UTI
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| Cystitis is | Dysuria, frequency,urgency, superpubic tenderness,hematuria (no vagina symptoms or discharge)
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| Pyelonephritis is | Maliase,fever, flank pain, costovertal tenderness, abdominal pain, nausea, vomiting,elevated WBC count
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| Urosepsis-is | Mental status changes, failure to thrive, change in urinary habits, dehydration, hypotension. Cystitis (bladder inflammation) fever, elevated WBCs, (+) urinealysis, pre-renal azeotemia
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| Prostatis is | Sudden onset of high fevers, chills, malaise, myalgias, locialized pain, urinary symptoms
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| Microscopic analysis | WBC, RBC, epithelial cells, casts, bacteria.
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| Macroscopic analysis- standard dipstick- | Color, pH, glucose, protein, ketone, bilirubin, blood, nitrite, leukocyte esterase, Casts:
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| pathophysiology of urinary tract infections | Bacteria usually originate from the bowel and ascend urethra and vagina. More common in women.
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| mechanisms and bacterial virulence | Urine: low pH, Micturition (complete emptying of the bladder), Prostatic secretions in men, Lactobacillus in the vaginal flora, One-way vesicoureteral valve,Epithelial cells of the bladder coated with glycosaminoglycan, Tamm-Horsfall p, Secretory IgA
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| Bacterial virulence characteristics | Innoculum size, Pathogenic organisms with mannose-resistance P-fimbriae (resistant to removal by glycosaminoglycans), Production of hemolysin – lyse PMNs, Aerobactin
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| Lueokocyte esterase indicates | WBC or Lysed wbc's
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| Nitrite positive indicates | Gram - bacteria that can reduce nitrates
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| Acute uncomplicated cyctitis female (15-50) | Dysuria, frequency, urgency, superpubic tenderness, hematuria (rare symptomatic)
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| Uncomplicated or complicated pyelonephritis | Flank pain, maliase, fever, costovertal tenderness, abdominal pain, elevated WBC
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| Treatment of Uncomplicated cyctitis (15-50) | Bactrim, Fluorquinolones, Augmention, nitrofurantion) 7days
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| Complicated cycstitis >50, men | Fluoroquinolones, bactrim DS 7-14 days
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| Asymptomatic bacteriumia in pregnancy treatment | Augmentin, cephalosporins, nitrofurantion (not 36 wwek) 3-7 days
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| Acute pyelonephritus treatment-mild to moderate | Fluoroquinolones, bactrium 7-14 days
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| Acute pyelonephrtis Moderate to sever | IV fluoroquinolones, 3rd cephalosporins, Unasyn or Zosyn 14-days
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| Urosepsis treatment | IV fluoroquinolones, 3rd cephalosporins, Unasyn or Zosyn 14-days
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| Acute or chronic prostatitis treatment | bactrim, fluoroquinolones, treat 3-4 weeks for acute or 4-6 weeks up to 12 weeks
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| Acute uncomplicated Cystitis monitor | Resolution of symptoms within 24-48 hrs & re-evaluate if symptoms persist or re-occur
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| Acute pyelonephritis- monitor | Resolution of S/S within 12-24 hours and significant improvement. WBC & temperature improvement should occur within 72hours. Follow-up in 2 weeks.
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| Urosepsis-monitor | Resolution of mental status changes, temperature, WBC, kidney function, Bp, Follow-up 2 weeks
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| Recurrent Uncomplicated Cystitis- Relapse Infection- | Same organism, occur within 2 weeks- Obtain culture & sensitivities Check for underlying causes for relapse and treat for an additional 2-6 weeks
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| Recurrent Uncomplicated Cystitis- Re-infection | New microorganism (species or strain)- Occur >2 weeks post treatment
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| a. Uncomplicated Cystitis-Recurrent Cystitis – | No Relation to Intercourse- Prophylaxis x 6-12 months then stop & observe
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| b. Uncomplicated Cystitis-Relation to Intercourse | Post-intercourse prophylaxis & Voiding after intercourse
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| asymptomatic or symptomatic candiuria treatment | Asymptomatic no treatment- except (ICU),symptomatic- fluconazole 200-400 mg po qd x 7-14d or IVAmphotericin B
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