Term
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Definition
-Females greater chance of getting infection than males. Because... -Longer urethra prevents bladder inoculation. -Anatomic proximity from GI tract -Antimicrobial prostate secretions -Males must have abnormality to develop UTI. (Rare in men <50 y/o) |
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Term
Physiologic Defenses against UTI's |
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Definition
-Anatomy (normal) -Mechanical voiding -Urethral and vaginal colonization with fecal flora -Urine defenses (low pH, high osmolality, high urea, uroepithelial glycoproteins) -PMNs |
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Term
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Definition
-Sexual intercourse -Recent antibiotics -Recent history of UTI -Pregnancy -Vesicoureteral reflux -Obstruction (kidney stone, BPH, tumor, strictures) -Mechanical instrumentation -Anticholinergics (TCA's, diphenhydramine, dicyclomine, oxybutinin) -Neurologic dysfunction |
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Term
Classification- based on where the infection is located |
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Definition
Upper tract infection: -Kidneys: pyelonephritis
Lower tract infection: -Bladder- cystitis -Urethra- urethritis -Prostate gland- prostatitis |
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Term
Classification- based on severity |
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Definition
Uncomplicated: -Healthy, non-pregnant female
Complicated: -Medical condition (diabetes, CKD) -Structural abnormality -Instrumentation -Functional deficit (CVA, SCI, obstruction) -Immunosuppression/hospital acquired -Pregnancy **Usually associated with MDR origanisms |
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Term
Common community aquired bacteria |
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Definition
Cystitis: -E.Coli (most common) -P. mirabilis, K. pneumoniae -S. saphrophyticus
Pyelonephritis -E. coli (almost always ~90%) |
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Term
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Definition
Microbes ascend the urethra to the bladder -Sexual intercourse -Altered flora -Impaired urine flow or incomplete voiding Fimbriae adhere to uroepithelial cells -Resist glycoproteins -No PMN fibriae recognition |
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Term
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Definition
-Hematogenous spread to kidney from another site -Spread from blood to kidney to bladder -Rare -Gram (+) organisms (usually S. aureus) |
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Term
Cystitis: Signs and symptoms |
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Definition
-Dysuria -Urgency -Pain -Frequency/burning -Suprapubic pain -Cloudy, foul smelling urine +/- hematuria |
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Term
Pyelonephritis: signs and symptoms |
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Definition
-Flank pain -N/V -Abdominal pain -Fever, chills -Malaise |
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Term
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Definition
-Midstream urine clean catch -Catheterization -Suprapubic bladder aspiration (usually only done in neonates) |
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Term
Urinalyis Interpretation for UTI |
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Definition
WBC- pyuria -non-specific -Inflammation may/may not be due to infection Leukocyte esterase -Quantifies amount of neutrophil esterase enzyme released to determine degree of pyuria Nitrite (positive or not, could be infection) -Detects gm (-) reduction of dietary NO3 -Non-reducers: Gram (+), P. aeruginosa |
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Term
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Definition
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Term
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Definition
-Gold standard for diagnosis -Males: symptoms + >/= 1,000 cfu/ml -Females: symptoms + >/= 1,000 cfu/ml
Multiple organisms may represent contamination |
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Term
Treatment: when to initiate |
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Definition
Cystitis -Positive local signs & symptoms -Urine dipstick positive LE and or nitrite or urine culture >1,000 cfu/ml (if obtained)
Pyelonephritis -Positive systemic signs & symptoms -Urine culture >10,000 cfu/ml |
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Term
When to obtain urine cultures |
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Definition
1. Negative urine dipstick despite s/sx 2. Not responding to tx 3. Suspected pyelonephritis 4. Atypical s/sx 5. Relapse despite recent tx 6. Positive pregnancy screen 7. Confirm cure following pyelonephritis |
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Term
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Definition
Use double strength BID Uncomplicated: 3 days Complicated: 10-14 days Pyelonephritis: IV/po 10-14 days
Benefits: 100% renal elim, good PO absorption Drawbacks: Pregnancy C (neural tube/kernicterus), ~30% E. coli resistance.
