Exam 6 - UTI

Question 1

Lower UTI =

Answer 1

Bladder, Urethra

Question 2

Upper UTI =

Answer 2

Kidney

Question 3

Lower UTI involves _____ and ____, while an Upper UTI involves _____ only.

Answer 3

Lower UTI involves BLADDER and URETHRA, while an Upper UTI involves KIDNEY only.

Question 4

“Simple” UTI =

Answer 4

No underlying problems

Question 5

“Complicated” UTI =

Answer 5

Presence of predisposing condition

Question 6

Which type of UTI (simple or complicated) requires longer duration of treatment?

Answer 6

COMPLICATED

Question 7

Name risk factors for UTI infection (6).

Answer 7

1) Age - younger children and older males
2) Sex - both genders
3) Anatomical abnormalities - bad kidney
4) Instrumentation - catheter
5) Trauma
6) Medications - anticholinergics decrease urine flow; SGLT2 inhibitors

Question 8

Name Community Acquired UTI bacteria (4).

Answer 8

1) E. coli
2) Proteus mirabilis
3) Staph. saprophyticus
4) Klebsiella spp.

Question 9

Name Hospital Acquired UTI bacteria (6).

Answer 9

1) Klebsiella spp.
2) Enterococcus faecalis
3) Pseudomonas aer.
4) E. coli
5) Staphylococcus a.
6) Candida

Question 10

What is the number 1 cause of community acquired UTI?

Answer 10

E. coli

Question 11

List Lower UTI s/s (7).

Answer 11

1) Dysuria
2) Polyuria
3) Urgency
4) Nocturia
5) Fever - possibly, but not usually
6) Confusion - elderly pts
7) Hematuria

Question 12

List Upper UTI s/s (9).

Answer 12

1) Flank pain
2) Malaise
3) Fever
4) Abdominal pain
5) Mental status changes/confusion - elderly
6) N/V
7) Elevated WBC
8) PCT positive
9) Hematuria

Question 13

T/F: You do not treat asymptomatic UTI, unless it is children or pregnancy.

Answer 13

TRUE

Question 14

Name diagnostic features for UTI UA.

Answer 14

>10 WBC's/hpf
>10^5 bacteria/mL urine 
\+nitrites 
\+leukocytes
\+bacteria

Question 15

Name the pts that would be classified as Uncomplicated UTI (6).

Answer 15

1) Immunocompetent
2) Absence of co-morbidities
3) No known urologic problems - polycystic kidney, neurogenic bladder, catheter
4) Non-pregnant
5) Premenopausal
6) Controlled DM (A1c <8)

Question 16

Name pts that would be classified as Complicated UTI (8).

Answer 16

1) Pyelonephritis
2) Immunocompromised
3) Hx of adolescent UTIs
4) PG
5) Underlying metabolic disorder
6) Urologic abnormality (kidney stones, atonic bladder, strictures, etc.)
7) Pre-adolescent or postmenopausal
8) Males <20 or >50

Question 17

What two antibiotics is ESBL producing E. coli sensitive to?

Answer 17

1) Ertapenem - IV only

2) Fosfomycin - expensive

Question 18

When is single dose therapy indicated in the treatment of UTI?

Answer 18

Acute, uncomplicated lower UTI

Question 19

Name the contraindications to single dose therapy for UTI (6).

Answer 19

1) PG
2) Males
3) Children
4) Resistant/relapsing/re-infection
5) Pyelonephritis
6) Complicated infection

Question 20

Name the medication used in single dose therapy for UTIs.

Answer 20

Fosfomycin tromethamine (Monurol) 
-Has a lot of GI upset (take on empty stomach)

Question 21

Name the indications for 3-day therapy for UTIs (3).

Answer 21

1) Healthy men aged 20-40
2) Girls over 5 years w/ symptoms
3) Healthy, non-pregnant women with first or second episode

Question 22

Name the 2 drugs of choice for UTIs.

Answer 22

1) TMP/SMX DS (Bactrim DS) PO BID x 3 days

2) Nitrofurantoin macrocrystals 100 mg PO BID x 5 days
- Not for pts with CrCl <50 mL/min

Question 23

Name the indications for 7-day therapy for UTIS (5).

