NRNP 6550 Final
1. Urine culture 100.000 colonies in asymptomatic: bacteruria
with UTI 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
2. Lower urinary bladder and urethra: cystitis/ urethritis/ prostatitis
tract UTI and up- kidney and ureters: pyelonephritis/ renal abcess
per urinary tract
UTI
3. Uncomplicated Uncomplicated: in normal working urinary tract
and complicated Complicated: defects in urinary tract or with other health problems
uti
4. Common E.coli (elderly women)
pathogens for Staphylococcus
UTI proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
5. Risk factors for Female
UTI critically ill
elderly
catheter (caused by biofilm)
DM
, NRNP 6550 Final
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
6. Findings UTI 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)
malaise
tachycardia/ tachypnea
7. Testing and re- Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC:
sults for UTI urine analysis.
UA: pos for nitrite or leukocyte or blood
, NRNP 6550 Final
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
8. Management First line:
acute cystitis - 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
9. Management un- Outpt:
complicated up- quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
per UTI Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
10.
, NRNP 6550 Final
Management - Admit
acute - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on
complicated renal function (trough less than 2 and peak level 5-10mg/L) and do not give for
bacterial CKD
pyelonephritis - Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
11. Urine analysis: Serum glucose at least 180mg/dl for glucose to appear in urine
glucose and ke-
tones 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
12. Acute Kidney In- -Acute renal function loss with inability to excrete metabolic waste products (urea
jury nitrogen and creatinine) to inability to maintain fluid and electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
13. RIFLE Risk: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less
than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less
than 0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO
1. Urine culture 100.000 colonies in asymptomatic: bacteruria
with UTI 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
2. Lower urinary bladder and urethra: cystitis/ urethritis/ prostatitis
tract UTI and up- kidney and ureters: pyelonephritis/ renal abcess
per urinary tract
UTI
3. Uncomplicated Uncomplicated: in normal working urinary tract
and complicated Complicated: defects in urinary tract or with other health problems
uti
4. Common E.coli (elderly women)
pathogens for Staphylococcus
UTI proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
5. Risk factors for Female
UTI critically ill
elderly
catheter (caused by biofilm)
DM
, NRNP 6550 Final
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
6. Findings UTI 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)
malaise
tachycardia/ tachypnea
7. Testing and re- Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC:
sults for UTI urine analysis.
UA: pos for nitrite or leukocyte or blood
, NRNP 6550 Final
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
8. Management First line:
acute cystitis - 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
9. Management un- Outpt:
complicated up- quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
per UTI Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
10.
, NRNP 6550 Final
Management - Admit
acute - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on
complicated renal function (trough less than 2 and peak level 5-10mg/L) and do not give for
bacterial CKD
pyelonephritis - Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
11. Urine analysis: Serum glucose at least 180mg/dl for glucose to appear in urine
glucose and ke-
tones 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
12. Acute Kidney In- -Acute renal function loss with inability to excrete metabolic waste products (urea
jury nitrogen and creatinine) to inability to maintain fluid and electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
13. RIFLE Risk: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less
than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less
than 0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO
