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pr3151_final exam > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

Who should be screened and treated for asymptomatic bacteriuria?

A

Pregnant patients and patients undergoing urologic procedure where mucosal trauma / bleeding is expected

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2
Q

What is the pathophysiology of ascending UTI?

A

Colonic / fecal flora colonise periurethral area, ascend to bladder and kidney

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3
Q

When is hematogenous (descending) UTI suspected?

A

When organisms that are not colonic are grown e.g. s. aureus, mycobacteria tuberculosis

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4
Q

Describe the 4 host defense mechanisms against UTI

A
  1. Bacteria in the bladder stimulates micturition, increase diuresis and flushes bacteria out
  2. Antibacterial properties of urine and prostatic secretions
  3. anti-adherence mechanisms of bladder
  4. Inflammatory response with PMNs (phagocytosis to control spread)
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5
Q

List the risk factors of UTI

A

Female (shorter urethra), sexual intercourse, abnormalities of the urinary tract, neurologic dysfunctions, anticholinergic drugs (urinary retention), catheterisation, diabetes, pregnancy, use of spermicides and diaphragms, previous UTI, family history of UTI

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6
Q

Provide 6 non-pharmacological counselling points to prevent UTI

A
  1. drink fluids
  2. urinate frequently
  3. pee after sex
  4. wipe from front to back
  5. keep area dry, wear cotton underwear
  6. find other forms of birth control, x diaphragms and spermicide use
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7
Q

What are the symptoms of pyelonephritis compared to cystitis?

A

flank pain, general systemic symptoms, costovertebral tenderness

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8
Q

What does positive nitrites in urine dipstick test indicate?

A

at least 10^5 gram negative bacteria present per mL of urine

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9
Q

What does positive leukocyte esterase in urine dipstick test indicate?

A

Highly correlated with significant pyuria (WBC in urine)

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10
Q

What does the presence of WBC casts (masses of cells and proteins) in UFEME indicate?

A

upper UTI

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11
Q

When may urine cultures be necessary?

A

Pregnant, recurrent UTI, catheter-associated, pyelonephritis, men

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12
Q

What are the likely pathogens in uncomplicated / community-acquired UTI?

A

E. coli, S. saprophyticus
Enterococcus, Klebsiella, proteus

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13
Q

When is a UTI considered uncomplicated?

A

UTI in premenopausal, non-pregnant woman with no history suggesting abnormal urinary tract

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14
Q

What are the likely pathogens in complicated / healthcare-associated UTI?

A

e. coli
enterococci
klebsiella, proteus, enterobacter, pseudomonas
(more resistant organisms, possibility of ESBL producing bact)

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15
Q

What are the 3 first-line regimens for empiric treatment of uncomplicated cystitis in women?

A
  1. PO Bactrim 960mg BD x3d
  2. PO Nitrofurantoin 50mg QDS x5d
  3. PO Fosfomycin 3g single dose
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16
Q

What is the recommended duration of treatment for complicated cystitis in women?

A

7 - 14 days or PO fosfomycin 3g EOD for 3 doses

17
Q

What are the alternative treatments for uncomplicated cystitis in women?

A

Beta-lactams x 5-7d
- PO Cefuroxime 250mg BD
- PO Augmentin 625mg BD
Fluoroquinolones x 3d
- PO Ciprofloxacin 250mg BD
- PO Levofloxacin 250mg OD
(FQ not rec due to high S/E and collateral damage)

18
Q

What are the recommended regimens for community-acquired pyelonephritis in women (non-severely ill)?

A

FQ
- PO Ciprofloxacin 500mg BD x 7d
- PO Levofloxacin 750mg OD x 5d
PO Bactrim 960mg BD x 10-14d
Beta-lactams x 10-14d
- PO Cefuroxime 250-500mg BD
- PO Augmentin 625mg TDS

19
Q

What are the recommended regimens for community-acquired pyelonephritis in women (severely ill)?

A

IV regimen (switch to PO when possible)
Ciprofloxacin 400mg BD OR Amox-clav 1.2g TDS OR Cefazolin 1g Q8H +/- Gentamicin 5mg/Kg

20
Q

What antibiotics should not be used in pyelonephritis?

A

Nitrofurantoin and Fosfomycin (does not go to kidney)

21
Q

What is the recommended treatment duration for cystitis in men with no concern for prostatitis?

A

x 10 - 14d with same drugs as cystitis in women

22
Q

What is the recommended regimen for UTI in men with concern for prostatitis?

A

PO Ciprofloxacin 500mg BD x 10-14d
PO Bactrim 960mg BD x 10-14d

23
Q

What are healthcare-associated risk factors for UTI?

A

recent hospitalisation in last 6m, use of antimicrobials, indwelling catheter, invasive urological procedure in last 6m

24
Q

What is the definition of nosocomial UTI?

A

Onset >48H after admission

25
Q

What are the recommended treatment regimens for nosocomial / healthcare-associated UTI?

A

Possibility of pseudomonas and ESBL, use broad-spectrum beta-lactam
- IV Cefepime 2g Q12H +/- amikacin 15mg/kg/day
- IV Meropenem 1g Q8H or IV Imipenem 500mg Q6H
For less sick patients
- PO Ciprofloxacin 500mg BD
- PO Levofloxacin 750mg OD
Duration x 10-14d

26
Q

What antibiotics should be avoided in pregnant women with UTI?

A

Fluoroquinolones, Aminoglycosides, Bactrim (1st and 3rd trimester), Nitrofurantoin (at term)

27
Q

What is the duration for treatment of ASB and cystitis in pregnant women?

A

x 4-7d

28
Q

What is the duration for treatment of pyelonephritis in pregnant women?

A

x 14d

29
Q

What constitutes Catheter-associated UTI?

A

presence of symptoms or signs compatible with UTI with no other identified source of infection along with 10^3 cfu/mL of ≥1 bacterial species in a single catheter urine specimen in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization or in a midstream voided urine specimen from a patient whose catheter has been removed within the previous 48h

30
Q

What is the duration for treatment for catheter-associated UTI?

A

7d with prompt resolution, 10-14d in delayed response

31
Q

What are the recommended regimens for catheter-associated UTI?

A
  • IV Meropenem 1g Q8H or IV Imipenem 500mg Q6H
  • IV Cefepime 2g Q12H +/- Amikacin 15mg.kg (single dose / daily)
  • PO/IV Levofloxacin 750mg OD x 5d (mild)
  • PO Bactrim 960mg BD x 3d (women <= 65, removed catheter, non-upper UTI)
32
Q

For which patient population is post-treatment culture to document bacteriological clearance of UTI indicated?

A

Pregnant women

pr3151_final exam (8 decks)

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