Urinary Tract Infections Quiz

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Questions and Answers

What is the minimum CFU/mL count combined with symptoms that indicates a UTI?

≥200 CFU/mL

≥100 CFU/mL

≥50 CFU/mL

≥102 CFU/mL (correct)

Which of the following characteristics is associated with pyuria?

Presence of bacteria not quantified

Less than 10 WBCs per mm3

Nitrites from non-enteric bacteria

Leukocyte esterase presence (correct)

Which medication is considered a first-line treatment for uncomplicated cystitis?

Nitrofurantoin (correct)

Fosfomycin

Ciprofloxacin

Amoxicillin

What is the key contraindication for using Nitrofurantoin?

CrCl < 30 mL/min Signup and view all the answers

What makes ciprofloxacin and levofloxacin inappropriate as first-line agents for uncomplicated cystitis?

Overuse decreasing their efficacy Signup and view all the answers

When treating uncomplicated pyelonephritis, what is a common practice?

Outpatient treatment is acceptable for stable patients Signup and view all the answers

What should be avoided if local susceptibility for trimethoprim/sulfamethoxazole is less than 80%?

Use in uncomplicated cystitis Signup and view all the answers

Which clinical aspect is treated as a complicated UTI for exam consistency?

Men presenting with UTIs Signup and view all the answers

Which symptom is specifically associated with pyelonephritis but not cystitis?

Flank pain Signup and view all the answers

What is a common microorganism responsible for uncomplicated urinary tract infections?

Escherichia coli Signup and view all the answers

Which of the following is NOT considered a risk factor for urinary tract infections?

Diet high in fiber Signup and view all the answers

What is the minimum count of CFU/mL in a urine culture that is indicative of bacteriuria?

≥105 CFU/mL Signup and view all the answers

Which of these is a characteristic symptom of cystitis?

Pyuria Signup and view all the answers

What is the standard of care regarding the use of nitrofurantoin during pregnancy?

It should not be used in the 1st trimester or at term if possible. Signup and view all the answers

Which population is typically considered at an increased risk for complicated urinary tract infections?

Pregnant women Signup and view all the answers

Which of the following factors is NOT associated with complicated urinary tract infections?

Short duration of symptoms Signup and view all the answers

Which antibiotic is recommended for treating mild to moderate pyelonephritis in pregnant women?

Zosyn/Carbapenems (not imipenem) Signup and view all the answers

Which of the following medications poses a risk of fetal ototoxicity?

Aminoglycosides Signup and view all the answers

What distinguishes complicated UTIs from uncomplicated UTIs?

Underlying health conditions Signup and view all the answers

What is a potential concern with the use of sulfonamides during pregnancy?

Hypothetical bilirubin displacement risk in neonates Signup and view all the answers

What is the appropriate treatment duration for uncomplicated urinary tract infections in pregnant women?

4-7 days Signup and view all the answers

Which of the following is the first-line treatment for uncomplicated pyelonephritis?

Ciprofloxacin 500 mg PO bid for 7 days Signup and view all the answers

When should inpatient hospitalization be considered for pyelonephritis?

In cases of severe illness with marked fever and inability to take PO medications Signup and view all the answers

What is the recommended duration of treatment with Levofloxacin for uncomplicated pyelonephritis?

7 days Signup and view all the answers

Which antibiotic should generally not be used for treating uncomplicated pyelonephritis?

Nitrofurantoin Signup and view all the answers

What is a characteristic of complicated UTIs?

Presence of urinary catheterization Signup and view all the answers

Phenazopyridine should be used with caution in which condition?

Renal impairment Signup and view all the answers

What should be done prior to initiating antibiotics for complicated UTIs?

Obtain urine cultures Signup and view all the answers

Which statement accurately describes the use of IV β-Lactams in treating pyelonephritis?

Can be part of the initial therapy for acutely ill patients Signup and view all the answers

What is the first-line drug for uncomplicated cystitis caused by Enterobacterales that produce an ESBL enzyme?

Nitrofurantoin Signup and view all the answers

In cases of bacteriuria during pregnancy, what is the critical cutoff for CFU/mL that indicates asymptomatic bacteriuria?

