IC13 UTI Flashcards
What are the factors determining UTI development? (3)
- Host defence mechanisms
- Size of inoculum
- Virulence / Pathogenicity (E. coli with pilli hard to washout)
What are host defence mechanisms in UTI? (4)
- Diuresis in bacteria presence
- Antibacterial properties of urine and prostatic secretions
- Anti-adherence mechanisms in bladder wall
- Inflammatory response with PMN (phacogytes)
What are the risk factors for UTI? (10)
- Sex
- Urinary tract abnormalities
- Neuro dysfunction
- Use of anti-cholinergics
- Catheterisation
- DM
- Pregnancy
- Spermicidal or diaphragm use
- UTI history
- Female
What are the counselling points for UTI? (7)
- Drink more water (6-8 cups)
- Pee upon urge
- Pee after sex
- Wear cotton underwear and loose fitting clothes
- Wipe front to back
- Try other methods of contraceptives
- Try not to use unlubricated condoms as they can irritate
What are the two testing methods for UTI?
UFEME and dipstick test
What does UFEME assess?
Pyuria, hematuria and UUTI (from casts)
What does the dipstick test assess?
Nitrite and Leukocyte esterase
What does nitrite positive mean?
Gram negative bacteria
What does LE positive mean?
Leukocytes present in urine, pyuria
When should you culture urine? (5)
Pregnant women
Recurrent UTI
Pyelonephritis
Catheter-associated UTI
UTI in men
Main pathogen for uncomplicated or CA-UTI?
85% E. coli
Pathogens for complicated or HA-UTI?
E. coli, GN bacilli and Pseudomonas
What are the HA-UTI risk factors? (4)
- Past hospitalisation in the last 90 days
- Current hospitalisation 2 or more days
- Residence in nursing home
- Current abx use
When to treat UTI? (3)
- Pregnant women
- Urologic procedure where mucosal damage is expected
- Symptomatic UTI
Treatment for Cystitis in Women
(first line)
PO Co-trimoxazole 800/160mg BD x 3 days
PO Nitrofurantoin 50mg QDS x 5 days
Treatment for Cystitis in Women
(alternatives) (4)
PO Cephalexin 250-500mg QDS x 10-14 days
PO Cefuroxime 250mg BD x 10-14 days
PO Amoxicillin-clavulanate 625mg BD x 10-14 days
PO Fosfomycin 3g single dose
Treatment for Pyelonephritis in Women (first line) (2)
PO Ciprofloxacin 500mg BD x 7 days
PO Levofloxacin 750mg BD x 5 days
[Pyelo = FQ]
Treatment for non-severe Pyelonephritis in Women (alternatives) (4)
PO Co-trimoxazole 800/160mg BD x 10-14 days
PO Cephalexin 500mg QDS x 10-14 days
PO Cefuroxime 500mg BD x 10-14 days
PO Amoxicillin-clavulanate 625mg BD / 1g TDS x 10-14 days
Treatment for severe Pyelonephritis in Women (2) (hint: severe so IV)
IV Cefazolin 1g q8h
IV Amoxicillin-clavulanate 1.2g q8h
Treatment for severe Pyelonephritis in Women (alternatives) (2) (hint: IV beta-lactams)
IV Cefazolin 1g q8h
IV Amoxicillin-clavulanate 1.2g q8h
Concern for prostatitis in men?
(add) PO Ciprofloxacin 500mg BD x 10-14 days
Treatment for Nosocomial infections (first line) (hint: IV)
IV Cefepime 2g q12h (with)
IV Amikacin 15mg/kg q24h x 7-14 days
[NOSO = CARBA]
[Carbapenem + AG]
Treatment of mild nosocomial UTI? (2)
PO Ciprofloxacin 500mg BD x 7-14 days
PO Levofloxacin 750mg BD x 7-14 days
Treatment of catheter-associated UTI (first line) (hint: IV)
IV Cefepime 2g q12h (with)
IV Amikacin 15mg/kg single dose x 7-14 days
[NOSO = CARBA]
[Carbapenem + AG]
Treatment of catheter-associated UTI or nosocomial UTI? (alternative treatment)
IV Imipenem 500mg q6h x 7-14 days
IV Meropenem 1g q8h x 7-14 days
[cath alternatives (CA) = carbapenems]
Drugs to avoid in pregnancy?
Ciprofloxacin
Co-trimoxazole (1, 3 trimester)
Nitrofurantoin (at term 38-42 wks)
Aminoglycosides
Duration of treatment for pyelonephritis in women?
10-14 days
Duration of treatment for nosocomial UTI?
7-14 days
Duration of treatment for cath-associated UTI
7 days, extend to 10-14 in delayed response
