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Roomies Collab Deck 1: Infectious Disease and CV > Urinary-tract Infections > Flashcards

Urinary-tract Infections Flashcards

1
Q

What is the most common cause of UTIs?

A

Bacteria from the GI tract entering the urinary tract, esp E.coli

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2
Q

Which organism should be suspected in a hospitalized patients with a UTI who is immunocompromised or has an indwelling catheter?

A

Candida, otherwise a rare cause of UTI

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3
Q

What is considered a lower UTI?

A

Infection of the bladder or urethra (cystitis or urethritis)

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4
Q

What is considered an upper UTI?

A

Infection of the ureters +/- the kidneys (pyelitis, pyelonephritis)

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5
Q

What are the main complications of upper UTIs? (4)

A
  1. Renal scarring
  2. Abscess formation
  3. Renal failure
  4. Sepsis
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6
Q

Which symptoms are considered lower urinary tract symptoms?

A

Dysuria, increased urinary frequency and urgency, urine that is strong smelling, cloudy, or contains blood, and persistent lower abdominal pain

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7
Q

Which symptoms are associated with upper UTI? (2)

A

Loin pain and fever

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8
Q

Is asymptomatic bacteriuria in pregnant women regularly treated?

A

Yes, it is a risk factor for pyelonephritis and premature labor
UTIs in pregnancy have also been associated with developmental delay and cerebral palsy in infants, as well as fetal death

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9
Q

At what point are UTIs considered recurrent?

A

At least 2 episodes within 6 months OR

3 episodes within 12 months

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10
Q

What is an important complication of UTIs in men?

A

Acute prostatitis, usually caused by a UTI

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11
Q

What are the symptoms of prostatitis?

A

Sudden onset fever, acute urinary retention or irritative voiding symptoms

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12
Q

What are the possible complications of prostatitis? (4)

A
  1. Prostatic abscess
  2. Bacteremia
  3. Epididymitis
  4. Pyelonephritis
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13
Q

How is chronic prostatitis defined?

A

A complication of acute prostatitis wherein urogenital pain and LUTS last at least 3 months

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14
Q

What are the aims of treatment of UTIs? (4)

A
  1. Relieve symptoms
  2. Treat underlying infection
  3. Prevent systemic infection
  4. Reduce the risk of complications
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15
Q

What is the non-drug treatment advised for patients with UTIs? (3)

A
  1. Drink plenty of fluids to avoid dehydration
  2. Use self-care strategies to reduce risk of infections
    - wipe from front to back after defecation
    - do not delay urination
    - do not wear occlusive underwear
  3. Some non-pregnant women with recurrent UTIs may wish to try cranberry products or D-mannose to prevent future infection (not a treatment)
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16
Q

Is asymptomatic bacteriuria routinely treated with antibacterials?

A

No, except in pregnant women

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17
Q

When should patients being treated for UTIs be reassessed? (2)

A
  1. If symptoms worsen at any time

2. If symptoms do not start to improve within 48 hours of starting treatment

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18
Q

Should pain management be offered to patients with UTIs?

A

Paracetamol or ibuprofen can be used for pain relief in most patients

Where appropriate, codeine may be used in patients with acute pyelonephritis or prostatitis

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19
Q

What is the treatment of choice for non-pregnant women with lower UTIs?

A

FIRST LINE:

  • oral nitrofurantoin
  • oral trimethoprim (if low risk of resistance)

SECOND LINE: if no improvement after at least 48 hours or if first line not suitable

  • oral nitrofurantoin (if not used first line)
  • oral fosfomycin
  • oral pivmecillinam hydrochloride
  • oral amoxicillin (high rate of resistance, so only if culture susceptible)
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20
Q

Can a back-up prescription be prescribed for non-pregnant women with uncomplicated lower UTIs?

A

Yes, delaying antibacterial treatment with a back-up prescription to see if symptoms will resolve, may be an option. Consider a back-up antibacterial prescription for use if symptoms worsen or do not improve within 48 hours OR an immediate antibacterial prescription depending on the case

21
Q

Can a back-up prescription be prescribed for men with uncomplicated lower UTIs?