≥105 CFU/mL Signup and view all the answers

Which of the following is recommended to avoid in pregnant women?

Quinolones Signup and view all the answers

Which treatment is appropriate for pyelonephritis and complicated UTIs caused by ESBL-producing Enterobacterales?

Trim-Sulfa Signup and view all the answers

What does the IDSA recommend for high-risk neutropenia patients regarding asymptomatic bacteriuria (ASB)?

Do NOT screen for ASB Signup and view all the answers

What should be considered before using imipenem-cilastatin during pregnancy?

Potential hypothetical fetal risks Signup and view all the answers

If a pregnant woman has a positive urinalysis for bacteriuria~12–16 weeks gestation, what is the next step?

Immediate treatment regardless of symptoms Signup and view all the answers

In the management of patients critically ill with infections caused by Enterobacterales, which class of drugs is preferred?

Carbapenems Signup and view all the answers

Study Notes

UTI Diagnosis and Urinalysis

A UTI is indicated by ≥102 CFU/mL plus symptoms.
Urinalysis reveals nitrites (from enteric bacteria), leukocyte esterase (from activated WBCs), pyuria (>10 WBCs/mm³), and bacteria (not quantified).

Pathogenesis and Microbiology

Pathogenesis includes risk factors like structural abnormalities, catheterization, pregnancy, and T2DM.
Uncomplicated UTIs primarily caused by Escherichia coli, followed by Proteus and Klebsiella.
Complicated UTIs can involve Candida species, Pseudomonas aeruginosa, and Enterococcus.

Presentation

Symptoms of cystitis: urinary frequency, urgency, dysuria, with possible pyuria or hematuria.
Symptoms of pyelonephritis: cystitis symptoms plus flank pain, fever, chills, and leukocytosis.

Treatment: Uncomplicated UTIs

1st Line:
- Nitrofurantoin 100 mg PO bid for 5 days (CI if CrCl < 30 ml/min).
- Trim/Sulfa 160/800 mg (DS) PO bid for 3 days (avoid if local susceptibility <80%).
2nd Line:
- Fosfomycin 3 g PO as a single dose (inferior bacterial efficacy).
3rd Line:
- Ciprofloxacin or Levofloxacin PO for 3 days (avoid if >10% resistance).
- PO β-Lactams (like Augmentin) for 3-7 days (amoxicillin/ampicillin are not recommended due to resistance).

Complicated UTIs

Increased risk of therapy failure; requires urine culture before starting antibiotics.
Diagnosis includes pyuria that does not confirm a UTI, while the absence may help rule out.
Patients who fail to improve or have severe symptoms may require hospitalization.

Uncomplicated Pyelonephritis Treatment

1st Line: Ciprofloxacin or Levofloxacin for 7 days (monitor local resistance).
2nd Line: Trim/Sulfa for 14 days with possible IV antibiotics before discharge if necessary.
3rd Line: IV β-Lactams, discouraged for PO β-Lactams unless susceptible.

Pain Management

Phenazopyridine (Pyridium, Azo) for symptomatic relief; causes urine discoloration.

Asymptomatic Bacteriuria (ASB)

Screening recommended for pregnant women, not for high-risk neutropenic patients or patients with indwelling catheters.

Pregnancy Considerations

Urinalysis in early pregnancy to screen for bacteriuria is essential.
Treatment should avoid quinolones and tetracyclines; nitrofurantoin is avoided in the 1st trimester and near term.
Pyelonephritis treated with IV antibiotics until the patient is stable, followed by PO options.

Key Takeaways

Understand differences between uncomplicated and complicated UTIs.
Ensure that symptomatic treatment considers underlying conditions and resistance patterns.
Always assess for pyelonephritis in complicated cases and treat accordingly.

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Description

Test your knowledge on urinary tract infections (UTIs), including their pathogenesis, microbiology, and treatment options. This quiz covers both uncomplicated and complicated UTIs, focusing on key symptoms and urinalysis findings. Are you ready to challenge what you know about UTIs?