UTI Flashcards
What is the difference between ASB and UTI
ASB refers to the isolation of significant colony of bacteria in urine from person without symptoms of UTI. UTI refers to isolation of significant colony counts of bacteria in urine from persons with symptoms of UTI
Does ASB need to be treated with antibiotics?
No
What are the 2 groups of patients who need treatment for ASB and why?
Pregnant women - to prevent pyelonephritis, preterm labour and low infant body weight
Patients going for urologic procedure in which mucosal trauma is expected - prevents bacteuremia and urosepsis
When should ASB treatment be screened and initiated for the 2 groups?
Pregnant women - Screen at first visits between 12-16 weeks gestation and treat for 4-7 days
Urologic procedure - Screen prior to procedure and treat as SAP
Describe the pathogenesis of UTI
Ascending - colonic / fecal flora colonise periurethral area and ascend to bladder and kidneys
Descending - organisms at distant primary site travel through blood stream and go into urinary tract. Cause UTI
Who are at a higher risk of UTIs?
Females - shorter urethra
Use of spermicides and diaphragm as contraceptives
What is the natural host defence mechanism the body takes to fight against UTI?
Micturition with increased diuresis
Antibacterial properties of urine and prostatic secretion
Anti adherence mechanism of bladder
Inflammatory response with PMNs; allowing phagocytosis to occur
List some of the risk factors associated with UTI
Females
Sexual intercourse
Abnormalities of urinary tract
Neurological disturbances
Anticholinergic drug
Catheterization and other mechanical related instrumentation
DM
Pregnancy
Use of diaphragms and spermicides
Genetic
Previous UTI not resolved
What are some preventive technique that a patient can undertake to minimize the future risk of getting UTI?
Drink lots of fluid (unless patient has fluid restrictions)
Urinate frequently and go when you feel the urge
Urinate shortly after sex
Wear loose fitting clothes and cotton underwear to keep area dry; avoid tight fitting jeans and nylon underwear
Wipe from front to back upon urinating for women
Modify birth control techniques
What is the difference between complicated and uncomplicated UTI
Complicated UTI refers to UTI with potential for serious outcome
Uncomplicated UTI refers to women who are health, premenopausal, nonpregnant and have no history suggestive of abnormal urinary tract
List some examples of uncomplicated UTI
UTI in men
UTI in pregnancy and children
Catheter associated UTI
Presence of complicating factors such as functional and structural abnormalities, GI instrumentation, DM and immunocompromised
What are the subjective evidence of a lower UTI?
Dysuria
Urgency
Frequency
Nocturia
Suprapubic heaviness
Gross hematuria
What are some other symptoms suggestive of an upper UTI?
Fever
Rigors
Headache
N/V
Malaise
Flank pain
Renal punch positive
Abdominal pain
Should urine culture be done for all patients?
No. Only do it for those who are pregnant; recurrent UTI; pyelonephritis; catheter associated UTI and men with UTI
What are some indications of a UTI upon receiving a UFEME report?
WBC > 10/ mm3 indicative of pyuria
RBC positive
Microorganisms such as yeast or bacteria
WBC casts - mass of cells and proteins usually found in renal tubules only –> indicative of upper UTI
Upon conducting a Dipstick, what are some key components to look for?
Leukocyte esterase
Nitrates
Can false negatives occur with Dipstick?
Yes. Can occur in presence of gram-positive and P.Aeruginosa bacteria; decrease urinary pH, frequent voiding and diluted urine
List the likely pathogen for uncomplicated UTI
E.coli
Staphylococcus saprophyticus
Enterococcus fecalis
Klebsiella pneumoniae
Proteus spp.
List the likely pathogens associated with complicated UTI
E.Coli
Enterococci
Proteus spp
Klebsiella spp.
P.Aeruginosa
Define nosocomial / healthcare associated UTI
UTI occurring in patients who are
- Hospitalized in last 90 days
- Current hospitalization more than 2 days ago
- Residence in nursing homes
- Recent antimicrobial use
Before choosing an antibiotic, what are the 3 things to consider
Is there a need to treat?
Organism factors?
Types of UTI?
What are the agents use for Cystitis in women? For each agent; list the dose, frequency and duration of treatment
PO Co-trimoxazle 960mg BD for 3 days
PO Nitrofurantoin 50mg QD for 5 days
PO Fosfomycin 3g single dose
What are the alternative agents for women with cystitis? List the dose, frequency and duration of treatment
PO Beta Lactams
- Cefuroxime 250mg BD for 5-7 days
- PO Amoxicillin clavulanate 625mg BD for 5-7 days
PO Fluroquinolones
- Levofloxacin 250mg daily
- Ciprofloxacin 250mg BD for 3 days
What do I do for complicated cystitis in women?
