Term
|
Definition
| most common, #1 cause of UTIs & prostatitis |
|
|
Term
|
Definition
| >10 leukocytes/mm^3 in the urine |
|
|
Term
|
Definition
| >= 10^5 bacteria/ml (cfu/ml) in urine |
|
|
Term
|
Definition
| pyuria + bacteriuria + symptoms |
|
|
Term
|
Definition
| infection/inflammation of bladder |
|
|
Term
|
Definition
| infection/inflammation of ureters &/or kidneys |
|
|
Term
|
Definition
| infection/inflammation of urethra |
|
|
Term
|
Definition
| most common route for bacterial UTI |
|
|
Term
| Natural Defenses against UTIs |
|
Definition
low pH of urine;
high urea concentration;
high organic acid concentration;
prostate secretion in males;
Lactobacillus in females (produce lactic acid);
increased diuresis/micturition;
glycosaminoglycan layer;
inflammatory response |
|
|
Term
|
Definition
| hair-like appendages that help E.coli adhere to urinary tract epithelial cells; |
|
|
Term
|
Definition
| cytotoxic protein lyses cells including RBCs (fairly uncommon --> hemorrhagic cystitis) |
|
|
Term
| Risk Factors for Women & UTI |
|
Definition
sexual intercourse;
use of diaphragms;
lack of urination after sexual intercourse;
recurrent UTIs;
diabetic women |
|
|
Term
|
Definition
age --> prostate;
lack of circumcision;
anal intercourse |
|
|
Term
|
Definition
| <2 wks from initial UTI w/ new UTI |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
treat systemic manifestations;
eradicate organisms;
prevent recurrence;
resolve symptoms; |
|
|
Term
| Principles of Antibiotic Tx of UTIs |
|
Definition
Antimicrobial NEEDs to concentrate in urine;
Treat ONLY if symptomatic;
EXCEPTIONS:
- Children --> if not tx, renal scarring & damage, ALWAYS tx;
- Pregnancy --> if not tx, causes prematurity, low birth weight, stillbirth;
- Urologic procedure is planned that is expected to cause mucosal bleeding; |
|
|
Term
| Tx for Uncomplicated bacterial cystitis in young adult, non-pregnant women |
|
Definition
3 day course preferred:
- TMP/SMX: 1 DS tab BID x 3 days
- Fluoroquinolones: Ciprofloxacin 250 mg BID x 3 days, Levofloxacin 250 mg daily x 3 days, Norfloxacin 400 mg BID x 3 days;
- Nitrofurantoin 100 mg q6 hrs x 7 days (if allergic/ADRs to TMP/SMX or FQ's) |
|
|
Term
| Tx of Complicated UTIs - Mild/Moderate Pyelonephritis |
|
Definition
Tx if low grade temp, stable vital signs;
May use outpatient treatment;
Treat with:
- TMP/SMX 1 DS tab BID x 7-10 days;
- Norfloxacin 400 mg BID x 7-10 days;
- Ciprofloxacin 250-500 mg BID x 7-10 days;
- Levofloxacin 250 mg once daily x 7-10 days;
- amoxicillin-clavulanate 500 mg q8 hrs x 7-10 days |
|
|
Term
| Tx of Severe complicated UTI - Pyelonephritis |
|
Definition
Pt presents w/ high-grade fever (>100.9), vomiting, diarrhea, tachycardia, elevated/suppressed WBC, tachypnea;
REquires hospitalization & initial IV antibiotics:
- IV fluoroquinolones (cipro & levofloxacin);
- aminoglycoside + ampicillin (use only if Enterococcus is suspected)
- extended spectrum IV cephalosporin +/- aminoglycoside |
|
|
Term
| Tx for Men w/ Complicated UTIs |
|
Definition
1) fluoroquinolone x 10-14 days;
2) TMP/SMX x 10-14 days
- if young, consider 7 day course
- Nitrofurantoin NOT typically used |
|
|
Term
| Tx of Catheter-Associated UTI |
|
Definition
If prompt resolution: 7 day therapy;
If delayed response: 10-14 day therapy;
If not severely ill: use 5-day course of levofloxacin; |
|
|
Term
| Tx of Recurrent Infections |
|
Definition
Self-administered therapy (refills on Rx);
Post-coital: TMP/SMX x 1 dose;
Low-Dose Prophylaxis: TMP/SMX, fluoroquinolones, nitrofurantoin;
Relapse: add 14 days of therapy until 6 wks of antibiotic given --> advise urologic exam --> prostatitis (if male) |
|
|
Term
|
Definition
Screened at baseline & 28 wks;
Tx: amoxicillin/clavulanate OR cephalosporin x 3-7 days
AVOID: tetracyclines, fluoroquinolones, 3rd trimester only - TMP/SMX |
|
|
Term
|
Definition
interferes w/ adherence of pathogens to epithelial cells in UT;
- DO NOT recommend (not enough evidence) for prophylaxis |
|
|
Term
|
Definition
urinary analgesic;
can cause false positive nitrite
- very uncommon, long-term use NOT recommended |
|
|
Term
| Monitoring Parameters for UTIs |
|
Definition
Symptoms;
No need to repeat culture to ensure eradication;
Temp/WBC;
If vomiting, BMP & fluid status |
|
|
Term
|
Definition
| inflammation of prostate gland |
|
|
Term
| Risk Factors for Prostatitis |
|
Definition
male;
sexual intercourse;
catheterization, urethral instrumentation, transurethral prostatectomy |
|
|
Term
|
Definition
| bacteria AND inflammatory cells MUST be present in prostatic secretions & urine |
|
|
Term
| Clinical Presentation of Acute Prostatitis |
|
Definition
| sudden onset fevers/chills, malaise, pain/tenderness (rectal/perineal), urinary symptoms (frequency/urgency/dysuria), swollen, tense, tender prostate gland; |
|
|
Term
| Clinical Presentation of Chronic Prostatitis |
|
Definition
difficulty urinating;
lumbago;
perineal pressure;
boggy (edematous), enlarged prostate |
|
|
Term
|
Definition
diagnostic procedure that is C/I in acute bacterial prostatitis;
- if prostate sample has 10x # of bacteria as bladder sample, bacterial prostatitis is the cause |
|
|
Term
| Pharmacology for Tx of Prostatitis |
|
Definition
1) Fluoroquinolones;
2) TMP +/- SMX;
- treate for 4-6 weeks --> to reach difficult-to-reach bacteria deep with in gland |
|
|
Term
| Suppressive Therapy for Prostatitis |
|
Definition
If recurrent infections DESPITE 4-6 wk course;
- Ciprofloxacin 500 mg PO 3x/week;
- TMP/SMX SS 1 tab PO daily;
- nitrofurantoin 100 mg PO daily |
|
|
Term
| Monitoring Parameters for Prostatitis |
|
Definition
Fever & dysuria should abate 2-6 days after antimicrobial therapy;
Optional urine count at 7 days predicts successful tx after 4-6 wks |
|
|
