#91 Treatment of Urinary Tract Infections in Nonpregnant Women

Question 1

What is the lifetime probability that a woman will have a UTI?

Answer 1

60%

Question 2

Definition of asymptomatic bacteriuria?

Answer 2

Considerable bacteriuria in a woman with no symptoms

Question 3

Definition of cystitis?

Answer 3

Infection limited to the lower urinary tract and occurs with symptoms of dysuria and frequent and urgent urination and, occasionally, suprapubic tenderness

Question 4

Definition acute pyelonephritis?

Answer 4

Infection of the renal parenchyma and pelvicaliceal system accompanied by significant bacteriuria, usually occurring with fever and flank pain.

Question 5

What is a UTI relapse?

Answer 5

Recurrent UTI with the same organism after adequate therapy

Question 6

What is a UTI reinfection?

Answer 6

Recurrent UTI caused by bacteria previously isolated after treatment and a negative intervening urine culture result or a recurrent UTI caused by a second isolate.

Question 7

What bacteria causes most cases of UTI?

Answer 7

Escherichia coli (80-90%) (predominantly O, K, and H antigen serotypes)

Question 8

What virulence factors facilitate e coli infection of vagina and uroepithelium cells?

Answer 8

Type 1 fimbria, P-fimbria, and S-fimbria, enhance binding to vaginal and uroepithelial cells. Virulence factors also increase resistance to serum bactericidal activity and resistance to host phagocytic activity.

Question 9

What is the predominant route of infection in the urinary tract?

Answer 9

Ascending infection

Question 10

Can a urinary infection be caused by blood borne bacteria?

Answer 10

Bloodborne pathogens may seed the renal parenchyma during episodes of bacteremia. Renal abscesses may arise from bacterial endocarditis bacteremia from Staphylococcus aureus. Rare cases of pyelonephritis, caused by fungemia from Candida species in hospitalized patients, have been reported.

Question 11

What are risk factors for UTI in a premenopausal woman?

Answer 11

Hx of UTI, recent or frequent sexual intercourse, use of diaphragm contraception, use of spermicide, increasing parity, diabetes, obesity, sickle cell trait, urinary tract calculi, anatomic abnormalities, indwelling or repetitive catheterization

Question 12

What are risk factors for UTI in a post menopausal woman?

Answer 12

vaginal atrophy, incomplete bladder emptying, poor perineal hygiene, rectocele, cystocele, urethrocele, uterovaginal prolapse, lifetime hx of UTI, type 1 DM.

Question 13

Presentation of older woman with UTI?

Answer 13

Asymptomatic, present moribund from septic shock (urosepsis), have symptoms only of urinary incontinence, or have any combination of these symptoms.

Question 14

How do you define significant bacteriuria based on culture?

Answer 14

> 100k CFU/mL from clean catch urine. Decrease to 1k - 10k for symptomatic patients.

Question 15

Resistance rates higher than what %age necessitate a change in antibiotic class?

Answer 15

higher than 15–20%

Question 16

What is the duration of antibiotic therapy for uncomplicated UTI?

Answer 16

Preferred is 3 day course. Some antibiotics need 7 day course

Question 17

Can acute pyelonephritis be treated as an outpatient?

Answer 17

Yes, in otherwise healthy women who are clinically stable, able to tolerate oral antibiotics, reliable to follow treatment plan

Question 18

What is the treatment duration for pyelonephritis? IV vs PO

Answer 18

Both are 14 days course

Question 19

What testing should be done after treatment for acute pyelonephritis and how soon after?

Answer 19

Urine culture immediately after finishing 2 week abx course

Question 20

How do you manage patients with recurrent UTIs?

Answer 20

Lifestyle changes. Suppressive abx therapy

Question 21

Is patient-initiated therapy appropriate for patients who suspect UTI?

Answer 21

Yes for patient with history of recurrent UTI. Has been found to be safe, effective, and economical. However, should instruct patients to come to the office if symptoms not better within 48h.

Many post menopausal women will have frequency and urgency and intermittent dysuria without UTI, should test them to avoid inappropriate antibiotic use

Question 22

When is a urine culture necessary (in context of suspected urinary infection)?

Answer 22

If patient not getting better after 48h of treatment. All cases of suspected upper urinary infections

Question 23

What is the best noninvasive mode of imaging to assess renal collecting system obstruction?

Answer 23

Renal ultrasound

Question 24

What treatment should be used for women with suspected urosepsis?

Answer 24

Broad spectrum IV abx. Aminoglycosides + ampicillin, piperacillin of first gen cephalosporin, third gen cephalosporin, aztreonam, piperacillin-tazobactam, fluoroquinolones

Question 25

How does cranberry juice affect UTI?

Answer 25

Decreases risk of recurrent UTI by the proanthocyanidin-inhibiting attachment of urinary pathogens to the urinary tract epithelial cells

Question 26

In whom do we treat asymptomatic bacteriuria?

Answer 26

all pregnant women, women undergoing a urologic procedure in which mucosal bleeding is anticipated, and women in whom catheter-acquired bacteriuria persists 48 hours after catheter removal.