Increase duration of antibiotics to 7-14 days OR increase fosfomycin dose to 3 doses
For community acquired pyelonephritis, what are some agents I can consider? List the dose, frequency and duration.
PO Fluoroquinolones
- Ciprofloxacin 500mg BD for 7 days
- Levofloxacin 750mg for 5 days
What are some alternatives to consider for community acquired pyelonephritis? List the dose, frequency and duration
PO Co-trimoxazole 960mg BD for 10-14 days
PO Cefuroxime 250-500mg BD for 10-14 days
PO Amoxicillin clavulanate 625mg TDS for 10-14 days
IF patients do become severely ill and require hospitalisation, what can you do for their regime for CA-acquired pyelonephritis?
Initiate IV therapy and switch to oral once patient is stable.
- IV Ciprofloxacin 400mg BD
- IV Cefazolin 1g q8h
- IV Amoxicillin-clavulanate 1.2g q8h
Define healthcare associated pyelonephritis.
Onset of UTI > 48h post-admission
Hospitalized and underwent invasive urologic procedure in last 6 months
Why are broad spectrum antibiotics preferred for HA-associated UTI
Risk of P.Aeruginosa and resistant strains of bacteria
What are some possible empiric therapy for HA-Assoc pyelonephritis in more severe patients? List the dose, duration and frequency.
IV cefepine 2g q12h +/- IV Amikacin 15mg/kg/day
IV meropenem 1g q8h
IV Imipenem 500mg q8h
Duration: 7-14 days
What are some possible empiric therapy for HA-Assoc pyelonephritis in less sick patients? List the dose, duration and frequency.
Can consider PO therapy
- PO Levofloxacin 750mg daily
- PO Ciprofloxacin 500mg BD
What should I consider before starting treatment for community acquired UTI in men?
Any concern for prostatitis; defines the duration of therapy
How should males be treated for those with no concern for prostatitis?
Similar to complicated cystitis (i.e. longer duration of 7-14 days)
In cases of prostatitis or pyelonephritis, how should males be treated ?
PO Ciprofloxacin 500mg BD
PO Co-trimoxazole 960mg BD
Duration should be 6 weeks
Define catheter associated UTI
Presence of symptoms or signs compatible with UTI with no other identified source of infection along with 103 cfu/mL of > 1 bacteria species in a single catheter urine specimen in patients with indwelling urethral/ indwelling suprapubic/ intermittent catheterization or midstream voided urine specimen from patient whose catheter has been removed within previous 48h
List some of the risk factors associated with catheter associated UTI
Poor quality of catheter care
Duration of catheterisation
Renal function impairment
Females
DM
Colonisation of drainage bag, catheter and periurethral segment
Is antibiotics necessary for all catheter related UTI?
No. Not needed for ASB and only indicated for indwelling catheter to hasten symptoms resolution and risk of subsequent infection
What are some symptoms associated with catheter related UTI?
New onset or worsening fever, rigor, malaise, altered mental status, lethargy with no altered cause, flank pain, renal punch positive, and pelvic discomfort
How should I treat mild catheter associated UTI?
PO/ IV Levofloxacin 750mg for 5 days
What are some empiric therapy for catheter associated UTI?
IV Cefepime 2 q12h +/- IV Amikacin 15mg/kg in a single dose
IV Imipenem 500mg q6h
IV Meropenem 1g q8h
What is the criteria for use of co-trimoxazole to treat catheter associated UTI? How long should co-trimoxazole be used?
Women less than 65 years old, with no upper UTI and already removed indwelling catheter
3 days
What is some non-pharmacological advice to prevent catheter associated UTI?
Avoid unnecessary catheter use
If catheter still indicated, use for minimal duration
Use closed system
Ensure aseptic insertion technique
Do not recommend prophylactic antibiotics, topical antibiotics and chronic suppressive antibiotics
What are some antibiotic to avoid during pregnancy?
Fluoroquinolones - renal cartilage damage
Aminoglycosides - Neuro toxicity
Nitrofurantoin - Avoid in last trimester
Co-trimoxazole - avoid in 1st and last trimester
What is the duration of beta lactams used for UTI in pregnancy?
ASB/ Cystitis: 4-7 days
Pyelonephritis : 14 days
For patients with UTI symptoms, what are some other adjunctive therapy I can recommend?
Pain: NSAIDS, Paracetamol
Vomiting: Rehydration
Urinary symptoms:
- Urine alkalinization
- Phenazopyridine 100-200mg TDS
For phenazopyridine, what are some adverse drug reactions and contraindications associated to the drug
ADR: N/V , Orange red discolouration of urine
Avoid in G6PD deficient
How should I advice a patient upon providing them medication?
Signs and symptoms take 24-72 hours to resolve
For pregnant women, repeat culture should be recommended to check for bacteriological clearance
