#91 Treatment of Urinary Tract Infections in Nonpregnant Women Flashcards
What is the lifetime probability that a woman will have a UTI?
60%
Definition of asymptomatic bacteriuria?
Considerable bacteriuria in a woman with no symptoms
Definition of cystitis?
Infection limited to the lower urinary tract and occurs with symptoms of dysuria and frequent and urgent urination and, occasionally, suprapubic tenderness
Definition acute pyelonephritis?
Infection of the renal parenchyma and pelvicaliceal system accompanied by significant bacteriuria, usually occurring with fever and flank pain.
What is a UTI relapse?
Recurrent UTI with the same organism after adequate therapy
What is a UTI reinfection?
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.
What bacteria causes most cases of UTI?
Escherichia coli (80-90%) (predominantly O, K, and H antigen serotypes)
What virulence factors facilitate e coli infection of vagina and uroepithelium cells?
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.
What is the predominant route of infection in the urinary tract?
Ascending infection
Can a urinary infection be caused by blood borne bacteria?
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.
What are risk factors for UTI in a premenopausal woman?
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
What are risk factors for UTI in a post menopausal woman?
vaginal atrophy, incomplete bladder emptying, poor perineal hygiene, rectocele, cystocele, urethrocele, uterovaginal prolapse, lifetime hx of UTI, type 1 DM.
Presentation of older woman with UTI?
Asymptomatic, present moribund from septic shock (urosepsis), have symptoms only of urinary incontinence, or have any combination of these symptoms.
How do you define significant bacteriuria based on culture?
> 100k CFU/mL from clean catch urine. Decrease to 1k - 10k for symptomatic patients.
Resistance rates higher than what %age necessitate a change in antibiotic class?
higher than 15–20%
What is the duration of antibiotic therapy for uncomplicated UTI?
Preferred is 3 day course. Some antibiotics need 7 day course
Can acute pyelonephritis be treated as an outpatient?
Yes, in otherwise healthy women who are clinically stable, able to tolerate oral antibiotics, reliable to follow treatment plan
What is the treatment duration for pyelonephritis? IV vs PO
Both are 14 days course
What testing should be done after treatment for acute pyelonephritis and how soon after?
Urine culture immediately after finishing 2 week abx course
How do you manage patients with recurrent UTIs?
Lifestyle changes. Suppressive abx therapy
Is patient-initiated therapy appropriate for patients who suspect UTI?
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
When is a urine culture necessary (in context of suspected urinary infection)?
If patient not getting better after 48h of treatment. All cases of suspected upper urinary infections
What is the best noninvasive mode of imaging to assess renal collecting system obstruction?
Renal ultrasound
What treatment should be used for women with suspected urosepsis?
Broad spectrum IV abx. Aminoglycosides + ampicillin, piperacillin of first gen cephalosporin, third gen cephalosporin, aztreonam, piperacillin-tazobactam, fluoroquinolones
How does cranberry juice affect UTI?
Decreases risk of recurrent UTI by the proanthocyanidin-inhibiting attachment of urinary pathogens to the urinary tract epithelial cells
In whom do we treat asymptomatic bacteriuria?
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.
