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PHARMACOOO > UTI > Flashcards

UTI Flashcards

1
Q

Host defense mechanism against UTI?

A
  • Bacteria in bladder stimulates micturition with increased diuresis → emptying of bladder
  • Antibacterial properties of urine & prostatic secretion
  • Anti-adherence mechanisms of bladder (prevent bacterial attachment to bladder)
  • Inflammatory response with polymorphonuclear leukocytes (PMNs) → phagocytosis → prevent/ control spread
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2
Q

Risk factors for UTI?

A

Females > males
Sexual intercourse
Abnormalities of urinary tract
Neurologic dysfunctions
Anti-cholinergic drugs (e.g. atropine, 1st gen antihistamine)
Catheterization and other mechanical instrumentation
Diabetes
Pregnancy
Use of diaphragms & spermicides
Genetic association (positive family history)
Previous UTI

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3
Q

Complicated UTI?

A

UTI associated with conditions that increase the potential for serious outcomes, risk for therapy failure
UTIs in men, children & pregnant women, functional and structural
abnormalities of urinary tract, genitourinary instrumentation, diabetes mellitus, immunocompromised host

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4
Q

uncomplicated UTI?

A

Usually in healthy premenopausal, non-pregnant women with no history suggestive of an abnormal urinary tract

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5
Q

Subjective evidence (symptoms) for cystitis?

A

dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain; gross hematuria

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6
Q

Subjective evidence (symptoms) for pyelonephritis?

A

fever, rigors, headache, nausea, vomiting, and malaise, flank pain, costovertebral tenderness (renal punch), or abdominal pain

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7
Q

When to culture?

A

✔ Pregnant women, recurrent UTI, pyelonephritis, catheter-associated UTI, all men with UTI
❌Uncomplicated cystitis

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8
Q

UFEME

A
  • White blood cells (WBC)
    o > 10 WBCs/mm3 = pyuria (w/ smx = UTI)
  • Red blood cells (RBC)
    o Presence (microscopic >5/ HPF or gross) = hematuria –> frequently occurs in UTI but non-specific
  • WBC casts
    o Indicate upper tract infection / disease
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9
Q

Chemical urinalysis (dipstick)

A
  • Nitrite
    Positive test detects presence of Gram-negative bacteria; requires at least 10^5 bacteria/mL
  • Leukocyte esterase (LE)
    Positive test detects esterase activity of leukocytes in urine. Correlates with significant pyuria (>10 WBCs/mm3)
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10
Q

Pathogen for uncomplicated/ community-acquired UTI

A
  • Escherichia coli (>85%)
  • Staphylococcus saprophyticus (5-15%)
  • Others: Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp
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11
Q

Pathogen for complicated/ healthcare-associated UTI

A
  • E. coli (≈50%)
  • Enterococci
  • Proteus spp, Klebsiella spp, Enterobacter spp, P.aeruginosa
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12
Q

Miscellaneous pathogen

A

S. aureus – commonly due to bacteremia; consider other primary site of infections
Yeast or Candida – possible contaminant; consider other
sites of infection

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13
Q

Need to treat?

A 
Yes if smx 
No except:
1. Pregnant woman
2. Pt going for invasive urologic procedures 
3. Children
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14
Q

Community-acquired women’s uncomplicated cystitis

A 
First line
	• PO co-trimoxazole 800/160 mg bid x 3d 
• PO nitrofurantoin 50 mg qid x 5d
• PO fosfomycin 3 g single dose
Alternative 
[PO beta-lactams x 3-7 days] preggo
• PO cefuroxime 250 mg bid
• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg bid
[PO fluroquinolones  x 3 days] 
• PO ciprofloxacin 250 mg bid
• PO levofloxacin 250 mg daily
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15
Q

Community-acquired women’s complicated cystitis

A

Same as uncomplicated cystitis but
Treat for longer duration e.g. 7-14days
Fosfomycin: PO 3g EOD x 3 doses

