p.17
Diagnosis of Urinary Tract Infections
What are common findings in urinalysis (UA) for pyelonephritis?
Pyuria, bacteria, and large amounts of granular or leukocyte casts.
p.1
Antimicrobial Therapy for UTIs
How do most uncomplicated UTIs resolve?
With a short course of oral therapy.
p.7
Antimicrobial Therapy for UTIs
Which drug class inhibits bacterial cell wall synthesis?
b-Lactams (penicillins, cephalosporins, aztreonam) and Vancomycin.
p.5
Common Pathogens in UTIs
What type of bacteria is Chlamydia?
Obligate intracellular bacteria.
p.12
Antimicrobial Therapy for UTIs
What precautions should be taken when using Nitrofurantoin?
Do not use in patients with low creatinine clearance (< 50 mL/min), monitor long-term patients closely, avoid concomitant probenecid, magnesium, or quinolones.
p.9
Antimicrobial Therapy for UTIs
What pathogens does Fosfomycin target?
Enterococci and most Enterobacteriaceae (not P. aeruginosa).
p.12
Antimicrobial Therapy for UTIs
What precautions should be taken when using Trimethoprim-sulfamethoxazole?
Avoid in pregnant patients and those receiving warfarin due to elevated prothrombin time.
p.16
Diagnosis of Urinary Tract Infections
What is a key symptom for diagnosing a UTI?
Acute onset of dysuria with positive urinalysis and culture.
p.25
Antimicrobial Therapy for UTIs
What should be done for patients allergic to cephalosporins?
Treat with azithromycin 2 g orally and either oral gemifloxacin 320 mg or intramuscular gentamicin 340 mg.
p.17
Diagnosis of Urinary Tract Infections
When should blood cultures be obtained in pyelonephritis patients?
In patients with systemic toxicity, those requiring hospitalization, or with risk factors such as pregnancy.
p.17
Diagnosis of Urinary Tract Infections
What imaging techniques can show focal swelling in acute pyelonephritis?
Ultrasound (US), CT, and MRI.
p.25
Complicated vs. Uncomplicated UTIs
What are some sequelae of pelvic inflammatory disease?
Tubal scarring, infertility, ectopic pregnancy, and chronic pelvic pain.
p.19
Antimicrobial Therapy for UTIs
What is the recommended treatment for pregnant women with acute pyelonephritis?
Ampicillin and gentamicin 1–2 g every 6 hours for 10–14 days.
p.19
Antimicrobial Therapy for UTIs
What is the dosage for Levofloxacin in inpatient treatment of acute pyelonephritis?
500–750 mg every 24 hours for 10–14 days.
p.18
Acute Pyelonephritis and Its Management
What should be done if there is no improvement in pyelonephritis within 72 hours?
Consider hospitalization and review cultures and sensitivities.
p.19
Antimicrobial Therapy for UTIs
What is the recommended oral treatment for moderately ill outpatient women with acute pyelonephritis?
TMP-SMX DS 160–800 mg every 12 hours for 14 days.
p.16
Risk Factors for Recurrent UTIs
What is the recommended minimum amount of PAC in cranberry pills for UTI prevention?
Ideally minimum 36 mg PAC.
p.17
Complicated vs. Uncomplicated UTIs
How can acute pyelonephritis infections be subdivided?
Into uncomplicated infections not requiring hospitalization, uncomplicated infections needing hospitalization, and complicated infections.
p.14
Antimicrobial Therapy for UTIs
What should be added to the treatment if Gram stain identifies gram-positive cocci?
Ampicillin or amoxicillin for better enterococcal coverage.
p.7
Antimicrobial Therapy for UTIs
How do quinolones work?
By inhibiting bacterial DNA gyrase.
p.25
Diagnosis of Urinary Tract Infections
What indicates a positive Gram stain in symptomatic men?
Polymorphonuclear leukocytes with intracellular gram-negative diplococci.
p.17
Acute Pyelonephritis and Its Management
What is the significance of CT in patients with fever lasting longer than 72 hours?
It is helpful for ruling out obstruction and identifying renal and perirenal infections.
p.23
Acute Pyelonephritis and Its Management
What characterizes Emphysematous Pyelonephritis (EP)?
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens.
p.15
Acute Pyelonephritis and Its Management
What are classic symptoms of acute pyelonephritis?
Acute onset of fever, chills, flank pain, and/or costovertebral tenderness.
p.7
Antimicrobial Therapy for UTIs
What is the difference between bacteriostatic and bactericidal agents?
Bacteriostatic agents inhibit bacterial growth, while bactericidal agents kill bacteria.
p.25
Diagnosis of Urinary Tract Infections
What is the preferred method for detecting N. gonorrhoeae and C. trachomatis?
