Term
| what is the most common site of bacterial infection in humans of all ages? |
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Definition
| the UT and sexually active women are at the highest risk. |
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Term
| what pathogen causes most (uncomplicated) UTIs? |
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Definition
| e. coli and other aerobic gram negative rods. |
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Term
| can community acquired UTIs be antibx-resistant? |
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Definition
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Term
| what characterizes most first UTIs? |
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Definition
| the first infection is usually community acquired w/o structural/functional abnormalities and in a sexually active female. the first UTI is usually separated from other infections by at least 6 months. |
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Term
| what characterizes recurrent UTIs? |
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Definition
unresolved bacteruria due to
*inadequate tx/dx, *bacterial persistence/relapse (recurrence of UTI by same organism after sterile urine obtained), and *reinfection (new infection w/different pathogens |
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Term
| what are the routes of infection for UTIs? |
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Definition
| hematogenous (kidney, testes, prostate), lymphatogenous (to bladder/kidney from bowel/cervix), ascending (bladder to the kidney - most common), ascending from the urethra (to prostate/bladder/seminal vesicle/epididymis/testicle) from the rectum (to vagina/urethra/bladder), and direct extension from neighboring organs (IBD, PID) |
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Term
| what are the factors affecting host resistance to infection? |
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Definition
| systemic disease (ie DM), obstruction to free flow of urine, status of urothelium, presence of foreign bodies, neoplasms, faulty personal habits, and trauma. |
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Term
| what is the key to treating UTIs? |
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Definition
| determining why it happened in the first place |
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Term
| what is a staghorn calculus? |
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Definition
| a kidney stone which filles the hollow part of the organ. these are infectious and have to be cleared in order to eradicate the infection. |
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Term
| what are bacterial factors which affect UTIs? |
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Definition
| cell kinetics (e. coli can double every 15 min), bacterial adherence (pili allow bacteria to hold still against urine flow and climb ureters), bacterial sensitivity to antibx, and bacterial resistance to antibx |
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Term
| what is the goal of UTI tx w/antimicrobial agents? |
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Definition
| total eradication of the organism. |
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Term
| why is nitrofurantoin a good UTI antibx? |
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Definition
| it remains unmetabolized in the urine (which is why doesn't really work for systemic infections or the kidneys). it is active against most gram neg enterics, staph, strep - but not pseudomonas/proteus (tough gram neg) |
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Term
| what pathogens is trimethoprim-sulmethoxazole good against? |
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Definition
| most uropathogens except enterococcus and psuedomonas - however, resistance is an issue. |
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Term
| what pathogens are fluoroquinolones good against? |
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Definition
| gram negative enterics and staph. ineffective against most strep and anerobic (but most UTIs are not anerobic) |
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Term
| what pathogens are aminogylcosides good against? |
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Definition
| most gram negatives, but ADRs: nephro/ototoxic |
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Term
| what pathogens are cephalosporins good against? |
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Definition
| most uropathogens, but a lot of resistance (PCN-related) |
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Term
| what pathogens are PCNs good against? |
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Definition
| 1st gen PCNs not very effective against gram neg - however aminoPCNs/antipseudomonal PCNs are effective |
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Term
| what are the anerobic antimicrobials? |
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Definition
| clindamyacin, metronidazole, tetracycline, erythromycin |
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Term
| what characterizes acute pyelonephritis? |
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Definition
| acute pyelonephritis involves both the *parenchyma and renal pelvis and is usually due to aerobic gram neg bacteria (e. coli most common). *predisposing factors: reflux, stone, obstruction, and neoplasm. *most common route of infection: ascending from bladder. |
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Term
| what is vesicoureteral reflux? |
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Definition
| when the bladder contracts and the flap valve over the ureter doesn't close properly - causing some urine to go back to the kidney |
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Term
| how do pts w/acute pyelonephritis present? |
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Definition
| chills, moderate-high fever, constant flank pain (dull-severe), often preceded by cystitis (common ascending route of infection), n/v/diarrhea common (common innervation w/GI tract), and malaise/prostration (any acute infection) |
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Term
| what are the lab findings associated with acute pyelonephritis? |
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Definition
| urinalysis is always positive (cloudy, pyuria, bacteriuria, proteinuria, often hematuria, and WBC casts), leukocytosis (usually increased, high WBC count), increased sedimentation rate, positive urine and often blood cx (cx should be done on admission to ID organisms - but still start empiric tx). |
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Term
