49. UTIs

Question 1

when do you treat asymptomatic UTIs?

Answer 1

when there is evidence of potential benefit - ie for pregnant women who test positive in 1st tri (all should be tested)

Question 2

acute uncomplicated cystitis is an infection of what?

Answer 2

the bladder (usu from ascent of bacterial pathogen)

commonly found in women 15-29, infants, and older ppl (5:1 female:male ratio)

Question 3

organisms causing acute uncomplicated cystitis?

Answer 3

E.coli
S.saphrophyticus
Klebsiella

Question 4

RFs for acute uncomplicated cystitis?

Answer 4

sexual intercourse

UTIs in prev 12 mos

diabetes

stress incontinence in prev 30 days

new sex partner in prev year

recent spermicide use +/- diaphragm

history of UTI in pt’s mother

Question 5

risk factors for antibiotic resistance in UTIs?

Answer 5

visits to healthcare centers

recent use of Abx (esp cephalosporins and FQ)

old age

comorbidities (diabetes, recurrent UTIs)

Question 6

Sxs of acute uncomplicated cystitis (or complicated)?

Answer 6

LUTS (dysuria, frequent voiding of small volumes, urgency)

hematuria, suprapubic pain

less likely if vaginal discharge or irritation

dx w/ nitrites of LE on urine dip

Question 7

treatment of acute uncomplicated cystitis?

Answer 7

1st: nitrofurantoin (100 mg BID X5D), fosfomycin (1 3g sache), or TMP-SMX (1 tab PO BID x 3D)

2nd line:
FQ (cipro, levofloxacin)
(more appropriate for allergies)

Question 8

acute pyelonephritis is an infection of what?

Answer 8

renal pelvis and kidney (usu from ascent of bacterial pathogen)

common in healthy women 15-29, infants and the elderly

Question 9

organisms causing acute pyelonephritis?

Answer 9

E.coli

Klebsiella pneumoniae

S.staphrophyticus

Question 10

RFs for acute pyelonephritis?

Answer 10

Sexual intercourse

UTI in past 12 mos

diabetes

stress incontinence in past 30 days

new sex partner in past year

recent spermicide use

hx of UTI’s in pt’s mother

Question 11

dx of acute pyelonephritis?

Answer 11

LUTS, **flank pain, nausea, vomiting, anorexia, abd pain, fever, tachycardia, hypotension (super bad), CVA tenderness, suprapubic/abd tenderness

UA positive LE and hematuria

peripheral blood smear w/leukocytosis w/or w/o left shift
(positive blood cx in only 15-30%)

urine culture growing lots of orgs

Question 12

considerations for treatment of acute pyelonephritis?

Answer 12

effectiveness

risk of adverse effects

resistance rates in local community - FQ RESISTANCE > or

Question 13

when to give inital IV dose re: acute pyelonephritis?

Answer 13

pts w/nausea or vomiting

local FQ resistance >10%

required use of oral B-lactam abx or bactrim ( re allergy, interactions or availability)

Question 14

predisposing factors to complicated UTI?

Answer 14

multiparous
benign prostatic hypertrophy
prostate cancer
neurogenic bladder
immunocompromised states
underlying diseases
indwelling catheters

Question 15

pediatric UTI dx?

Answer 15

pyuria and at least 50,000 colonies per mL of single uropathogenic organism in an appropriately collected specimen of urine

Question 16

pediatric UTI tx?

Answer 16

any oral abx w/good gram-negative coverage is a reasonable choice: TMP/SMX, amoxicillin, nitrofurantoin

monitor closely after 7-14 days of tx

Question 17

pediatric UTIs complications?

Answer 17

sometimes assoc w/vesicoureteral reflux

only order voiding cystourethrography (VCUG) if 2+ UTIs or if renal/baldder ultrasound reveals hydronephrosis, scarring, or other findings that would suggest high grade VUR or obstructive uropathy

Question 18

acute pyelonephritis treatment?

Answer 18

If FQ resistance >10%, start w/IV ceftriaxone or gentamicin, then give PO FQ

FQ first IV then cipro orally BID X 7D or TMP/SMX 800 mg orally BID X14D