Nucleic-acid amplification tests (NAATs).
p.23
Acute Pyelonephritis and Its Management
Why might antimicrobial therapy be necessary before surgery for XGP?
To stabilize the patient preoperatively.
p.6
Antimicrobial Therapy for UTIs
When should AB be treated?
In pregnant women and patients undergoing procedures with anticipated transmucosal bleeding.
p.23
Acute Pyelonephritis and Its Management
What makes surgery for XGP difficult?
The surrounding inflammatory reaction.
p.3
Diagnosis of Urinary Tract Infections
What comorbidities should be considered in urinary tract infection evaluations?
Comorbidities such as diabetes or other chronic conditions.
p.10
Antimicrobial Therapy for UTIs
What precautions should be taken when using Amoxicillin with clavulanic acid?
Increased risk of rash with concomitant viral disease and allopurinol therapy.
p.1
Common Pathogens in UTIs
How do Type P pili differ from Type 1 pili in terms of mannose?
Type P pili are mannose resistant, while Type 1 pili are mannose sensitive.
p.1
Complicated vs. Uncomplicated UTIs
What defines an uncomplicated urinary tract infection (UTI)?
An infection in a healthy patient with a structurally and functionally normal urinary tract.
p.6
Complicated vs. Uncomplicated UTIs
What is Asymptomatic Bacteriuria (AB)?
AB occurs when bacteria are identified in a urine sample without signs or symptoms of UTI.
p.14
Antimicrobial Therapy for UTIs
What is the initial antibiotic treatment for emphysematous cystitis?
Broad gram-negative coverage.
p.16
Risk Factors for Recurrent UTIs
What are postcoital antibiotics used for?
To prevent urinary tract infections related to intercourse.
p.16
Diagnosis of Urinary Tract Infections
What should be checked to evaluate urinary retention?
Post void residual (PVR).
p.11
Antimicrobial Therapy for UTIs
What are common adverse reactions associated with fluoroquinolones?
Mild GI effects, dizziness, lightheadedness, and photosensitivity.
p.16
Risk Factors for Recurrent UTIs
What behaviors are recommended to reduce UTI recurrence?
Hydration and frequent voiding.
p.14
Risk Factors for Recurrent UTIs
How is a recurrent UTI defined?
Two UTIs in a 6-month period or three UTIs in a 12-month period.
p.4
Acute Pyelonephritis and Its Management
What are some indications for radiologic investigation in acute pyelonephritis?
Potential ureteral obstruction, history of calculi, potential papillary necrosis, history of genitourinary surgery, poor response to antimicrobial agents, diabetes mellitus, polycystic kidneys, neuropathic bladder, and unusual infecting organisms.
p.10
Antimicrobial Therapy for UTIs
What are common adverse reactions associated with Amoxicillin or Ampicillin?
Hypersensitivity (immediate or delayed) and gastrointestinal upset.
p.3
Diagnosis of Urinary Tract Infections
What anatomical factors are relevant in urinary tract infection assessments?
Anatomic urologic abnormalities.
p.16
Diagnosis of Urinary Tract Infections
What should be considered if a patient has negative culture but UTI symptoms?
Other diagnoses should be considered.
p.9
Complicated vs. Uncomplicated UTIs
What defines a complicated UTI?
A UTI occurring in a patient with a compromised urinary tract or caused by a very resistant pathogen.
p.18
Diagnosis of Urinary Tract Infections
What is the purpose of blood and urine cultures in pyelonephritis?
To evaluate for complicating factors and guide treatment.
p.12
Antimicrobial Therapy for UTIs
What are common adverse reactions associated with Nitrofurantoin?
Peripheral polyneuropathy, GI upset, hemolysis with G6PD deficiency, pulmonary hypersensitivity reactions.
p.23
Acute Pyelonephritis and Its Management
What is the primary treatment for XGP?
Surgical excision of the infected kidney and surrounding inflammatory tissue.
p.5
Common Pathogens in UTIs
Which species of Mycoplasma are relevant for urological infections?
M. hominus and M. genitalium.
p.17
Acute Pyelonephritis and Its Management
What is a renal abscess?
A collection of purulent material confined to the renal parenchyma.
p.5
Common Pathogens in UTIs
What is the significance of Treponema in urological infections?
T. pallidum is a relevant pathogen.
p.7
Antimicrobial Therapy for UTIs
What is a common mechanism of drug resistance for b-lactams?
Production of b-lactamase.
p.22
Acute Pyelonephritis and Its Management
Where does XGP typically begin?
Within the pelvis and calyces.
p.1
Common Pathogens in UTIs
What is the function of Type P pili in E. coli?
Exhibit tropism to the kidney and are found in most strains causing pyelonephritis.
p.20
Acute Pyelonephritis and Its Management
What may urine cultures show in cases of renal abscess?