| what diagnostic tests are run for acute pyelonephritis? |
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Definition
| thorough H+P, urinalysis/cx, check voiding systems (particularly in older men - BPH), abdominal x-ray (can show stones/gas/air/fluid levels - not as common at present), CT scan/IVP, renal ultrasound (can show if there is an obstruction producing a hydronephrosis or kidney stones), and voiding cystourethrogram (> 3 wks later, after acute phase - fill bladder with opaque medium and then X-ray or fluoroscope them with voiding, will show if reflux is present) which is good if no obvious stone or obstruction is found to have caused the infection. |
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Term
| what should be in the ddx for acute pyelonephritis? |
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Definition
| pancreatitis (head and tail in proximity to kidneys), pneumonia (can give pain in upper quadrants), acute abdomen (such as appendicitis), acute pelvic inflammatory disease, acute bacterial prostatitis/acute epididymo-orchitis (pain can radiate from the spermatic cord to lower abdomen) |
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Term
| what are complications of acute pyelonephritis? |
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Definition
| complications are uncommon if uncomplicated (*no mechanical problem) and treated promptly. if complicated (as is usually the case w/stones), bacteremia which can progress to shock is possible. renal abscess is possible and if acute pyelonephritis is *recurrent in children, scarring can progress to renal failure. |
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Term
| how is acute pyelonephritis managed? |
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Definition
| if severe/complicated (fever/pain/n/v): hospitalize (b/c cannot tx PO) and do immediate urine/blood cx. broad spectrum antibx systemically for at least 14 days. recognize/treat complicating factors such as obstruction or infected stones. maintain adequate hydration/output and control pain, fever, and n/v. |
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Term
| what is chronic pyelonephritis? |
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Definition
| this occurs in children w/recurring acute pyelonephritis or adults w/complicating factors such as DM, obstruction, calculi. chronic pyelonephritis results in scarring (not seen in acute) and deteriorating renal function. |
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Term
| what are the signs/symptoms of chronic pyelonephritis? |
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Definition
| usually asymptomatic (fever only present in acute infection). when advanced and bilateral: HTN, azotemia, anemia (end stage renal failure) |
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Term
| what are chronic pyelonephritis dx studies? |
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Definition
| *progressive proteinuria, BUN and creatinine as disease advances. small, scarred kidneys on x-ray, US, and isotope scanning. pyuria/bacteriuria may/may not be present. vesicoureteral reflux on VCU. CBC usually normal unless acute. |
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Term
| what are the complications associated with chronic pyelonephritis? |
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Definition
| renal scarring, bacteremia, renal stones, HTN, and progressive renal failure w/azotemia/HTN/anemia |
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Term
| what is tx for chronic pyelopnephritis? |
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Definition
| prompt dx. medical/sx correction of complicating factors (stones etc). long term suppressive antibx (particularly in children w/reflux), and dialysis+transplant in pts w/end stage renal failure. |
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Term
| what characterizes the incidence of renal abscesses? |
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Definition
| renal abscesses may be renal cortical (hematogenous from staph, DM, IV drug use), corticomedullary (obstruction, reflux, calculi, DM, coliform organisms), and perinephric (rupture of intrarenal abscess). |
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Term
| how do renal abscess pts present? tx? |
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Definition
| renal abscess pts are sick/febrile. these abscesses require drainage/antibx and are usually secondary to obstruction or reflux (DM). all require prompt dx (x-ray, ultrasound, scanning and CT). these pts will be quite ill and nephrectomy is sometimes necessary. |
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Term
| what is acute cystitis? symptoms? |
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Definition
| an acute bacterial infection caused mainly by e. coli. this occurs mainly in sexually active females via anal flora. symptoms: increased frequency, urgency, dysuria, burning, nocturia, w or w/o hematuria (these symptoms are fairly nonspecific, but a positive cx confirms cystitis). *fever not common (really only associated with kidney)*. |
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Term
| how is acute cystitis diagnosed? |
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Definition
| through H+P (does it burn/hurt etc), urinalysis (pyuria, bacteriuria, often hematuria, + urine cx), urodynamic evaluation (when indicated), and cystoscopy (when hematuria is still present after clearing infection). |
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Term
| how is acute cystitis treated? |
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Definition
| 1-3 days antibx (needs to be safe for vaginal flora and cheap - like nitrofurantoin), counsel re: hygiene/sexual activity (pee frequently, wipe backward), suppressive antibx if recurrent (~3 months), and eliminate contributing factors (ie 3rd degree cystocele). |
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Term
| what characterizes recurrent cystitis? |
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Definition
| persistent/frequently recurring infection due to the same pathogens as in acute cystitis/pyelonephritis. predisposing factors are usually present, the bladder mucosa shows a chronic change, irritating voiding symptoms are present, bacteruria/pyuria are usually present and recurrent cystitis may produce and ascending infection. |
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Term
| how is recurrent cystitis treated? |
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Definition
| long term antibx (60-80 days), treatment of contributing/predisposing factors (cystocele, stricture, dysfunctional bladder), and counsel re: voiding habits. |
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