatic bacteruria

Answer 6

1. voided urinary sample with same species present above 10E5
   - women 2 consecutive samples, men 1
   - in cath - only 10E2
   common in women

Question 7

most common bact.

Answer 7

• E. coli
• Klebsiella pneumonia
• other enterobact.
• coag neg. staph
• group B strep

Question 8

what are consequences in non-pregnant women

Answer 8

• more likely to dev. symptomatic UTI

- ABx reduced at 6 month, but not year

Question 9

what are consequences in women with diabetes

Answer 9

• no increase in UTI

- no beneft for ABx

Question 10

take home about non-symptomatic

Answer 10

• can have bacteria, but without Sx, there is not an issue

Question 11

when is screening of benefit

Answer 11

only when it prevents adverse outcome

• preggers
• before URO procedures

Question 12

2 risks in pregnant

Answer 12

1. 20-30x pyeloneph
2. increased with of premature
   both decreases with ABx Tx

Question 13

what is risk in people undergoing TURP

Answer 13

• 60% become bacteremic

- ABx the night before lowers risk

Question 14

what is uncomplicated cystitis

Answer 14

• infection of bladder
• dysuria, freq, urgency
• bacteruria
• +ve leukocyte esterases, nitrites

Question 15

3 principles for uncomp. cystitis

Answer 15

1. narrow spectrum
2. short course
3. proven efficacy

Question 16

2 Tx reccomendations

Answer 16

1. nitrofuratoin
   or
2. trimethoprim/sulfa

Question 17

what are 3 reccomendations for reccurent acute uncomp. UTIs

Answer 17

1. behavioral mods
2. AB prophylaxis
   >3/year
   > confirmed by culture
   - post-coital or bedtime dose
3. self-diagnosis and Tx

Question 18

what makes pyelo uncomp. and comp.

Answer 18

uncomp
- healthy, pre-meno, non-preg
comp.
- perinephric abscess
- emphysematous pyelo
- papillary necrosis

Question 19

what is Sx of pyelo

Answer 19

• flank pain
• N/V
• fever
• CVA tenderness
• sepsis possible

Question 20

what is ABx outpatient therapy

Answer 20

• low fever, no dehydration
• fluroquinolone
• trimethoprim sulfa

Question 21

what is in-patient therapy (4)

Answer 21

IV then switch to oral - all need 14 days

1. flouro
2. amplicillin+gentamicin
3. 3rd gen ceph
4. B-lactam

Question 22

what are cath assoc. UTIs

Answer 22

• indwelling cath
• Sx of UTI
• no other source of infection
• > 10E3 cfu

Question 23

Sx of cath. UTI

Answer 23

• fever, rigors
• flank pain, CVA tenderness
• urgency freq, suprapubic pain
• if SCI - spacticity, auto dysreflexia

Question 24

3 princincples of cath. prevention

Answer 24

1. only place when needed
2. discontinue ASAP
3. consider automatic D/C times and MD reminders

Question 25

4 Tx reccomnedations for caths

Answer 25

1. culture urine before ABs 2. change cath in 2 weeks 3. Tx based on culture 4. 7 days if prompt response, 10-14 otherwise