A

No, UTIs in men are inherently complicated and should therefore be treated with immediate antibacterial prescription AND midstream urine sample (before treatment) to be sent for culture and susceptibility testing

22
Q

What is the treatment of choice for men with lower UTIs?

A

FIRST LINE:

  • oral nitrofurantoin
  • oral trimethoprim

SECOND LINE: if no improvement in 48 hours or if first line not suitable
- consider pyelonephritis or prostatitis

23
Q

Can a back-up prescription be prescribed for pregnant women with uncomplicated lower UTIs?

A

No, lower UTIs in pregnant women are inherently complicated, therefore an immediate antibacterial prescription should be given PLUS midstream urine sample obtained before treatment for culture and susceptibility

24
Q

What is the treatment of choice for pregnant women with lower UTIs?

A

FIRST LINE:
- oral nitrofurantoin

SECOND LINE: (if no improvement after at least 48 hours OR if first line not suitable)

  • oral amoxicillin (only if culture susceptible)
  • oral cefalexin
25
Q

What is the treatment of choice for pregnant women with asymptomatic bacteriuria?

A

Amoxicillin, cefalexin, or nitrofurantoin

26
Q

Is trimethoprim safe to use in pregnancy?

A

No, it is a folate antagonist

27
Q

What is the management of acute prostatitis?

A
  1. An immediate abx should be given
  2. A midstream urine sample should be obtained before starting treatment to be sent for C/S
  3. Refer patient to hospital if symptoms are not improving after 48 hours of treatment or if they have any signs or symptoms suggestive of a more serious condition eg sepsis, acute urinary retention, or prostatic abscess
28
Q

What is the treatment of choice for acute prostatitis?

A

FIRST LINE:

  • oral ciprofloxacin
  • oral ofloxacin
  • oral trimethoprim (if unable to take quinolones)

SECOND LINE: (on specialist advice)

  • oral Levofloxacin
  • oral co-trimoxazole
29
Q

What is the treatment of choice for patients with acute prostatitis who are severely unwell or unable to take oral treatment?

A

Intravenous administration of the following

  • Amikacin
  • ceftriaxone
  • cefuroxime
  • ciprofloxacin
  • gentamicin
  • Levofloxacin

*abx may be combined if concerned about sepsis

30
Q

What is the immediate management of acute pyelonephritis? (3)

A
  1. Immediate antibacterial prescription
  2. MSU obtained before treatment
  3. Consider referring or seeking specialist advice for patients who are significantly dehydrated or unable to take oral fluids and medicines, are pregnant, or have a higher risk of developing complications
31
Q

What is the treatment of choice for acute pyelonephritis in non-pregnant women and men who are NOT severely unwell?

A

FIRST LINE:

  • oral cefalexin or ciprofloxacin
  • IF SENSITIVITY KNOWN, oral co-amoxicillin or TMP
32
Q

What is the treatment of choice for acute pyelonephritis in non-pregnant women and men who ARE severely unwell or unable to take oral treatment?

A

FIRST LINE: ALL IV

  • Amikacin
  • ceftriaxone
  • cefuroxime
  • ciprofloxacin
  • gentamicin
  • co-amoxiclav IF given in combination or sensitivity known

*antibacterials may be combined if concerned about susceptibility or sepsis

33
Q

What is the treatment of choice for pregnant women with acute pyelonephritis who are NOT severely unwell?

A

FIRST LINE:

- oral cefalexin

34
Q

What is the treatment of choice for pregnant women with acute pyelonephritis who ARE severely unwell or unable to take oral treatment?

A

FIRST LINE:

- IV cefuroxime

35
Q

Which patients should be referred to specialist care for recurrent UTIs? (5)

A
  1. Men
  2. Pregnant women
  3. Patients with suspected cancer
  4. Patients with recurrent upper UTIs
  5. Patients with recurrent lower UTIs with an unknown cause
36
Q

What management should be offered for post menopausal women experiencing recurrent UTIs?

