Exam 6 - UTI Flashcards
Lower UTI =
Bladder, Urethra
Upper UTI =
Kidney
Lower UTI involves _____ and ____, while an Upper UTI involves _____ only.
Lower UTI involves BLADDER and URETHRA, while an Upper UTI involves KIDNEY only.
“Simple” UTI =
No underlying problems
“Complicated” UTI =
Presence of predisposing condition
Which type of UTI (simple or complicated) requires longer duration of treatment?
COMPLICATED
Name risk factors for UTI infection (6).
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
Name Community Acquired UTI bacteria (4).
1) E. coli
2) Proteus mirabilis
3) Staph. saprophyticus
4) Klebsiella spp.
Name Hospital Acquired UTI bacteria (6).
1) Klebsiella spp.
2) Enterococcus faecalis
3) Pseudomonas aer.
4) E. coli
5) Staphylococcus a.
6) Candida
What is the number 1 cause of community acquired UTI?
E. coli
List Lower UTI s/s (7).
1) Dysuria
2) Polyuria
3) Urgency
4) Nocturia
5) Fever - possibly, but not usually
6) Confusion - elderly pts
7) Hematuria
List Upper UTI s/s (9).
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
T/F: You do not treat asymptomatic UTI, unless it is children or pregnancy.
TRUE
Name diagnostic features for UTI UA.
>10 WBC's/hpf >10^5 bacteria/mL urine \+nitrites \+leukocytes \+bacteria
Name the pts that would be classified as Uncomplicated UTI (6).
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)
Name pts that would be classified as Complicated UTI (8).
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
What two antibiotics is ESBL producing E. coli sensitive to?
1) Ertapenem - IV only
2) Fosfomycin - expensive
When is single dose therapy indicated in the treatment of UTI?
Acute, uncomplicated lower UTI
Name the contraindications to single dose therapy for UTI (6).
1) PG
2) Males
3) Children
4) Resistant/relapsing/re-infection
5) Pyelonephritis
6) Complicated infection
Name the medication used in single dose therapy for UTIs.
Fosfomycin tromethamine (Monurol) -Has a lot of GI upset (take on empty stomach)
Name the indications for 3-day therapy for UTIs (3).
1) Healthy men aged 20-40
2) Girls over 5 years w/ symptoms
3) Healthy, non-pregnant women with first or second episode
Name the 2 drugs of choice for UTIs.
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
Name the indications for 7-day therapy for UTIS (5).
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
Name the 3 drugs of choice for 7-day therapy for UTIs.
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
Name alternative drugs for 7-day therapy for UTIs.
3rd generation CPN
- Cefdinir
- Cefpodoxime
What are the 3 supportive/adjunctive therapies of UTI treatment?
1) Fluids
2) Phenazopyridine
3) Antipyretics
Pyelonephritis is synonymous with upper or lower UTI?
UPPER UTI
What life-threatening complications can result from Pyelonephritis?
1) Sepsis
2) Renal failure
What is the minimum amount of days for antibiotic treatment with Pyelonephritis?
10-14 days
Name the 3 antibiotics used in outpatient therapy for acute pyelonephritis (nonpregnant woment).
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)
What class of CPN are these two drugs: Cefpodoxime, Cefdinir?
3rd Generation
T/F: Augmentin is a beta-lactam.
TRUE
Who requires inpatient therapy for pyelonephritis? (5)
1) Unable to tolerate medications
2) Dehydration, hypotension
3) Pediatric/elderly
4) Immunocompromised
5) PG
Name empiric inpatient therapy options for pyelonephritis (4).
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%
Name alternative inpatient therapy for pyelonephritis that is not that good of an option.
Aminoglycoside +/- Ampicillin
How long is the duration for inpatient pyelonephritis therapy?
7-10 days total of antibiotics
When is the use of prophylactic antibiotics indicated?
> 3 infections/year
What is prophylactic therapy for >3 infections/year unrelated to intercourse?
1) TMP/SMX 1/2 tab hs OR 1 tab 3x/week
2) Nitrofurantoin 50-100 mg hs
3) Cephalexin 250 mg hs
What is prophylactic therapy for >3 infections/year related to intercourse?
1) TMP/SMX 1 tab
2) Nitrofurantoin 50-100 mg
3) Cephalexin 250 mg
ALL after intercourse
What is the disease state that is a common cause of recurrent infection in males over 30 years of age?
Bacterial Prostatitis
What is the most common cause of recurrent UTI in men?
Bacterial prostatitis
Name the 5 bacterial pathogens responsible for prostatitis.
1) E. coli
2) Pseudomonas spp.
3) Proteus mirabilis
4) Klebsiella pneumoniae
5) Neisseria gonorrhea
How does bacterial prostatitis present?
Similar to UTI - dysuria, frequency, urgency
Hematopsermia and painful ejaculation and/or defecation
Swollen, tender, enlarged prostate
How is bacterial prostatitis diagnosed?
Hx and PE
Midstream urine catch
Describe prostatitis treatment.
- 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