No growth or a microorganism different from that isolated from the abscess.
p.25
Common Pathogens in UTIs
What is the most frequently reported infectious disease in the United States?
Chlamydia, caused by C. trachomatis.
p.10
Antimicrobial Therapy for UTIs
What is a significant adverse reaction of Antistaphylococcal penicillins?
Acute interstitial nephritis, especially with methicillin.
p.14
Complicated vs. Uncomplicated UTIs
When should imaging and cystoscopic evaluation be performed in women with recurrent UTIs?
In women with risk factors for a complicated UTI.
p.10
Antimicrobial Therapy for UTIs
What should be monitored when using Antipseudomonal penicillins?
Hypernatremia, as these drugs are given as sodium salt.
p.3
Complicated vs. Uncomplicated UTIs
What was established in the cystogram of the 2-year-old girl?
An atrophic left kidney with marked reflux.
p.18
Acute Pyelonephritis and Its Management
What are the common symptoms and signs of pyelonephritis?
Fever, flank pain, and leukocytosis.
p.6
Diagnosis of Urinary Tract Infections
What is the criteria for AB in women?
Same bacteria identified in quantitative counts of ≥ 100,000 CFUs in two consecutive voided samples.
p.15
Risk Factors for Recurrent UTIs
What are some risk factors for recurrent urinary tract infections (UTIs)?
Sexual activity, new sexual partner within the past year, family history of UTI in first-degree female relative, recent antimicrobial use, spermicide use, history of UTI before menopause, menopause, incontinence, elevated postvoid residual, cystocele.
p.1
Common Pathogens in UTIs
What is an important step in the uropathogenesis of E. coli?
Bacterial adherence with appendages (pili or fimbriae) to the surface urothelium.
p.12
Antimicrobial Therapy for UTIs
What are the common adverse reactions of Trimethoprim-sulfamethoxazole?
Hypersensitivity, rash, GI upset, photosensitivity, hematologic toxicity (especially in patients with AIDS).
p.22
Acute Pyelonephritis and Its Management
What are the primary factors involved in the pathogenesis of XGP?
Nephrolithiasis, obstruction, and infection.
p.14
Acute Pyelonephritis and Its Management
When is surgical intervention considered for emphysematous cystitis?
For those who respond poorly to initial medical management or have severe necrotizing infections.
p.19
Antimicrobial Therapy for UTIs
What should be done with dosages for all treatments mentioned?
All dosages should be adjusted for renal function.
p.6
Antimicrobial Therapy for UTIs
What factors should influence antimicrobial selection?
Efficacy, safety, cost, and compliance.
p.7
Antimicrobial Therapy for UTIs
What does fosfomycin inhibit?
Bacterial cell wall synthesis.
p.11
Antimicrobial Therapy for UTIs
In which patients should fluoroquinolones be avoided?
Children and pregnant patients.
p.22
Acute Pyelonephritis and Its Management
What symptoms are commonly experienced by patients with XGP?
Flank pain, fever, chills, and persistent bacteriuria.
p.22
Common Pathogens in UTIs
Which organism is most commonly involved in XGP?
Proteus, followed by E. coli.
p.9
Diagnosis of Urinary Tract Infections
What should be done if a patient fails to respond to UTI therapy?
Repeat urine cultures should be performed.
p.22
Diagnosis of Urinary Tract Infections
What do blood tests often reveal in patients with XGP?
Anemia and possibly hepatic dysfunction.
p.5
Common Pathogens in UTIs
Which bacteria are classified as nonfermenters?
Pseudomonas and Acinetobacter.
p.6
Diagnosis of Urinary Tract Infections
What is the threshold value for defining significant bacteriuria in dysuric patients?
10^2 colony-forming units (CFU)/mL of a known pathogen.
p.19
Antimicrobial Therapy for UTIs
What is the treatment regimen for severely ill inpatient women with possible sepsis?
Ampicillin and gentamicin 1–2 g every 6 hours for 10–14 days.
p.20
Acute Pyelonephritis and Its Management
How can Gram-positive infections occur in patients with multiple skin carbuncles?
Via hematogenous seeding.
p.6
Diagnosis of Urinary Tract Infections
How many positive samples are needed to diagnose AB in men?
Only one positive, clean-catch sample is necessary.
p.20
Acute Pyelonephritis and Its Management
What symptoms may patients with a renal abscess present with?
Fever, chills, abdominal or flank pain, and occasionally weight loss and malaise.
p.7
Antimicrobial Therapy for UTIs
What is the mechanism of action of trimethoprim-sulfamethoxazole?
Antagonism of bacterial folate metabolism.
p.6
Antimicrobial Therapy for UTIs
What are possible first-line antimicrobial therapies for uncomplicated cystitis?
