EXAM 3 UTI Flashcards
UTI risk factors
female: more common
Previous UTI, urinary tract obstruction, instrumentation and catheterization
male:
condom catheterization
complicated UTIs characteristics
anatomic abnormality: obstruction, hydronephrosis, renal tract calculi, colovesical fistula
recent procedure/instrumentation: placement of tubes, stent, catheters
immunocompromised
recurrent infections despite treatment
male sex
UTI in pregnancy
What is the most common pathogen for UTI?
E. Coli
UTI presentation
New onset dysuria, increased urination, and frequency
Suprapubic heaviness
Urine smelling/turbid
Hematuria
Pyelonephritis presentation
UTI symptoms
Systemic symptoms – fever, chills, rigors, nausea, vomiting, diarrhea
Flank pain –> CVA (costovertebral angle) tenderness
complicated UTI presentation
Classic UTI symptoms
Fever
Malaise
Altered mental status –> alone does not mean UTI
Urinary incontinence
Change in appetite
catheter-associated UTI
Classic UTI symptoms often not present
Pain over kidney and bladder
Fever
Lethargy and malaise
UTI and pyelonephritis diagnosis
Cystitis symptoms or Pyelonephritis symptoms
+ microbiological criteria:
> 10^5 of > 1 bacterial species from a clean void
> 10^3 of > 1 bacterial species from a catheter (placed in last 48hr)
UTI urinalysis
Bacteria present
WBC present > 10 cells/hpf
Leukocyte (WBC) esterase present
Nitrate may/may not be present (enterobacterales)
Takes hours
UTI urine culture
Identifies organism for antibiotic selection
Repeat urine culture after treatment generally not recommended
May require criteria for urine culture to reduce overtreatment UTI
2-3 days
asymptomatic bacteriuria
Typically ASB does not require treatment
Most common misdiagnosed infection as UTI
Overdiagnosis leads to ABX resistance
UTI treatment drugs
Nitrofurantoin (uncomplicated)
Fosfomycin (ucomplicated)
SMX/TMP
Fluoroquinolones: ciprofloxacin, levofloxacin
B-lactams
which b-lactams can be used in UTI
Cephalexin
Cefadroxil
Cefpodoxime
Amoxicillin/clavulanate
Amoxicillin (only after susceptibility confirmed)
treatment duration for UTIs
uncomplicated: 3-7 days
complicated: 7-14 days
inpatient treatment UTI
IV treatment is started while we wait on cultures
Ampicillin/gentamicin
piperacillin/tazobactam
cefazolin/gentamicin
gentamicin alone
cefepime
ceftraixone
considerations for hospitalized patients UTI treatment
Bacteremia can occur in patients w/ complicated UTI and pyelonephritis
De-escalate to narrow spectrum antibiotic
prostatitis considerations
treatment similar to UTI
ABX must penetrate prostate
duration: 2-4 weeks
prostatitis treatment
recommended therapies:
Fluoroquinolones
Sulfamethoxazole/trimethoprim
some b-lactams (cephalexin, amoxicillin/clavulanate)
recurrent UTI management
definition: 3+ in 1 year or 2+ in 6 mos
May consider prophylactic ABX:
choose narrow spectrum –> nitrofurantoin or bactrim