Hyperkalemia: increased risk if also on ACE/ARB Crystalluria and bone marrow suppression (adverse events)
Monitor: hydration, SCr, K, and CBC |
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Term
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Definition
Levofloxacin QD Cipro BID Uncomplicated: 3 days Complicated: 10-14 days Pyelonephritis: IV/po 10-14 days
Benefits: Bactericidal, good urine & prostate concentrations, pseudomonas coverage Drawbacks: QTc prolongation, promote resistance, Ca++ decrease absorption, preg C, not for S. aureus UTIs, avoid in children |
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Term
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Definition
Only for uncomplicated!: 100mg po BID x 7 days
Benefits: Bactericidal, adequate urine levels, good po absorption, pregnancy B (C in 3rd term) Drawbacks: Not good for pyelonephritis, Macrodantin QID dosing, contraindicated if <60ml/min CrCl, no proteus/pseudo coverage
Monitoring: pulmonary sx, LFTs, pain sx, educate about dark urine |
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Term
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Definition
Amoxicillin (uncomplicated only): 500 mg po TID x 7 days Amox/Clav (complicated/pyelo): 500mg po BID x 14 days Cephalexin (uncomplicated): 250-500mg po QID x 7 days Cefpodoxime (complicated): 200mg po BID x 10 days
All are preg B |
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Term
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Definition
Urinary analgesic -For dysuria due to UTI, trauma, or surgery -Inappropriate for self-care -False-negative leukocyte esterase test -Place in tx: adjunct for max 2-3 days with concurrent AB tx |
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Term
Uncomplicated cystitis: treatment |
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Definition
3 day regimen (higher cure rates for uncomplicated females) -Bactrim DS 1 po BID -Cipro 250-500mg po BID -Levaquin 250-500 po QD
7 day regimens: -Nitrofurantoin (macrobid 100mg po BID or macrodantin 50-100mg po QID) -Amoxicillin 500mg po TID or Amox/clav 500mg po BID -Cephalexin 250-500mg po QID |
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Term
Complicated Cystitis: treatment |
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Definition
-Remove obstruction/correct abnormality -Urine cultures (use to de-escalate tx) -Broad spectrum AB therapy (see pyelonephritis) -Tx for 10-14 days |
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Term
Pyelonephritis: IV treatment |
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Definition
Cipro 400mg q12h/Levo 500mg q24h Gent/tobra 3-5mg/kg (IBW) q 24h x 1-3 doses +/- ampicillin/sulbactam Ceftriaxone 1 gm q 24h or cefipime 1gm q6h Piperacillin/tazobactam 3.375gm q6-8h TMP/SMX 8-10mg/kg q12h |
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Term
Pyelonephritis: PO treatment |
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Definition
Only if there are mild symptoms
Cipro 500mg BID x 10-14 days Cefpodoxime proxetil 200mg BID x 10 days Levaquin 500mg daily x 10 days Amox/clav 500mg TID x 14 days TMP/SMX DS BID x 14 days |
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Term
Pyelonephritis: Guidelines for Tx |
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Definition
-Start empiric therapy after urine and blood cultures -IV antibiotics, at least for first dose -De-escalate tx based on sensitivities -Consider po to complete 10-14 day course -Reculture 1-2 weeks after tx completion |
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Term
Pyelonephritis: IV vs PO candidates |
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Definition
PO: -Low-grade fever -Normal or slightly elevated WBC count -No N/V
IV: -High fever, elevated WBC, sepsis -N/V, dehydration -Tract obstruction -Bacteremia -Uncomplicated cystitis progression |
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Term
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Definition
-2 consecutive voided urine specimens (women) or 1 sample (men) >100,000 cfu/ml without sx -Common in elderly, institutionalized, indwelling catheter pts -Positive urine culture alone not diagnostic for UTI
DO NOT TREAT unless pregnant or urology surgery |
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Term
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Definition
Physiologic changes in pregnancy: -Dilation of renal pelvis and ureters -Decreased ureteral peristalsis -Reduced bladder tone -Nutrient-rich urine
Result in urinary stasis and reduced defenses against reflux
If positive asymptomatic culture tx x 7 days (reculture w/in 7-14 days after tx completion + monthly until preg complete): -Cephalexin, amoxicillin, fosfomycin, +/- nitrofurantoin (not 3rd trimest)
AVOID: FQ's, Tetracyclines, TMP/SMX
Tx failure: alternative AB x 14 days |
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Term
Recurrent UTI prevention: Prophylaxis |
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Definition
Low dose AB's -Daily or QOD @ HS -Post-coital prophylaxis x 1 dose -Patient-initiate tx x 3 days
SMX/TMP or nitrofurantoin- 1st line
When to initiate?: >/= 2 symptomatic infections in 6 months >/= 3 symptomatic infections in 12 months |
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Term
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Definition
Infection of prostate gland and surrounding tissue
If occurs in men <35 y/o, STD is common cause: gonorrhea or chlamydia
Acute s/sx: high fever/chills, dysuria/myalgias, pelvic/perineal pain (treat 4 weeks) Chronic: nonspecific perineal pain >3 months (treat 6-12 weeks) |
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