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UTI (Dx tests
must have good reason to get imaging (stones, abscess …
UTI
Dx tests
- must have good reason to get imaging (stones, abscess :volcano:)
Bacteria
Bladder (complicated vs uncomplicated cystitis)
- uncomplicated (3d Abx course): any cystitis that's not complicated
- uncomplicated: must be non pregnant female :forbidden::pregnant_woman::skin-tone-2:
- Complicated (7d ABx course)
- Complicated Cystitis remembered by the "P's"
- Penis
- Plastic (foleys)
- Procedures Urological
- Pyelonephritis (implies UTI above bladder, therefore no longer cystitis. Ambulatory pyelo can be treated like UTI)
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Urethritis
- not UTI, but STI
- almost always Gonorrhea/Chlamydia
Gram - rods
- E Coli (85% UTI)
- Klebsiella (enteric)
- Proteus (enteric)
:pencil2:Anaerobes generally don't cause UTIs, but UTIs are generally gram - organisms (GNR) from the GI tract :poop: (from the anus)
Risk factors:
- 18-25 yo sexually active :female_sign::woman::skin-tone-2:
- are on some contraception
- shorter urethra than :male_sign:
- :male_sign:males practicing anal sex are at highest risk :male-firefighter::skin-tone-3::two_men_holding_hands: (Penis & colonic organisms)
UA: :check: when there is leukocyte esterase or nitirites, WBC and bact.
- use of microscopy :microscope:: need > 10 WBC/hpf = UTI
:warning: Usually this is all you need! No Cx or imaging
UCx: useful if
- pregnant :pregnant_woman::skin-tone-2:
- Had procedure
- uncertain about identity of organism (:shrug::skin-tone-4:??), if pt fails to respond or has previous multi drug resistant organisms
100,000 colonies = UTI
- will show sensitivities
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Urethritis
Path: STD: Gonnorhea/Chlamydia :clap::skin-tone-2:
- same disease: ie treat both
Pt: Not typical s/s of UTI
- discharge (cervix or urethra)
:pencil2:Cervicitis & Urethritis are essentially the same disease
Dx: Gonnorrhea/Chlamydia
- swab: older test
- Urine studies
Tx:
- Ceftriaxone 250mg 1x IM
&
- Azithromycin PO 1x or Doxy :bicyclist: PO for 7d
- Azithromycin is better for compliance
(UVA FM): if Chlamydia = Azithro only
- shitty exception to the rule
- Chlamydia more common than Gonnorhea
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Asx Bacteriuria
Path: same bugs- Gram - rods (GNR), GBS :pregnant_woman::skin-tone-2:
Pt: Asx screen
- screen for pregnant :pregnant_woman::skin-tone-2:women
- undergoing urological procedure
:warning:do not screen other patients, we will not treat them!
Dx: UA
- Generally get UCx, esp. w/ :pregnant_woman::skin-tone-2:
Tx:
- :pregnant_woman::skin-tone-2: gets Amoxacillin (nowhere else is this 1st line)
- :pregnant_woman::skin-tone-2: w/. Nitrofurantoin if PCN :pencil2:allergic
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Cystitis
Path: GNR
Pt: Urgency :tired_face:, frequency, dysuria in younger female:female_sign::woman::skin-tone-2:
- no systemic signs, non-toxic
- can see sepsis in elderly :older_woman::skin-tone-3:, & altered: but step/shelf won't test this
Dx: Test before treating. UA
Tx: empiric
- TMP-SMX (contraindicated in CKD)
- Nitrofurantoin
- Fosfomycin
f/u
- complicated : 7d
- uncomplicated : 3d
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- Broad overview of GU system, to start: presentation and duration of Abx course
- pathologies of all UTIs
- Dx steps
- Individual diseases: Higher you go, worse it is, the longer you treat w/ Abx, the more ill pt will be
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