Exam 3 - UTIs Flashcards
what are examples lower urinary tract infections?
cystitis (bladder)
urethritis (urethra)
prostate (prostatitis)
what are examples of upper urinary tract infections?
pyleonephritis (kidney)
definition of uncomplicated UTI?
a young female with no structural/functional abnormalities
definition of complicated UTI?
some blocking the urine flow
in men, old people, or pregnant people
Definition of Recurrent UTI?
> /= 2 UTIs in 6 mos
or
/= 3 UTIs in 1 year
definition of reinfection vs recurrent UTIs
reinfection: occurs over 2 weeks after treatment (will be a diff bug)
recurrent: occurs within 2 weeks (will be same bug form first infection)
Definition asymptomatic bacteriuria?
common in pts > 65 yo significant bacteriuria (>10^5) but NO symptoms
when to treat asymptomatic bacteriuria
if pregnant woman
Criteria for Significant Bacteriuria:
_____ CFU bacteria/mL in a symptomatic male
> /= 10^4
Criteria for Significant Bacteriuria:
_____ CFU bacteria/mL in asymptomatic individuals on two consecutive specimens
> /= 10^5
Criteria for Significant Bacteriuria:
_____ CFU coliforms/mL in a symptomatic females
or
_____ CFU noncoliforms/mL in a symptomatic females
> /= 10^2 coliforms
> /= 10^5 noncoliforms
2 pathogenesis ways for UTIs?
ascending pathway (colonic pathway enters urethra/vagina --> bladder = colonization) OR hematogenous spread (infection comes from a distal site of infection)
Host defense mechanisms against UTIs?
- Urine – low pH, high urea, osmolality extremes
- Flushing/voiding/urinating
- when bacteria into bladder – you diuresis more than normal to get it out
- urinary mucus prevents adherence of bacteria
- lactobacillus present in vagina (related to estrogen)
Common ADEs for acute pyelonephritis?
FLANK pain!
more systemic symptoms (fever/chills)
Abx options for UTIs?
Macrobid SMX-TMP fosfomycin FQs (not first line) beta lactams (not first line)
Side effects of macrobid?
pulmonary toxicity**
antacids decrease rate of absorption
hepatoxicity
peripheral neuropathy
Contraindications for macrobid?
CrCl < 30 mL/min
Pregnant women at term (38 - 42 wks)
neonates < 1 month of age
How long to treat UTI? Macrobid: SMX-TMP: Fosfomycin: FQs: beta-lactams:
macrobid: 5 days SMX-TMP: 3 days Fosfomycin: 1 day (one dose) FQs: 3 days beta lactams: 3 - 7 days
How long to treat UTI?
If pt is complicated (diabetes, symptoms > 7 days, recent UTI, use of diaphragm, or > 65 yr old)
7 - 10 days of treatment
How long to treat UTI?
If pregnant?
7 days!
what UTI drugs should be avoided in pregnancy?
Macrobid (at term)
and SMX-TMP (in last trimester due to hyperbilirubinemia/kernicterus)
Post coital therapy for UTI prevention?
1 dose SMX-TMP after sex (only 1 tab per day max)
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - Enterobacteriaceae?
Cipro or Levofloxacin
or SMX/TMP
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - Enterococcus species?
ampicillin
vanc
(or linezolid or levofloxacin)
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - Pseudomonas
ciprofloxacin
pip/tazo
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - FQ-R enterobacteriacease
ertapenem (ceftriaxone/meropenem)
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - ESBL/Amp-C producing enterobacteriaceae?
ertapenem (cefepime)
Prostatitis Treatment - Primary empiric regimen:
Acute/Uncomplicated - FQ-R Pseudomonas
Imipenem (meropenem)