Nitrofurantoin and trimethoprim.
p.16
Complicated vs. Uncomplicated UTIs
What is the significance of having ≥ 3 UTI episodes in 12 months?
It indicates a pattern of recurrent urinary tract infections.
p.25
Antimicrobial Therapy for UTIs
What is the recommended treatment for chlamydial urethritis?
Single-dose oral azithromycin 1 g or oral doxycycline 100 mg twice daily for 7 days.
p.5
Common Pathogens in UTIs
What is the role of Mycobacteria in urological infections?
M. tuberculosis is a relevant pathogen.
p.19
Antimicrobial Therapy for UTIs
What is the dosage and frequency for Ciprofloxacin in outpatient treatment of acute pyelonephritis?
500 mg every 12 hours for 7 days.
p.22
Acute Pyelonephritis and Its Management
What is Xanthogranulomatous Pyelonephritis (XGP)?
A rare, severe, chronic renal infection resulting in diffuse renal destruction.
p.3
Diagnosis of Urinary Tract Infections
What recent medical history is important in evaluating urinary tract infections?
Recent infections/antibiotic use.
p.22
Acute Pyelonephritis and Its Management
What characterizes XGP histologically?
Accumulation of lipid-laden, foamy macrophages.
p.23
Acute Pyelonephritis and Its Management
Why is intraoperative frozen section unreliable in XGP?
Lipid-laden macrophages associated with XGP resemble clear cell adenocarcinoma.
p.15
Common Pathogens in UTIs
What are some resistant species that should be suspected in recurrent UTI cases?
Proteus, Klebsiella, Pseudomonas, Serratia, Enterobacter, Citrobacter.
p.4
Acute Pyelonephritis and Its Management
What conditions may indicate potential ureteral obstruction?
Stone, ureteral stricture, or tumor.
p.19
Antimicrobial Therapy for UTIs
What is the recommended oral treatment for pregnant women with acute pyelonephritis?
Cephalexin 500 mg every 6 hours.
p.23
Acute Pyelonephritis and Its Management
What are some poor prognostic factors associated with Emphysematous Pyelonephritis?
Hypoalbuminemia, shock, bacteremia, hemodialysis requirement, thrombocytopenia, altered mental status, and polymicrobial infection.
p.3
Antimicrobial Therapy for UTIs
What was the outcome of the prophylactic therapy for the 15-year-old girl?
Reinfections ceased with prophylactic therapy.
p.2
Diagnosis of Urinary Tract Infections
What symptoms are associated with acute pyelonephritis?
Fever, chills, flank pain, costovertebral-angle tenderness, nausea, vomiting, and malaise.
p.1
Complicated vs. Uncomplicated UTIs
What characterizes a complicated UTI?
Associated with factors that increase the chance of acquiring bacteria and decrease the efficacy of therapy.
p.20
Acute Pyelonephritis and Its Management
What is the primary pathway for ascending infections in renal abscesses?
Tubular obstruction from prior infections or calculi.
p.7
Antimicrobial Therapy for UTIs
What is the mechanism of action of aminoglycosides?
Inhibition of ribosomal protein synthesis.
p.15
Acute Pyelonephritis and Its Management
What is acute pyelonephritis?
Inflammation of the kidney due to an infection of the renal parenchyma.
p.25
Antimicrobial Therapy for UTIs
What is the treatment regimen for gonorrhea?
Ceftriaxone 250 mg intramuscularly and azithromycin 1 g orally.
p.18
Diagnosis of Urinary Tract Infections
What is indicated if there is a need to rule out complicating factors in pyelonephritis?
Optional radiologic evaluation.
p.5
Common Pathogens in UTIs
What type of bacteria is Staphylococcus?
Gram-positive aerobic cocci.
p.13
Complicated vs. Uncomplicated UTIs
What should be considered when diagnosing a woman with acute uncomplicated cystitis?
Alternate diagnoses such as pyelonephritis or complicated UTI.
p.18
Diagnosis of Urinary Tract Infections
What is the significance of urine culture in the management of pyelonephritis?
To guide treatment and monitor for resistance.
p.6
Risk Factors for Recurrent UTIs
Who should not be treated for Asymptomatic Bacteriuria?
Premenopausal women, nonpregnant patients, patients with diabetes, older community dwellers, and others listed in Box 12.5.
p.11
Antimicrobial Therapy for UTIs
What should be monitored in patients taking fluoroquinolones and antidiabetic agents?
Glucose levels, due to reported hypoglycemia and hyperglycemia.
p.9
Antimicrobial Therapy for UTIs
What is the role of parenteral antimicrobials in complicated UTIs?
They should be administered based on the susceptibility patterns of known uropathogens.
p.24
Acute Pyelonephritis and Its Management
What is EP in the context of urologic emergencies?