A

Vaginal estrogen (unlicensed) at the lowest effective dose IF behavioral and personal hygiene measures alone are not effective or appropriate

Treatment should be reviewed within 12 months

oral HRT should not be given specifically to reduce the risk of UTIs

37
Q

What measures should be offered to non-pregnant women with recurrent UTIs? (3)

A
  1. Behavioral and personal hygiene measures
  2. Vaginal estrogens (in post menopausal women)
  3. Antibacterial prophylaxis (single dose OR daily)
  • Advise patients about the risk of resistance with long-term antibacterial use, seeking medical help if symptoms of an acute UTI develop, and to return for review within 6 months
38
Q

For patients receiving prophylactic antibiotics for recurrent UTI prevention, how often should treatment be reviewed?

A

Review the success and ongoing need for antibacterial prophylaxis at least every 6 months. If antibacterial prophylaxis is stopped, ensure the patient has rapid access to treatment if they develop an acute UTI

39
Q

What is the antibiotic of choice for UTI prevention?

A

FIRST LINE:
- oral TMP or oral nitrofurantoin

SECOND LINE:
- amoxicillin (unlicensed) or cefalexin

40
Q

What is the immediate management of patients with catheter-associated UTIs? (3)

A
  1. Consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days
  2. An immediate antibacterial prescription should be given
  3. Urine sample obtained before treatment is taken

*Consider referring or seeking specialist advice for patients who are significantly dehydrated or unable to take oral fluids and medicines, if pregnant, have higher risk of developing complications, have recurrent catheter associated UTIs, or have bacteria resistant to oral antibacterials

41
Q

What is the treatment of choice for non-pregnant women and men with catheter-associated UTI WITHOUT signs of upper UTI?

A

FIRST LINE:

  • oral amoxicillin (ONLY if culture susceptible)
  • oral nitrofurantoin
  • oral TMP (if low risk of resistance)

SECOND LINE:
- oral pivmecillinam hydrochloride

42
Q

What is the treatment of choice for non-pregnant women and men with catheter-associated UTI WITH signs of upper UTI who are NOT severely unwell?

A

FIRST LINE:

- oral cefalexin, ciprofloxacin, co-amoxicillin (if culture susceptible), or TMP (if culture susceptible)

43
Q

What is the treatment of choice for non-pregnant women and men with catheter-associated UTI WITH signs of upper UTI who ARE severely unwell or unable to take oral treatment?

A

FIRST LINE: ALL IV

  • Amikacin
  • ceftriaxone
  • cefuroxime
  • ciprofloxacin
  • gentamicin
  • co-amoxiclav (only in combination, unless culture results confirm susceptibility)

*antibacterials may be combined if concerned about susceptibility or sepsis

44
Q

What is the treatment of choice for catheter-associated UTI in pregnant women who are NOT severely unwell?

A

FIRST LINE:

- oral cefalexin

45
Q

What is the treatment of choice for catheter-associated UTI in pregnant women who ARE severely unwell?

A

FIRST LINE:

- IV cefuroxime

46
Q

Which organisms are associated with catheter-associated UTIs? (7)

A
  1. E.coli
  2. Klebsiella
  3. Proteus
  4. Enterococcus
  5. Pseudomonas
  6. Enterobacter
  7. Serratia
47
Q

Which gram(-)s are covered by first generation cephalosporins? (3)

A
  1. Proteus
  2. E.coli
  3. Klebsiella

(In addition to gram positives, first gen cephalosporins cover “PEcK” gram negative organisms)

48
Q

Which gram(-)s are covered by second generation cephalosporins? (6)

A
  1. Proteus
  2. E.coli
  3. Klebsiella
  4. H.influenza
  5. Neisseria
  6. Serratia

(In addition to gram positives and PEcK organisms covered by first gen cephalosporins, second gen cephalosporins cover “HeNS PEcK” gram negative organisms)

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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