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Infectious Diseases > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

What are the bugs to cover for complicated cystitis in women or cystitis WITHOUT concern for prostatitis or pyelonephritis in men?

A

E. coli (most common)
Staphylococcus saprophyticus, Enterococcus, K. pneumoniae, P.mirabilis

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2
Q

What are the normal host defense mechanisms against UTI?

A
  1. Bact in the urine stim micturition, to give rise to the urge to void bladder (purge bact)
  2. Anti-bact property of urine and prostatic secretions
  3. Anti-adherent mechanism (enzymes) of bladder mucosal
  4. Polymorphoneuclear leukocytes (PMNs) phagocytose bact
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3
Q

What are the symptoms of cystitis?

A

Frequency
Urgency
Dysuria
Nocturia
Gross hematuria
Suprapubic heaviness/pain

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4
Q

What are the treatment categories for UTI?

A
  1. Non-complicated cystitis in women
  2. Complicated cystitis in women or cystitis WITHOUT concern for prostatitis or pyelonephritis in men
  3. Pyelonephritis in women
  4. Cystitis WITH concern for prostatitis or pyelonephritis in men
  5. Healthcare acquired UTI
  6. Catheter associated UTI
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5
Q

What is the recommended regimen for pyelonephritis in women?

A

Ciprofloxacin 500 mg BD x7d
Levofloxacin 750 mg daily x5d

For severely ill
IV ciprofloxacin 400 mg Q12H
IV cefazolin 1g Q8H
IV amoxicillin-clavulanate 1.2g Q8H and/or IV gentamicin 5 mg/kg

Alt:
Cotrimoxazole 800/160 mg BD x 10-14d
PO cephalexin 500 mg QID x 10d
PO cefuroxime 250-500 mg BD x10d
PO amoxicillin-clavulanate 625 mg TDS x10d

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6
Q

When do we screen and treat for ASB?

A

Pregnancy: ASB may lead to low birth weight

In pts planning to undergo urologic procedures where the mucosal lining of the UTI may be breached: risk or urosepsis, does not include placement or removal or urinary catheter.

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7
Q

What is the recommended regimen for cystitis WITH concern for prostatitis or pyelonephritis in men?

A

Ciprofloxacin 500 mg BD x 10-14d
Cotrimoxazole 800/160 mg BD x10-14d

If confirmed prostatitis or pyelonephritis treat for 6 weeks.

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8
Q

What is the recommended regimen for CA-UTI?

A

IV cefempime 2g Q12H +/- amikacin 15 mg/kg
IV imipenem 500 mg Q6H or IV meropenem 1g Q8H
Usually 7d treatment (prompt resolution: defeverse in 72h) and 10-14d w delayed resp

PO/IV levofloxacin 750 mg daily x5d

For female <=65y, without upper urinary tract symptoms after indwelling catheter rem
PO cotrimoxazole 800/160 BD x3d

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9
Q

What is the recommended regimen for uncomplicated cystitis in women?

A

1st line:
Cotrimoxazole 800/160 mg BD x 3d OR
Nitrofurantoin 50 mg QID x5d OR
Fosfomycin 3g EOD single dose

Alt:
Cephalexin 250-500 mg QID x5d
Cefuroxime 250 mg BD x5d
Amoxicillin-clavulanate 625 mg BD x 5/7
Ciprofloxacin 250 mg BD x3d
Levofloxacin 250 mg once daily x3d

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10
Q

What are the symptoms of pyelonephritis?

A

Fever, rigors, malaise
Headache
NV
Flank pain
Costovertebral tenderness (+ve renal punch)
Abdo pain

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11
Q

What are the bugs to cover for HA-UTI?

A

E. coli (most common)
Enterococcus, K. pneumoniae, P. mirabilis, S. aureus, Enterococcus, P. aeruginosa

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12
Q

Describe the epidemiology for UTI

A

1-6 mo: M>F
1-adult: F>M
>65: F=M
Elderly»

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13
Q

What are some non-pharm management strategies for UTI?