EP is a urologic emergency where most patients are septic and require intensive care.
p.19
Antimicrobial Therapy for UTIs
What is the duration of treatment for Ciprofloxacin (extended release) in outpatient settings?
1000 mg every 24 hours for 7 days.
p.18
Acute Pyelonephritis and Its Management
What is the recommended approach if there is an obstruction or abscess in pyelonephritis?
Drain the obstruction or abscess.
p.11
Antimicrobial Therapy for UTIs
What effect can fluoroquinolones have on theophylline levels?
They can significantly increase theophylline plasma levels.
p.7
Antimicrobial Therapy for UTIs
What is a mechanism of resistance for aminoglycosides?
Aminoglycoside-modifying enzymes.
p.9
Complicated vs. Uncomplicated UTIs
What is the typical duration of therapy for complicated UTIs?
10–14 days on culture-specific antibiotics.
p.22
Diagnosis of Urinary Tract Infections
What does a CT scan typically show in cases of XGP?
Unilateral renal enlargement with little or no function and a large calculus in the renal pelvis.
p.25
Risk Factors for Recurrent UTIs
How is M. genitalium primarily transmitted?
By direct genital-genital mucosal contact.
p.21
Renal Abscess and Perinephric Abscess
When is early percutaneous drainage recommended for perinephric abscesses?
For abscesses larger than 3 cm in diameter.
p.27
Antimicrobial Therapy for UTIs
What are some patient-applied topical therapies for anogenital warts?
Imiquimod cream, podofilox solution, and sinecatechins ointment.
p.14
Risk Factors for Recurrent UTIs
What should be included in the medical history for recurrent UTIs?
Prior number of infections, frequency, culture results, associated symptoms, and identifiable triggers or risk factors.
p.2
Complicated vs. Uncomplicated UTIs
What are some factors that suggest a complicated urinary tract infection?
Functional or anatomic abnormality of the urinary tract, male gender, pregnancy, older adult patient, diabetes, immunosuppression, spinal cord injury, childhood urinary tract infection, recent antimicrobial agent use, indwelling urinary catheter, urinary obstruction, urinary tract instrumentation, hospital-acquired infection, symptoms for 7 days at presentation.
p.3
Risk Factors for Recurrent UTIs
How does a history of pediatric voiding dysfunction relate to UTIs?
It may indicate a higher risk for recurrent urinary tract infections.
p.23
Acute Pyelonephritis and Its Management
In which patients does Emphysematous Pyelonephritis usually occur?
Patients with diabetes and urinary tract obstruction.
p.10
Antimicrobial Therapy for UTIs
What are the common adverse reactions of Cephalosporins?
Hypersensitivity, gastrointestinal upset, positive Coombs test, and decreased platelet aggregation.
p.8
Antimicrobial Therapy for UTIs
Which pathogens are treated by Ampicillin with sulbactam?
Staphylococcus (not MRSA), Enterococci, P. mirabilis, H. influenzae, and Klebsiella spp.
p.21
Renal Abscess and Perinephric Abscess
What are common causes of a perinephric abscess?
Rupture of an acute cortical abscess, extravasated infected urine, infection of a perinephric hematoma, or hematogenous seeding.
p.26
Antimicrobial Therapy for UTIs
What is the treatment for persistent or recurrent NGU if azithromycin was used initially?
Moxifloxacin 400 mg PO QD × 7 days.
p.4
Common Pathogens in UTIs
What are nonnitrite producing bacteria?
All gram positives and pseudomonads, such as Pseudomonas and Acinetobacter.
p.24
Acute Pyelonephritis and Its Management
What is the treatment for Fournier gangrene?
A combination of broad-spectrum antibiotics and extensive surgical debridement.
p.6
Complicated vs. Uncomplicated UTIs
What characterizes uncomplicated cystitis?
Acute onset of dysuria and change in baseline voiding symptoms.
p.12
Antimicrobial Therapy for UTIs
What are the precautions for using Vancomycin?
Caution with other potentially nephrotoxic and ototoxic drugs due to risk of nephrotoxicity and/or ototoxicity.
p.3
Risk Factors for Recurrent UTIs
What role does family history play in urinary tract infection evaluations?
Family history can indicate genetic predispositions to urinary tract issues.
p.4
Acute Pyelonephritis and Its Management
Which patients are at risk for potential papillary necrosis?
Patients with sickle cell anemia, severe diabetes mellitus, or analgesic abuse.
p.16
Risk Factors for Recurrent UTIs
What is the role of vaginal estrogen in UTI management?
It may help in postmenopausal women to reduce UTI recurrence.
p.8
Antimicrobial Therapy for UTIs
What additional pathogens does Amoxicillin with clavulanate target?
P. mirabilis and Klebsiella spp.
p.8
Antimicrobial Therapy for UTIs
Which pathogens are targeted by First-generation cephalosporins?
