ID E1- GU Infections

What is the MC bacterial infection in humans?

UTI

What is an uncomplicated UTI?

invasion of a structurally and functionally normal urinary tract by a nonresident infectious organism

What is a complicated UTI?

occurrence of infection associated with an underlying condition that increases risk of infection or of failing therapy (ie obstruction, anatomic abnormality)

Lower or upper UTI:

Urethritis

Lower

Lower or upper UTI:

Cystitis

Lower

Lower or upper UTI:

Pyelonephritis

Upper

Lower or upper UTI:

Perinephric abscess

Upper

What is the MC pathogen that causes acute uncomplicated cystitis?

E. coli

What is "Honeymoon cystitis"?

symptoms of cystitis following sexual intercourse

Fever is absent in (upper/lower) UTIs

Lower

What other condition should be ruled out in men before diagnosing cystitis?

Prostatitis

WBC casts in the urine indicate (upper/lower) UTI

Upper

What is the study of choice to detect anatomic/physiologic factors associated with complicated UTIs?

CT without contrast

What is the first line treatment for uncomplicated UTI in women?

Nitrofurantoin monohydrate (Macrobid)

What is the first line treatment for uncomplicated UTI in men?

Bactrim

For postmenopausal women with recurrent uncomplicated cystitis, what can be an effective preventive measure?

Vaginal estrogen cream

Cystitis or Pyelonephritis:

CVA tenderness & flank pain

Pyelonephritis

Cystitis or Pyelonephritis:

PT is visibly ill

Pyelonephritis

Cystitis or Pyelonephritis:

N/V, fever and chills

Pyelonephritis

What might you see in the labs if a pt has pyelonephritis?

Leukocytosis with left shift + WBC casts

Who should be admitted for pyelonephritis?

cannot tolerate oral intake, Unstable vitals, Severe symptoms w/ high fever, Pregnancy, Concerns about compliance, Suspected urinary obstruction, Comorbid disorders

What is the MC pathogen that causes pyelonephritis?

E. coli

What is the outpatient treatment for pyelonephritis?

Cipro PO +/- Ceftriaxone IV

What is the inpatient treatment for pyelonephritis?

IV FQ

What is asymptomatic bacteriuria?

isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen from an individual w/o s/s of UTI

How is asymptomatic bacteriuria in women defined?

2 consecutive clean-catch voided urine specimens with isolation of the same organism in quantitative counts

How is asymptomatic bacteriuria in men defined?

Single clean-catch voided urine specimen with isolation of a single organism in quantitative counts in the absence of symptoms

Pregnant women should be screened during which trimester for asymptomatic bacteriuria?

1st

If UA is positive in a pregnant women for asymptomatic bacteriuria, what is the first line treatment?

Nitrofurantoin PO

What increases the risk of UTI in older men?

Prostate disease

What is the treatment for bacterial prostatitis?

Bactrim PO