A
  1. Drink 6-8 glasses of water a day
  2. Void bladder at first urge
  3. Avoid tight fitting jeans and nylon underwear that trap moisture and promote bact growth
  4. Wear loose fitting clothes and cotton underwear, keep that area dry
  5. Urinate shortly after sexual intercourse to clear any bact that may have entered the bladder
  6. For females using sperimicide and diaphragm as contraceptive methods, consider other methods such as male latex condom. Note: spermicidal and non-lubricating condoms can cause irritation –> bact
  7. For females wipe from front to back, especially after a bowel movement
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14
Q

Define uncomplicated UTI

A

Healthy, non-pregnant females of child bearing (pre-menopausal) age with no history or suggestion of structural abnormalities in urinary tract, with no comorbidities

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15
Q

What is the pathophysiology of UTI?

A

Ascending: colonisation of periurethra or urethra region –> ascend to colonise bladder and kidneys

Descending (hematologic): distant primary infection site –> disseminates (bacteremia) –> colonise bladder and kidneys

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16
Q

What are the bugs to cover for Pyelonephritis in women?

A

E. coli (most common)
Staphylococcus saprophyticus, Enterococcus, K. pneumoniae, P.mirabilis

17
Q

What are the signs of UTI?

A
  1. UFEME
    WBC: >10 cells/mm^3 –> pyuria
    RBC: >5 cells/HPF or gross –> hematuria
    WBC casts: presence of mass of cells/proteins from renal tubules–> upper UTI
    Microorganisms
  2. Dipstick
    Nitrates: presence with gram -ve (nitrate –> nitrite) but false -ve w gram +ve and pseudomonas, frequent voiding, low [ ]
    Leukocyte esterase: presence of esterase activity of leukocytes (or neutrophils) –> pyuria
18
Q

What are the bugs to cover CA-UTI?

A

E. coli (most common)
Enterococcus, K. pneumoniae, P. mirabilis, S. aureus, Enterococcus, P. aeruginosa

19
Q

What are the risk factors for UTI?

A

Females (shorter urethra), Congenital defects/abnormal structure of UTI (kidney stones, BPH, urethral strictures, vesicouteral reflux), DM, immunocompromised, spermicide and diaphragm usage, sexual intercourse, Neuro dysfn (stroke, DM, spinal cord injuries), Anticholinergic drugs, catheterisation , DM, pregnancy, genetic assoc, prev UTI

20
Q

What are the bugs to cover for cystitis WITH concern for prostatitis and pyelonephritis in men?

A

E. coli (most common)
Staphylococcus saprophyticus, Enterococcus, K. pneumoniae, P.mirabilis

21
Q

What is the recommended regimen for HA-UTI?

A

IV cefepime 2g Q12H +/- IV amikacin 15 mg/kg/d x7-14d
IV imipenem 500 mg Q6H or IV meropenem 1g Q8H x7-14d

For less sick pts
PO ciprofloxacin 500 mg BD x7-14d
PO levofloxacin 750 mg daily x 7-14d

22
Q

Differentiate asymptomatic bacteriuria (ASB) from UTI

A

ASB is the isolation of clinically significant amounts of bacteria in urine WITHOUT the presence of urinary symptoms.

UTI is the isolation of clinically significant amounts of bacteria in urine WITH urinary symptoms.

23
Q

What are the bugs to cover for non-complicated cystitis in women?

A

E.coli (most likely)
Staphylococcus saprophyticus, Enterococcus, K. pneumoniae, P. mirabilis

24
Q

What is the recommended regimen for complicted cystitis in women or cystitis WITHOUT concern of prostatitis or pyelonephritis in men?

A

Same agents as uncomplicated cystitis in women but treat for longer - 7-14d

PO fosfomycin 3g EOD x3 doses

Infectious Diseases (9 decks)

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