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Urinary Tract Infections

Urinary Tract Infections. Tory Davis, PA-C UNE PA Program. UTI. Can involve any part of urinary tract Urethra Bladder Ureter(s) Kidney(s) Bladder and urethra most commonly involved. How, who and why. MC pathogen E.coli from GI tract (70-80%) Also Enterococcus faecalis In women:

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Urinary Tract Infections

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  1. Urinary Tract Infections Tory Davis, PA-C UNE PA Program

  2. UTI • Can involve any part of urinary tract • Urethra • Bladder • Ureter(s) • Kidney(s) • Bladder and urethra most commonly involved

  3. How, who and why • MC pathogen E.coli from GI tract (70-80%) • Also Enterococcus faecalis • In women: • Close proximity of urethra to anus • Short distance from urethral opening to bladder • In men: • more often due to obstruction, incl • Structural abnormalities • Catheterization • Neurogenic bladder • Enlarged prostate

  4. Symptoms Can Indicate Location • Urethritis causes dysuria • Cystitis causes: • Urinary urgency & frequency, hematuria, suprapubic pain, malodorous urine • Pyelonephritis: • flank pain, fevers/chills, nausea/vomiting

  5. Risk Factors • Female • Sexually active • Use of contraceptive diaphragm and/or spermicidal agents • Aging • Post meno estrogen causes thinner tissue in vag, urethra, bladder base

  6. More risk factors • For both males and females: • Urinary tract obstruction • Immunocompromise • Urinary catheter -

  7. Work up • History – past UTI, blood present, flank pain, recent intercourse (new bacteria), • PE • + CVAT (costoverterbral angle tenderness – bang on kidneys) – make you think pyelo.

  8. Diagnosis • Clean-catch (midstream urine) • Dip for nitrites (b/c bac-t produce enzyme that converts urine nitrates to nitrites) and leukoesterases (protein produced by WBCs) • Microscopy for WBCs • Urine culture and sensitivity

  9. Antibiotics • In an uncomplicated outpt, no catheter • Bactrim (TMP/SMX) DS (double strength) bid for 3 days • Fluoroquinolone (ie Ciprofloxacin) BID x 3 d • Amoxicillin+clavanulate (Augmentin) • Nitrofurantoin (Macrobid)

  10. And have a heart.. • Urinary analgesic phenazopyridine (Pyridium) 200 mg TID prn dysuria • NB - Makes urine orange or blue

  11. Tx other • Fluids- lots of water • Avoid bladder irritants- coffee, soda, alcohol • Cranberry- decreases ability of bac-t to adhere to bladder wall

  12. UTI Prevention • Cranberry • Wipe front-to-back • Urinate after intercourse • Avoid irritants, incl feminine hygiene products and smoking • Shower rather than bath • Prophylactic abx for recurrent UTIs • Dosing: daily low dose vs post-sex dose vs prn symptomatic dosing

  13. Special populations require special considerations • Like who? • What’s special about them?

  14. Pyelonephritis • Ascending infection from lower urinary tract travels up ureters to the pyelum (pelvis) of the kidney (nephros) and causes an “–itis” • Or hematogenous spread • Not good • Sick people

  15. Pyelo • Fevers • Rigors • Flank pain • Nausea/vomiting • + CVAT • +/- lower UTI sx • + blood cultures • But good hx and PE, plus urine may be enough

  16. Pyelo Tx • Admission if fevers and leukocytosis • IV fluids • IV abx (Cipro, ampicillin if preg) • Continue abx until fever-free x 24h, but can switch to oral dosing when pt improves

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