Streptococcus, Staphylococcus (not MRSA), Escherichia coli, P. mirabilis, and Klebsiella spp.
p.26
Antimicrobial Therapy for UTIs
What is the recommended treatment for Trichomonas vaginalis?
A single dose of oral metronidazole 2 g or tinidazole 2 g.
p.24
Acute Pyelonephritis and Its Management
What is Fournier gangrene?
A potentially life-threatening progressive infection of the perineum and genitalia.
p.5
Common Pathogens in UTIs
Which group of Streptococcus is known for causing infections?
S. pyogenes (group A) and S. agalactiae (group B).
p.13
Antimicrobial Therapy for UTIs
What are the recommended classes of antibiotics for treating uncomplicated cystitis?
Fluoroquinolones or Beta-lactams (with caution).
p.8
Antimicrobial Therapy for UTIs
Which pathogens are covered by Amoxicillin or Ampicillin?
Streptococcus, Enterococci, and Proteus mirabilis.
p.12
Antimicrobial Therapy for UTIs
Which patient population has a higher incidence of adverse reactions to Trimethoprim-sulfamethoxazole?
Patients with AIDS and older adults.
p.11
Antimicrobial Therapy for UTIs
What are common adverse reactions associated with fosfomycin?
Headache, GI upset, and vaginitis.
p.22
Diagnosis of Urinary Tract Infections
What is the role of Tc-99m DMSA in diagnosing XGP?
It may be used to confirm and quantify the differential lack of function in the involved kidney.
p.8
Antimicrobial Therapy for UTIs
What is the coverage of Antistaphylococcal penicillins?
Streptococcus and Staphylococcus (not MRSA).
p.26
Common Pathogens in UTIs
What is Trichomonas vaginalis?
A flagellated parasite that infects the urethra in men and the urethra, vagina, and vulva in women.
p.8
Antimicrobial Therapy for UTIs
What is the coverage of Aztreonam?
Most gram-negative pathogens, including P. aeruginosa.
p.26
Diagnosis of Urinary Tract Infections
Why might testing for Trichomonas vaginalis not be warranted in the initial workup for NGU?
Due to the low prevalence of T. vaginalis in NGU.
p.24
Diagnosis of Urinary Tract Infections
What symptoms may men experience with gonococcal urethritis?
Urethritis, epididymitis, prostatitis, and proctitis.
p.7
Antimicrobial Therapy for UTIs
What is the role of nitrofurantoin in treating bacterial infections?
Inhibition of several bacterial enzyme systems.
p.5
Common Pathogens in UTIs
What type of bacteria does Enterobacteriaceae include?
Gram-negative aerobic rods.
p.20
Acute Pyelonephritis and Its Management
What conservative management may be employed for clinically stable patients with small abscesses?
Antibiotics and careful observation.
p.2
Diagnosis of Urinary Tract Infections
What symptoms are associated with cystitis?
Dysuria, frequency, urgency, suprapubic pain, hematuria, and fever.
p.13
Antimicrobial Therapy for UTIs
What should be avoided when prescribing Trimethoprim-sulfamethoxazole?
If resistance prevalence exceeds 20% or if used for UTI in the previous 3 months.
p.13
Complicated vs. Uncomplicated UTIs
What is Emphysematous Cystitis (EC)?
A rare and potentially life-threatening form of complicated cystitis associated with high mortality.
p.4
Common Pathogens in UTIs
Which bacteria produce nitrites in urine?
All Enterobacteriaceae, including E. coli, Klebsiella, Enterobacter, Proteus, Citrobacter, Morganella, and Salmonella.
p.24
Acute Pyelonephritis and Its Management
What initial procedures may be performed for patients with EP?
Placement of a ureteral stent or percutaneous nephrostomy tube.
p.8
Antimicrobial Therapy for UTIs
What pathogens do Second-generation cephalosporins (cefamandole, cefuroxime, cefaclor) cover?
Streptococcus, Staphylococcus (not MRSA), E. coli, P. mirabilis, H. influenzae, and Klebsiella spp.
p.2
Diagnosis of Urinary Tract Infections
What urine dipstick findings are most helpful in diagnosing a UTI?
Positive nitrites, leukocyte esterase, and blood.
p.13
Complicated vs. Uncomplicated UTIs
What is the primary treatment for Emphysematous Cystitis?
Medical therapy alone, which consists of IV antibiotics.
p.8
Antimicrobial Therapy for UTIs
What is the coverage of Fluoroquinolones?
Streptococcus and most gram-negative pathogens, including P. aeruginosa.
p.27
Antimicrobial Therapy for UTIs
What procedural treatments are available for anogenital warts?
