Urinary Tract infections part 2 Flashcards
pt presents with right sided flank pain, nausea, vomiting.
renal bladder ultrasound shows right sided hydronephrosis, consistent with PYELONEPHRITIS - uncomplicated
recommendation for outpatient treatment if FQ resistance is 25%
Ceftriaxone 1g IM 1 dose
then, wait for the culture and streamline therapy
pt is started empirically on cipro for acute pyelonephritis
2 days later urine culture returns and it’s E. COLI that shows resistance to methicillin, cipro, and macrobid
how should therapy be streamlined for outpatient delivery
change to cefuroxime - oral cephalosporin
68 yr old admitted to hospital for acute pyelonephritis
NKA
2 months ago took cipro for ESBL e. coli UTI
what’s best empiric treatment
etrapenem IV (carbapenem - drug of choice for ESBL)
define recurrent UTIs
who is it common in and what are the risk factors
2 or more UTIs within 3 months OR 3+ UTI’s within 1 year
common in healthy unpregnant women. risks are frequent sex and spermicides
2 categories of recurrent UTI’s and differentiate them
reinfection and relapse
reinfection - caused by a DIFFERENT ORGANISM than the original
relapse - repeat infection with the SAME organism (usually within 2 weeks of the original infection)
what accounts for the MAJORITY of recurrent UTIs - relapses or reinfections?
reinfections
true or false
recurrent UTIs that are reinfections are treated like a whole new infection
TRUE - it’s a whole different organism
true or false
a relapse can be due to unsuccessful treatment, a resistant organism, or even anatomical abnormalities
true
it’s same organism as original
3 therapeutic options for recurrent UTI
-postcoital therapy (take AB after sex as prevention)
-continous low dose prophylaxis (ONLY if pt has greater than 3 episodes a yr - in clinincal practice it’s more like 7-8 bc of collateral damage)
-treated as separately occurring infections if less than or equal to 3 a year
define asymptomatic bacteriuria
> 100,000CFU/mL of urine in a patient without any signs or symptoms of a UTI
in what patient population is asymptomatic bacteruria common?
elderly and females
do we treat asymptomatic bacteriuria with antibiotics?
NO - but in some cases we do:
-pt is pregnant (bc it’s associated with preterm labor)
-pt is undergoing a urologic procedure
-renal transplant recipients
the antimicrobial agent used in asymptomatic bacteriuria is selected based on what
the urine culture results
duration of therapy for asymptomatic bacteriuria in pregnant women vs duration for those undergoing urologic procedure
pregnant - 4-7 days
urologic procedure - short course therapy of 1-2 doses 30-60 mins before the procedure
what’s the role of cranberry in treating/preventing UTI
it decreases the adherence of bacteria to the epithelial cells of the bladder
there are inconsistent studies tho- so no solid recommendation. as long as no DDI – its fine to take it
role of lactobacillus in urinary tract infections
keeps vaginal pH in range (4-4.5)
regulates genitourinary bacteria
what is phenazopyridine
a urinary analgesic
true or false
phenazopyridine has NO antimicrobial properties and is just a urinary analgesic
true - DOES NOT TREAT THE UTI ITSELF
adverse effects of phenazopyridine
red-orange discoloration of body fluids, rash, anaphylaxis
RARE - hemolytic anemia, methemoglobinemia, renal failure
3 OTC brands of phenazopyridine
pyridium
azo-standard
uristat
max dose phenazopyridine
what is concern with phenazopyridine
200mg TID LIMITED 1-2 DAYS for symptomatic relief of painful urination from UTI
concern is that it could mask the symptoms and signs of untreated/inappropriately treated UTI
TRUE OR FALSE
phenazopyridine is not used in combination with antibiotics
FALSE - it is
pt is 22 with asymptomatic bacteriuria (only bacteria are high – -no other signs of infection like high white count, leuk esterase, or nitrites)
give treatment plan
MORE INFO NEEDED on pregnancy status
if she IS pregnant, treated based on the bacteria that grows for 4-7 days