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16
Q

Community-acquired women’s pyelonephritis

A 
Oral:
[PO fluoroquinolones] 
• PO ciprofloxacin 500 mg twice daily x 7 days or
• PO levofloxacin 750 mg daily x 5 days
[PO co-trimoxazole 160/800mg twice daily x 14 days] 
[PO beta-lactam x 10-14 days] 
• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg tds
IV: 
• IV ciprofloxacin 400mg bid
• IV cefazolin 1g q8h
• IV amoxicillin-clavulanate 1.2g q8h
and/or 
• IV/IM gentamicin 5mg/kg
17
Q

Community-acquired men’s cystitis

A

Same as uncomplicated cystitis in women but
Treat for longer duration e.g. 7-14days
Fosfomycin: PO 3g EOD x 3 doses

18
Q

Community-acquired men’s pyelonephritis/ cystitis + prostatitis

A

▪ PO ciprofloxacin 500 mg twice daily x 10-14 days

▪ PO co-trimoxazole 800/160 mg twice-daily x 10-14days

19
Q

Nosocomial/ healthcare associated pyelonephritis

A

Possibility of pseudomonas aeruginosa, ESBL E.coli/klebsiella should be considered
• IV cefepime 2g q12h +/- IV amikacin 15mg/kg/d x 7-14 days
• IV imipenem 500mg q6h or IV meropenem 1g q8h x 7-14 days
• PO levofloxacin 750mg (for less sick patients) x 7-14 days
• PO ciprofloxacin 500mg bid (for less sick patients) x 7-14 days

20
Q

CA-UTI tx?

A

• IV imipenem 500mg q6H or IV meropenem 1g q8h
• IV cefepime 2g q12H +/- IV amikacin 15mg/kg (1 dose)
• PO/ IV levofloxacin 750mg x 5d (for mild CA-UTI)
• PO Co-trimoxazole 960mg bid x 3d (for women ≤65 years with CA-UTI without upper urinary tract symptoms after an indwelling catheter has been removed)
- Duration of treatment: usually 7 days in those with prompt resolution of symptoms and 10–14 days of treatment for those with a delayed response

21
Q

CA-UTI occurs in?

A

Presence of symptoms or signs compatible with UTI +
10^3 cfu/mL of ≥1 bacterial species in a single catheter urine specimen in patients with indwelling urethral/ related shit/ in urine of pt who removed it last 48h

22
Q

Risk factors of CA-UTI?

A
  • Duration of catheterization  <7days only 1 organism, >28days likely polymicrobial
  • Colonisation of drainage bag, catheter and periurethral segment
  • DM
  • Female
  • Renal function impairment
  • Poor quality of catheter care, including insertion
23
Q

To treat?

A

Yes if smx; take culture before antibx given
- consider if pt is stable & fever is low grade
No except:
prior to traumatic urological procedure

24
Q

Smx of CA-UTI?

A

: new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain; costovertebral angle tenderness; acute hematuria; pelvic discomfort

25
Q

Prevention of CA-UTI?

A
  • Avoid unnecessary catheter use
  • Use for minimal duration
  • Long-term indwelling catheters changed before blockage is likely to occur
  • Use of closed system
  • Ensure aseptic insertion technique
  • Topical antiseptic or antibiotics not recommended
  • Prophylactic antibiotics and antiseptic not recommended
  • Chronic suppressive antibiotics is not recommended
26
Q

UTI drug to avoided in pregnancy

A

Ciprofloxacin
Cotrimoxazole (Folate, kernitctus, G6PD)
Nitrofurantoin (G6PD)
AG

27
Q

What to use in UTI pregnancy?

A

beta lactams

  • Treat for 7 days for asymptomatic bacteriuria or cystitis
  • Treat for 14 days for pyelonephritis
28
Q

Adjunctive therapy for UTI?

A

Pain & fever Paracetamol/ NSAIDs
Vomiting Rehydration
Urinary symptoms Phenazopyridine
an azo dye and exerts a topical analgesic effect on the urinary tract mucosa to provide symptomatic relief
treatment should be limited for the duration of symptoms
C/I: G6PD deficiency
ADR: nausea, vomiting, orange-red discolouration of urine and stool
Urine alkalization
relief discomfort in mild UTI, unproven benefit

29
Q

Non-antimicrobial options for UTI prevention?

A

Cranberry juice
Intravaginal estrogen cream
Lactobacillus probiotics

PHARMACOOO (5 decks)

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