Lecture 11 - UTI Flashcards
How to pathogens generally get into body to get UTI?
Mostly ascending, common up from urethra
Descending not common
Host defense mechanisms of UTI
Anatomy
Pee power = urination
pH of Urine
Mobilization of PMNs
Lower Tract infection
Cystitis, Bladder
Signs & symptoms:
Dysuria, urgency, frequency, nocturne, and suprapubic heaviness
Upper Tract infection
pyelonephritis, Kindeys
Signs & Symptoms:
Flank pain, Costovertebral angle tenderness, fever, nausea, vomiting, malaise
What is an uncomplicated infection?
no structural or functional abnormalities
Not preggo
No urologic instrument
Premenopausal age
What is complicated infection?
complex anatomy ie Male*
Catheter placement
Risk factors for UTI
Catheterization = biggest risk
Gender
Age
Sexy time
Diaphragm/spermicide use
Hx of UTI
renal disease
diabetes
drugs
UTI diagnosis?
Urinalysis and Urine culture
When should you collect urine?
Mid stream is what you want
What to look for on UA for UTI?
Bacteria = present
WBC > 10, indicates pyuria/inflammation
Squamous Epithelial high amount (> 4)= contamination sample
What to look for on Urine culture for UTI?
Significant bacteriuria = > 10,000 CFU
Less likely UTI of < 10,000 CFU
Situations in which lower colony counts may be sig include…
pts who already on abx on time of culture
Symptomatic young women
Suprapubic aspiration
Men with pyuria ( 10+ WBC per cubic mL)
Acute uncomplicated Cystitis 1st line rec
Nitro 100mg BID 5 days
Bactrim DS BID 3 days (dont use if resistance > 20%)
Fosfomycin 3g Daily 1 day
Acute uncomplicated Cystitis alternatives
FQ: ofloxacin, cipro, levo = 3
B lactam = amox/clav, cefdinir, cefaclor, cem/pro = 3-7 days
Nitro clinical pearls
dont use CrCl < 30
dont use pyelonephritis
fosfomycin clinical pearls
single dose
dont use pyelonephritis
Bactrim clinical pearls
Hyperkalemia
Sulfa allergy
Fluoroquinolone clinical pearls
QTc prolongation
Seizure risk
Moxi = dont get renally cleared so dont use
if you get < 3 episodes of UC cystitis then….
treat as separately occurring infection
If you get > 3 episodes/yr or 2 episodes/6 months treat as Relapse or Reinfection
Relapse: same organism and susceptibility, extend ABX duration
Reinfection: different pathogen/strain, retreat and consider prohlyaxis
Prophylaxis of Reinfection UTI post sex treatment
Bactrim
Nitro
Cephalexin
Cipro
All for one dose
Prophylaxis of reinfection UTI unknown cause
6 month treatment
Bactrim QD or TIW
Nitro QD
Cephalexin QD
fosfomycin q10 days
if infection occurs, switch to therapy and then back to prophylaxis
Complicated Cystitis treatments
- get urine culture & use susceptibilities
Durations: varies
Pyelonephritis Outpatient Mild-moderate txm
Levo 750 = 5 days
Cipro 1000 or 500 BID = 7
Bactrim DS BID = 14
IF > 10% resistance to FQs, give 1 dose of IV ceftriaxone or AG
Pyelonephritis Inpatient Severe Txm
Ceftriaxone**
AGs
Cefepime
Pip/tazo
Carbapenem
FQs
7-14 days, IV -> PO when stable
Asymptomatic Bacteriuria info
if no symptoms then shouldn’t use Abx
Exceptions: preggo, urological procedure w/ anticipated bleeding
Risk of untreated ASB (asymptomatic Bacteriuria) in preg
potential to cause serious adverse effects, prematurity, low birth weight and still birth
UTI in pregnancy treatments
Amox
Amox-clav
Cephalexin
Babies love beta lactams = 4-7 day treatment
Avoid nitro at term. Avoid Bactrim at 1st term and post 38week
Avoid Tetracyclines & FQs***
Premature brith = primary risk
Prostatitis symptoms
Acute: fever, chills, malaise, tenderness, myalgia
Chronic > 3 months difficulty peeing, lower back pain, discomfort
Prostatitis treatment
Bactrim, cipro, levo
Acute = 2-4weeks, Chronic = 4-6wks chronic
** Avoid Nitro **
Candiduria treatment
Fluconazole 200 Daily
Likely related to catheterization…remove and re-eval
0 days most patients, 7-14 days if treating
Urinary Aanalgesics Phenazopyridine
Common ADRs: red/orange discoloration
Indication: Max of 2 days
Dont use CrCl < 50, can mask symptoms UTI
Preventive Care for UTI
Better hydration
Pee after sex
Cranberry juice = sus evidence
Lactobacillus = probiotic
