Chapter 76: Therapy for UTI Flashcards
infections of the kidney and urinary tract
Predominately in women;
any UTI in a man should be followed up with imaging for anatomical abnormalities
infections of the kidney and urinary tract causes
Complicated:
Instrumentation (catheters, procedures) immunosuppression, obstruction, ureteral or urethral strictures, tumors. Pregnancy.
Elderly - much higher incidence of anatomic abnormalities including benign prostatic hypertrophy, urethral stricture, neurogenic bladder.
Men
Uncomplicated:
Common in women in childbearing age.
Clinical manifestations between women/men are generally the same: dysuria, urgency, frequency, fatigue, nausea and lethargy.
UTI pathogens
Mainly women
Escherichia coli accounts for 80%
Staphylococcus saprophyticus 5-15%.
Staphylococcus species.
Klebsiella species
Proteus species
Men, including the above +
50% cases include Proteus spp.,
Klebsiella,
multiple gram-negative enterococcus
pyelonephritis s/sx
flank pain, high fever, malaise, WBC and bacteria in urine, urinary s/sx similar to cysitis
cystitis s/sx
increased urinary frequency, urgency, dysuria (painful urination) pain above pubic region, WBCs and bacteria in urine, more common in women
commonly used UTI drugs
Trimethoprim-sulfamethoxazole [TMP/SMX (Bactrim)]**
Ciprofloxacin
Amoxicillin/clavulanate (Augmentin)
other considerations for UTI
Nitrofurantoin (Macrobid)**
1st line treatment for uncomplicated UTI in women
Concentrated purely in the urine (not used for Pyelonephritis)
Long term use can lead to pulmonary fibrosis
Fosfomycin (Monurol) **
1 pill dose
UTI Geriatric Considerations
Epidemiology: Most common clinical illness for adults over 65 years of age.
Men 10.9/100
Women 14/100
Causes
Gram – bacilli
Gram + organisms
Fungi (especially in patients with indwelling catheters
S/S
Same + lethargy and confusion
Lab/Dx
Multiple organisms often present
change in behavior in gero patient causes include
UTI
Pneumonia
TIA
Drug toxicities
