NRNP 6550 Final Exam Urine culture with UTI (ANS-
100.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients but also pyuria
pyuria: more than 10 leukocytes
elevated erythrocytes with pyelonephritis WBC in urine
false positive with tumor, urethritis and poor collection technique
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI
(ANS- bladder and urethra: cystitis/ urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complicated uti
(ANS- Uncomplicated: in normal working urinary tract
Complicated: defects in urinary tract or with other health problems
Common pathogens for UTI (ANS- E.coli (elderly women) Staphylococcus proteus mirabilis (elderly men) Klebsiella enterecoccus pseudomonas Providencia (institutionalized)
Fungus: candida
- / 4
Risk factors for UTI (ANS- Female critically ill elderly catheter (caused by biofilm) DM calculi, tumor, stricture neurogenic bladder
Women:
sexual intercourse or new sex partner pregnancy previous UTI
Men:
prostate enlargement prostatitis lack of circumcision gay HIV
Findings UTI (ANS-
Lower:
Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills uncommon No flank pain
Upper:
flank pain fever and chills hematuria n/v ams (in elderly) 2 / 4
malaise tachycardia/ tachypnea
Testing and results for UTI (ANS- Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in women or UTI in men rule out obstruction, calculi, or
necrosis with:
xr voiding CT abdomen US pelvis MRI pelvis
Management acute cystitis (ANS-
First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby,
give cephalexin instead) or sulfa
- 5 days: nitrofurantoin, caution in elderly
Second line:
- qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!)
- B-lactams: amoxi-clav, cefdinir for 3 - 7 days
Management uncomplicated upper UTI (ANS-
Outpt:
quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt: 3 / 4
Ceftriaxone or cefotaxime Ampicillin
CAUTION:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
Management acute complicated bacterial pyelonephritis (ANS-
- Admit
- Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal
function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
Urine analysis: glucose and ketones
(ANS- Serum glucose at least 180mg/dl for glucose to appear in urine
Glucose in ua caused by:
- Fancone Syndrome (bad wall: caused by ahminoglycosides for example)
- DM
- Cushing's
- Vit C can give false negative
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury (ANS-
- / 4