Answer 23

1) Men >40 years of age
2) pre-existing renal disease
3) PG
4) re-infection or resistant infection
5) children not indicated for 3 day therapy

Question 24

Name the 3 drugs of choice for 7-day therapy for UTIs.

Answer 24

1) TMP/SMX DS (Bactrim DS) PO BID

2) Amox/Clav (Augmentin) 875 mg PO BID
OR Amoxicillin 500 mg PO TID

3) Nitrofurantoin 100 mg PO BID

Question 25

Name alternative drugs for 7-day therapy for UTIs.

Answer 25

3rd generation CPN

• Cefdinir
• Cefpodoxime

Question 26

What are the 3 supportive/adjunctive therapies of UTI treatment?

Answer 26

1) Fluids
2) Phenazopyridine
3) Antipyretics

Question 27

Pyelonephritis is synonymous with upper or lower UTI?

Answer 27

UPPER UTI

Question 28

What life-threatening complications can result from Pyelonephritis?

Answer 28

1) Sepsis

2) Renal failure

Question 29

What is the minimum amount of days for antibiotic treatment with Pyelonephritis?

Answer 29

10-14 days

Question 30

Name the 3 antibiotics used in outpatient therapy for acute pyelonephritis (nonpregnant woment).

Answer 30

1) TMP/SMX DS (Bactrim DS) PO BID x 14 days
2) Ciprofloxacin 500 mg PO BID x 7 days (not empiric therapy)
3) Ceftriaxone 1 g IV/IM x 1 PLUS TMP/SMX or a beta lactam (3rd gen CPN - Cefpodoxime, Cefdinir; Augmentin)

Question 31

What class of CPN are these two drugs: Cefpodoxime, Cefdinir?

Answer 31

3rd Generation

Question 32

T/F: Augmentin is a beta-lactam.

Answer 32

TRUE

Question 33

Who requires inpatient therapy for pyelonephritis? (5)

Answer 33

1) Unable to tolerate medications
2) Dehydration, hypotension
3) Pediatric/elderly
4) Immunocompromised
5) PG

Question 34

Name empiric inpatient therapy options for pyelonephritis (4).

Answer 34

1) Ceftriaxone 1 g IV Q24H
2) Pip/Tazo 4.75 g IV Q8H
3) Ertapenem or Meropenem (hx of ESBL)
4) Ciprofloxacin 400 mg IV Q12H IF local resistance <10%

Question 35

Name alternative inpatient therapy for pyelonephritis that is not that good of an option.

Answer 35

Aminoglycoside +/- Ampicillin

Question 36

How long is the duration for inpatient pyelonephritis therapy?

Answer 36

7-10 days total of antibiotics

Question 37

When is the use of prophylactic antibiotics indicated?

Answer 37

> 3 infections/year

Question 38

What is prophylactic therapy for >3 infections/year unrelated to intercourse?

Answer 38

1) TMP/SMX 1/2 tab hs OR 1 tab 3x/week
2) Nitrofurantoin 50-100 mg hs
3) Cephalexin 250 mg hs

Question 39

What is prophylactic therapy for >3 infections/year related to intercourse?

Answer 39

1) TMP/SMX 1 tab
2) Nitrofurantoin 50-100 mg
3) Cephalexin 250 mg

ALL after intercourse

Question 40

What is the disease state that is a common cause of recurrent infection in males over 30 years of age?

Answer 40

Bacterial Prostatitis

Question 41

What is the most common cause of recurrent UTI in men?

Answer 41

Bacterial prostatitis

Question 42

Name the 5 bacterial pathogens responsible for prostatitis.

Answer 42

1) E. coli
2) Pseudomonas spp.
3) Proteus mirabilis
4) Klebsiella pneumoniae
5) Neisseria gonorrhea

Question 43

How does bacterial prostatitis present?

Answer 43

Similar to UTI - dysuria, frequency, urgency

Hematopsermia and painful ejaculation and/or defecation

Swollen, tender, enlarged prostate

Question 44

How is bacterial prostatitis diagnosed?

Answer 44

Hx and PE

Midstream urine catch

Question 45

Describe prostatitis treatment.

Answer 45

• prolonged antibiotic course (4 weeks) for pts with severe infection (otherwise 10-14 days)
• guided by cultures
• TMP/SMX = DOC when N. gonorrhea is NOT suspected
• FQNs not recommended empirically