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Infection > Recurrent UTI > Flashcards

Recurrent UTI Flashcards

1
Q

definition recurrent UTI

A

recurrences of complicated or uncomplicated
at least 3 in a year
or two UTI in last 6 months

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2
Q

prevalence rUTI in young women

A

20-50% with UTI will have another one within a year

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3
Q

risk of UTI in women in lifetime

A

50%

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4
Q

prevelence of rUTI

A

30% of those with one uti will have rUTI

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5
Q

Lawrentshuk 2006 flexi

van haarst urology 2001

A

8% had abnormalities on cystoscopy
NPV of imaging was 99%
so no cystoscopy in women with no risk factors and normal imaging

Van haarst 2001
100 women less than 40, 1% abnormal imaging, 22% abnormal cystoscopy - never relevant

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6
Q

imaging in rUTI

A

US beneficial in women Franco 2005 best practice clinic obs gynae

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7
Q

non pharm management

A 
D mannose
cranberry tablets
topical vaginal oestrogens
methenamine hippurate
vaccines
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8
Q

cranberry products

A 
Jurol 2017
28 trials SR
RR 32%
Luis
evidence probably helps
no conclusion on formulation
avoid if on warfarin
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9
Q

vaginal oestrogen cream

Raz and stamm

A 
estriol cream
0.5mg
applied topically
night 2 weeks 
then twice weekly for 8 months
reduced rUTI 16% vs 62% NNT 2-4 NEJM 1992 Raz and Stamm
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10
Q

D mannose
SR
dose
action mechanism

A

rct non blinded
dose 2g superior placebo and as effective as nitro
SR Kyriakides 2020
inhibits bacterial adherence to urothelial cells

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11
Q

methanamine hippurate
trial
mechanism

A 
converted to formaldehyde in acidid urine environment
directly toxic
ALTAR trial results
compared abx - Forbes, Chris Harding 
hipprex is non inferior
less costly
new first line option
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12
Q

dose hipprex

A

1g every 12 hours
in catheters
1g every 8-12 hours

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13
Q

dose hipprex

A

1g every 12 hours
in catheters
1g every 8-12 hours

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14
Q

CI to hipprex

A

gout
metabolic acidosis
severe dehydration

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15
Q

CI to hipprex

A

gout
metabolic acidosis
severe dehydration

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16
Q

vaccines
name recommended by EAU
what is it

A

UroVaxom is only one recommended EAU
immunologically active bacterial lysates of 18 ecoli strains

also Urovac
and UROMUNE

17
Q

cochrane review of prophylactic abx

A

RR 0.21 for single recurrence NNT 1.85 but RR after completion prophylaxis is 0.82

18
Q

cochrane review of prophylactic abx

A

RR 0.21 for single recurrence NNT 1.85 but RR after completion prophylaxis is 0.82

19
Q

cure rate self start abx

A

> 09 Hooton NEJm 2012

20
Q

principle of intravesical treatment

A

glycosaminoglycan hyaluronic acid HA and chrondroitin sulphate CS used to enhance protective function urothelium

21
Q

intravesical agents

A

cystistat HA
hyacyst HA
gepan CS
iAluril HA and CS

22
Q

SR of intravesical

A

De Vita

decreased cystitis recurrence, UTI recurrenc enad pelvic pain

23
Q

action of cranberries
containing compound
how they act against ecoli

A

Prophylaxis with cranberries is a potential prevention strategy with
health benefits associated with the high concentrations of polyphenols such as PACs proanthocyanidins in these berries.
PACs are stable phenolics with antiadhesion activity against E. coli.
They act as receptor analogues and inhibit E. coli adhesion to cells by binding to the fimbrial tips

24
Q

dose of cranberry products

A

Stothers described 2
ways of orally administering cranberry products,
that is tablets of concentrated cranberry juice and
pure unsweetened cranberry juice.
Wing et al administered 2 doses of PACs, including a high dose (240 mg PACs per day) and a low dose (80 mg PACS per day).

25
Q

Wan systematic review cranberry products

A

The findings clearly showed the potential use of cranberries for the
clinical condition of urinary tract infection. Cranberry products significantly reduced the incidence of urinary tract infections as indicated by the weighted risk ratio (0.6750, 95% CI 0.5516e0.7965, p <0.0001). The results of subgroup analysis demonstrated that patients at some risk for urinary tract infections were more susceptible to the effects of cranberry ingestion.

26
Q

history of recurrent UTI -8

A

Distinguish between isolated UTI and recurrent
Upper or lower tract
Sexual history and relevant association UTI
Past urological history, factors suggesting UTI may be complicated
Fluid intake
Use of antibiotic
Wiping patterns
Pregnancy status, use of oral contraceptive
Past medical history, drugs, immunocompromise

27
Q

prevention strategies of rUTI -7

A 
Ensure high fluid intake
Void before and after sexual intercourse
Avoid detergents in bath
Avoid spermicidal contraceptives
Keep urine acidic
Lactobacilli to vaginal area
Topical oestrogen 
Cranberry juice and tablets
28
Q

which rUTI prevention have evidence 5

A 
topical oestrogens
d mannose
prophylactic abx
some for cranberry
avoid spermicides
29
Q

how does d mannose works

A

inhibits adhesion of bacteria and improving clearnace of bacteria in urine

Infection (16 decks)

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