Cryotherapy, surgical excision, and acid applications.
p.11
Antimicrobial Therapy for UTIs
What can significantly decrease the oral absorption of fluoroquinolones?
Concomitant use of antacids, iron, zinc, or sucralfate.
p.4
Acute Pyelonephritis and Its Management
What is a poor response to treatment in acute pyelonephritis?
Poor response to appropriate antimicrobial agents after 5–6 days of treatment.
p.15
Diagnosis of Urinary Tract Infections
What are indications for further investigation of recurrent UTIs?
Previous urinary tract trauma or surgery, previous bladder or renal calculi, gross hematuria after resolution of infection, obstructive symptoms, high post-void residual, urea-splitting bacteria on culture, previous abdominopelvic malignancy, bacterial persistence after treatment, diabetes or immune compromise, pneumaturia, fecaluria, history of diverticulitis, repeated pyelonephritis, asymptomatic microhematuria after resolution of infection.
p.23
Acute Pyelonephritis and Its Management
What is the classic triad of symptoms for severe acute pyelonephritis?
Fever, vomiting, and flank pain.
p.16
Diagnosis of Urinary Tract Infections
What is the purpose of urologic evaluation in UTI management?
To evaluate for bacterial persistence and other underlying issues.
p.11
Antimicrobial Therapy for UTIs
What is a precaution for using fosfomycin?
Hypersensitivity to fosfomycin.
p.26
Antimicrobial Therapy for UTIs
What is the alternative treatment for NGU if azithromycin is not used?
Erythromycin base 500 mg PO qid × 7 days, erythromycin ethylsuccinate 800 mg PO qid × 7 days, levofloxacin 500 mg QD × 7 days, or ofloxacin 300 mg PO bid × 7 days.
p.4
Diagnosis of Urinary Tract Infections
What does the absence of nitrites in urine indicate?
It does not mean bacteria are not present, as not all bacteria produce nitrites.
p.23
Diagnosis of Urinary Tract Infections
What imaging technique is used to diagnose Emphysematous Pyelonephritis?
CT scan, which shows mottled gas in the renal parenchyma.
p.26
Antimicrobial Therapy for UTIs
What is the treatment for persistent or recurrent NGU if doxycycline was used initially?
Azithromycin 1 g PO × 1 dose plus metronidazole 2 g PO × 1 dose or tinidazole 2 g PO × 1 dose for men who have sex with women in high-prevalence areas.
p.21
Renal Abscess and Perinephric Abscess
What laboratory features are associated with a perinephric abscess?
Leukocytosis, elevated serum creatinine, and pyuria.
p.27
Genitourinary Tuberculosis
What bacteria causes genitourinary tuberculosis (GU TB)?
Mycobacterium tuberculosis complex (MTBC).
p.4
Diagnosis of Urinary Tract Infections
What factors affect the ability to provide an adequate midstream clean-catch sample?
Increased body mass index, vaginal atrophy, poor manual dexterity, inability to bear weight, intravaginal pessary, and nonsterile collection receptacle.
p.26
Antimicrobial Therapy for UTIs
What is the preferred treatment for the initial episode of nongonococcal urethritis (NGU)?
Azithromycin 1 g PO × 1 dose or doxycycline 100 mg PO bid × 7 days.
p.21
Renal Abscess and Perinephric Abscess
What is the first-line procedure for most renal abscesses larger than 5 cm?
Drainage remains the first-line procedure of choice.
p.10
Antimicrobial Therapy for UTIs
What is the incidence of cross-reactivity in patients allergic to penicillin or cephalosporins when using Aztreonam?
1% incidence of cross-reactivity.
p.21
Renal Abscess and Perinephric Abscess
What characterizes a perinephric abscess?
It extends beyond the renal capsule but is contained by Gerota’s fascia.
p.10
Antimicrobial Therapy for UTIs
What are the major risks associated with Aminoglycosides?
Ototoxicity, nephrotoxicity, and neuromuscular blockade with high levels.
p.24
Diagnosis of Urinary Tract Infections
What are the symptoms of acute orchitis and epididymitis?
Pain, swelling, and inflammation of the testicle and epididymis.
p.26
Diagnosis of Urinary Tract Infections
How is Trichomonas vaginalis diagnosed?
Using NAATs or wet mounts of cultures.
p.24
Diagnosis of Urinary Tract Infections
What diagnostic tests should be performed for patients with suspected orchitis?
Urine culture and STI testing, if indicated.
p.27
Genitourinary Tuberculosis
What appearance may ureteral strictures take in GU TB?
A 'beaded corkscrew' appearance.
p.20
Acute Pyelonephritis and Its Management
What procedure may be necessary to differentiate an abscess from a tumor?
Image-guided needle aspiration.
p.26
Complicated vs. Uncomplicated UTIs
What should be done if there are recurrent or persistent symptoms of NGU?
