urinary tract infections Flashcards
a patient has recently been started on abx for a UTI. she comes in worried because her urine is a different colour. what is the drug that has caused this and what colour would the urine be?
nitrofurantoin
yellow brown
UTIs are predominantly caused by bacteria from the gastrointestinal tract entering the urinary tract, with this bacteria being the most common cause
e coli
infection due to Candida albicans is rare but may occur in…
hospitalised patients who are immunocompromised or have an indwelling catheter.
pylonephronitis is associated with lower or upper UTIs?
upper - this is when they affect the kidneys
cystitis and urethritis is associated with lower or upper UTIs?
lower
cytisis is inflammation of the
bladder
urethritis is inflammation of the
urethra
most common symptoms of lower UTI
- dysuria
- increased urinary freq and urgency
- strong smelling urine
- cloudy or bloody urine
- persistent lower abdominal pain
these two signs usually indicate upper UTI
- loin pain (back pain where kidneys are)
- fever
in pregnant women, this is a risk factor for pyelonephritis and premature labour
asymptomatic bacteriuria
UTIs have been associated with these issues in the infant, aswell as fetal death (2)
- developmental delay
- cerebral palsy
insertion of a catheter into the urinary tract increases risk of..
developing UTI
the longer the catheter is in place for increases risk of …
bacteriuria
when are UTIs considered recurrent (2)
at least 2 episodes within 6 months
or three or more episodes within 12 months
what is acute prostatitis and what is it usually caused by
infection of prostate gland
usually caused by UTI
common symptoms of acute prostatitis
- sudden onset of fever
- acute urinary retention or irritative voiding symptoms
chronic prostatitis is a complication of acute prostatitis and is defined as at least…
3 months of urogenital pain usually associated with lower UTI symptoms
non drug treatment of UTI
- drink plenty of fluids to avoid dehydration
- self care strategies to reduce risk of recurrent infections (e.g. wipe from front to back, do not delay urination, do not wear occlusive underwear)
Is asymptomatic bacteriuria routinely treated with abx?
no, with the exception of pregnant women
oral 1st line abx in non pregnant women (2 options)
nitrofurantoin or trimethoprim (if low risk of resistance)
oral 2nd line if no improvement after at least 48h, or first like not suitable in non-pregnant women
- nitrofurantoin if not used 1st line
- fosfomycin
- pivmecillinam
- amoxicillin (high rate of resistance, only use if culture susceptible)
when can amoxicillin be used for abx therapy for non pregnant women with acute uncomplicated lower UTI
it is one the the 2nd line options but high rate of resistance so only use if culture sensitive
when should you consider treatment non-pregnant women acute uncomplicated lower UTI
- can be self limiting
- option is so delay abx treatment with back up rx to see if symptoms will resolve
- consider back up rx for use if symptoms worsen or do not improve within 48h or an immediate abx rx
when should you treat lower UTI In men
- give immediate abx rx
- take midstream urine sample before treatment and send for culture and suscepibility testing
oral 1st line for lower UTI In men (2 options)
nitro or trimethoprim
What to consider if UTI in men if no improvement after at least 48h or if 1st line not suitable
consider pyelonephritis or prostatitis
when should you treat UTI in pregnant women
immediate abx rx should be given
take midstream urine sample before treatment is taken and sent for culture and susceptibility testing
what is 1st line and second line in pregnant UTI
- 1st line: nitrofurantoin
- 2nd line if no improvement after at least 48h ,or first line not suitable: amoxicillin (only if sensitive) or cefalexin
drug treatments for pregnancy asymptomatic bacteriuria (3)
amoxicillin
cefalexin
nitrofurantoin
use of nitrofurantoin in pregnancy and BF
avoid at term - may produce neonatal haemolysis
avoid in BF - only small amounts in milk but enough to produce haemolysis in G6PD-deficient infants
when should you give treatment for acute prostatitis
An immediate antibacterial prescription should be given
A midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing
when to refer acute prostatitis
Refer patients 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 such as sepsis, acute urinary retention, or prostatic abscess.
1st line for acute prostatitis (3)
ciproflox or oflox
alternative if unable to take quinolones (e.g. tendon disorder related to quinolone use, caution in seizures, psychiatric disorders etc) is trimethoprim
2nd line on specialist advice for acute prostatitis (2)
levoflox if not given 1st line
cotrimoxazole
when to treat acute pyelonephritis
An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing.
when would you refer acute pyelonephritis
Consider referring or seeking specialist advice for patients with acute pyelonephritis who are significantly dehydrated or are unable to take oral fluids and medicines, are pregnant, or have a higher risk of developing complications.
pyelonephritis choice of abx therapy in non pregnant women and men
- oral 1st line (4)
cefalexin or ciproflox
if sensitivity known, co-amox or trimethoprim
pregnant women 1st line for acute pyelonephritis (plus IV)
cefalexin
1st line IV if severely unwell or unable to take oral treatment: cefuroxime
for postmenopausal women experiencing recurrent UTIs, what can you consider
consider a vaginal oestrogen [unlicensed indication] at the lowest effective dose if behavioural and personal hygiene measures alone are not effective or appropriate.
Treatment should be reviewed within 12 months. Oral oestrogens (hormone replacement therapy) should not be given to postmenopausal women specifically to reduce the risk of recurrent UTIs.
for patients with recurrent UTIs (men, pregnant, suspected cancer, or recurrent upper UTI and those with recurrent lower UTI with unknown cause)….
refer or seek specialist advice
in non pregnant women, what can you consider for people recurrent UTI
- consider a trial of antibacterial prophylaxis if behavioural and personal hygiene measures, and vaginal oestrogen (in postmenopausal women) are not effective or appropriate.
- Single-dose antibacterial prophylaxis [unlicensed indication] should be considered for use when exposed to an identifiable trigger.
- Daily antibacterial prophylaxis should be considered in non-pregnant women who have had no improvement after single-dose antibacterial prophylaxis, or who have no identifiable triggers.
what to do consider for men and pregnant women if behavioural and personal hygiene measures alone are not effective or appropriate in reducing recurrent UTI
With specialist advice, daily antibacterial prophylaxis should be considered
1st line and 2nd line for women and men - recurrent UTI (4)
1st line trimethoprim or nitrofurantoin
2nd line amox (unlicensed) or cefalexin
what to do if catheter associated UTI and when to give treatment
onsider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days, without delaying antibacterial treatment. An immediate antibacterial prescription should be given and a urine sample obtained before treatment is taken and sent for culture and susceptibility testing.
when to consider referring or seeking specialist advice for catheter associated UTI
who are significantly dehydrated or unable to take oral fluids and medicines, are pregnant, have a higher risk of developing complications, have recurrent catheter-associated UTIs, or have bacteria resistant to oral antibacterials.
catheter associated UTI for non pregnant women and men - oral 1st line if no upper UTI symptoms (3)
- amox (only if susceptible)
- nitrofurantoin
- trimethoprim (if low risk resistance)
catheter associated UTI for non pregnant women and men - oral 2nd line if no upper UTI symptoms and 1st line not suitable
pivmecillinam
catheter associated UTI for non pregnant women and men - oral 1st line if upper UTI Symptoms
- cefalexin, ciproflox, co-amox (if susceptible), trimethoprim (if low risk of resistance)
catheter associated UTI - pregnant women, 1st line oral and IV
oral cefalexin
IV if severely unwell or unable to take oral treatment cefuroxime
