Recurrent UTIs

Question 1

rUTI minimum workup

Answer 1

-History (LUTS, bowel Sx, flank pain, menopausal status, timing of infections, contraceptive methods,
-Pelvic exam (tic, pelvic floor,
-Review documented positive cultures
-Ensure no contamination (consider catheterized specimen)

Question 2

rUTI definition

Answer 2

3+ in a year or 2+ in 6 months
NOT pregnant, not on ISC or with foley

Question 3

DDx for rUTIs (9)

Answer 3

Urethral atrophy
Stone
Urethral diverticula
UPJO
Poor emptying
DM2
Neoplasm
VUR
Fistula
Foreign body

Question 4

Imaging for rUTIs

Answer 4

Do NOT routinely obtain in index patient
-Obtain if inappropriate response to Rx

Question 5

Prior to treating each UTI, what must be done

Answer 5

UA/UCx

Question 6

Options for treating rUTIs

Answer 6

Self-start while awaiting culture
If asymptomatic, do NOT workup/treat!
Nitrofurantion, bactrim, fosfomycin x7d
IV abx x7d if resistant organism
Prophy
Cranberry
Vaginal estrogen if peri/post-menopausal
(Lactobacillus, D-mannose, Methenamine tbd)

Question 7

Should you document clearance?

Answer 7

nope

Question 8

Urease producers

Answer 8

proteus, ureaplasma, nocardia, cryptococcus, staph, klebsiella

Question 9

bacteria that don’t reduce nitrite

Answer 9

enterococcus, streptococcus, staphylococcus, pseudomonas, acinetobacter, candida, adenovirus