Repeat the treatment regimen for the initial episode of NGU.
p.9
Complicated vs. Uncomplicated UTIs
What should be corrected in patients with complicated UTIs?
Any underlying urinary tract abnormalities.
p.13
Complicated vs. Uncomplicated UTIs
What is a pathognomonic finding of Emphysematous Cystitis?
Gas noted within the bladder wall on CT imaging.
p.13
Complicated vs. Uncomplicated UTIs
Who is typically affected by Emphysematous Cystitis?
Older women with poorly controlled diabetes.
p.27
Common Pathogens in UTIs
Which HPV types are associated with most cervical and other cancers?
High-risk types, predominantly 16, 18, 31, 33, and 35.
p.24
Risk Factors for Recurrent UTIs
What are some risk factors for developing Fournier gangrene?
Alcoholism, diabetes, recent urogenital or colorectal instrumentation or trauma, and preexisting peripheral vascular disease.
p.27
Genitourinary Tuberculosis
How can TB infect the genitourinary tract?
Through ascending infection or hematogenous seeding.
p.24
Acute Pyelonephritis and Its Management
What are essential management steps for patients with EP?
Fluid resuscitation, glucose and electrolyte management, and broad-spectrum antimicrobial therapy.
p.11
Antimicrobial Therapy for UTIs
What should be considered when using pivmecillinam?
Use with caution in patients with penicillin hypersensitivity.
p.24
Acute Pyelonephritis and Its Management
When is nephrectomy advised in cases of EP?
When patients do not respond to conservative management or if there is extensive and diffuse gas with renal destruction.
p.21
Renal Abscess and Perinephric Abscess
What imaging technique is valuable for demonstrating a primary abscess?
CT (Computed Tomography) is valuable for this purpose.
p.8
Antimicrobial Therapy for UTIs
Which pathogens do Aminoglycosides target?
Staphylococcus (urine) and most gram-negative pathogens, including P. aeruginosa.
p.21
Renal Abscess and Perinephric Abscess
What may be necessary if the kidney is nonfunctioning or severely infected?
Nephrectomy may be necessary.
p.3
Diagnosis of Urinary Tract Infections
What significant finding was noted in the excretory urogram of the 18-year-old girl?
Focal, coarse scarring in the right kidney.
p.2
Diagnosis of Urinary Tract Infections
What is the significance of pyuria in diagnosing a UTI?
Pyuria is defined as >5 white blood cells (WBCs)/high-power field (HPF) and moderate pyuria (>50 WBCs/HPF) in conjunction with urinary symptoms may indicate a UTI.
p.27
Risk Factors for Recurrent UTIs
At what age does the CDC recommend routine vaccination against HPV?
At 11 or 12 years of age.
p.27
Genitourinary Tuberculosis
What are typical constitutional symptoms of TB?
Fever, weight loss, night sweats, and malaise.
p.10
Antimicrobial Therapy for UTIs
In which patients should Aminoglycosides be avoided?
Pregnant patients and those with severely impaired renal function, diabetes, or hepatic failure.
p.10
Antimicrobial Therapy for UTIs
What caution should be taken when using Aminoglycosides with other drugs?
Use with caution in patients taking other potentially ototoxic and nephrotoxic drugs.
p.8
Antimicrobial Therapy for UTIs
Which pathogens are treated by Third-generation cephalosporins (ceftriaxone)?
Streptococcus, Staphylococcus (not MRSA), and most gram-negative pathogens excluding P. aeruginosa.
p.2
Diagnosis of Urinary Tract Infections
What does the presence of leukocyte esterase in urine indicate?
It indicates pyuria but not specifically bacteria.
p.27
Genitourinary Tuberculosis
What specific symptoms may indicate GU TB?
Dysuria, storage symptoms, hematuria, and flank pain.
p.27
Genitourinary Tuberculosis
What complications can arise from untreated GU TB?
Renal failure and infertility.
p.21
Renal Abscess and Perinephric Abscess
What symptoms may patients with a perinephric abscess present with?
An abdominal or flank mass can be felt in approximately half of the cases.
p.27
Common Pathogens in UTIs
What viruses are responsible for anogenital warts?
Human papillomaviruses (HPVs), specifically types 6 and 11.
p.2
Diagnosis of Urinary Tract Infections
Why is imaging not required in most cases of UTI?
Because most cases can be diagnosed based on urine analysis, but some scenarios may warrant imaging to identify underlying abnormalities.
p.21
Renal Abscess and Perinephric Abscess
What is the recommended treatment for small perinephric abscesses in clinically stable patients?
They may be treated with antibiotics alone.
p.27
Genitourinary Tuberculosis
What happens to the renal parenchyma in progressive GU TB?
Granulomas form and can lead to caseating cavities and abscesses.
