UTI Flashcards
Risk factors for the development of UTIs
Younger age groups (neonates/infants)
Female sex
Uncircumcised infants
Constipation (but basically any sort of bowel/bladder dysfunction)
Anatomic abnormalities (VUR)
Functional abnormalities (neurogenic bladder)
Female sexual activity
Immunocompromised state (HIV, transplant)
DM
Genetic predisposition
Main pathogen that causes UTIs
E. coli (duh)
UTI infection pathways: retrograde ascent
enter through urethra and migrate to the bladder
UTI infection pathways: nosocomial infection
introduction of foreign body to the UT, more resistant pathogens
UTI infection pathways: hematogenous route
infection originates outside of the UT (like from bacteremia or sepsis) resulting in systemic infection with subsequent UT seeding.
The hematogenous route is more common in what patients?
Infants, immunocompromised patients
UTI infection pathways: fistula
between the UT and GI tract/vagina
“Lower” UTI classification
Bladder- cystitis
Urethra- urethritis
“Upper” UTI classification
Kidney- pyelonephritis
Complicated UTI
Longer treatment course
GU tract with structural/functional abnormalities
Uncomplicated UTI
Occurs in anatomically normal UT with no prior instrumentation
Bacterial persistence (colonization)
Documentation of negative urine cultures after UTI treatment, but because of incomplete eradication, the original infecting organism is isolated on subsequent episodes
Bacterial colonization usually occurs in patients with what?
Underlying anatomical abnormalities
UTI signs and symptoms in neonates
jaundice, FTT, fever, difficulty feeding, irritability, vomiting, diarrhea
UTI signs and symptoms in infants and children <2
Everything’s the same as neonates, but no jaundice
UTI signs and symptoms in children >2
fever, frequency, dysuria, enuresis (toilet accidents), hematuria, abdominal pain
UTI diagnostic criteria: what do rapid urine tests look for?
Looks for urine-specific gravity and pH, glucose, protein, blood, nitrites, leukocyte esterase (LE)
Not intended to replace a urine culture as a diagnostic tool
UTI diagnostic criteria: microscopy
crystals, RBCs, WBCs (pyuria), casts, bacteria
UTI diagnostics: urine culture; what is the gold standard?
Suprapubic aspiration (SPA)
UTI diagnostics: other methods of collecting urine for a culture
Transurethral catheterization, “clean catch”
AAP definition of a UTI: clean catch
Significant bacteria and pyuria, >100K cfu/ml of 1 bacteria
AAP definition of a UTI: catheterization
Significant bacteria and pyuria, >50K cfu/ml of 1 bacteria
AAP definition of a UTI: SPA
Significant bacteria and pyuria, but literally any evidence of growth
First-line treatments for UTIs
CEPHALOSPORINS
Bactrim
Beta-lactam/beta-lactamase inhibitor
When to treat UTIs with parenteral ABX
Acutely ill (septic) children, infants <2 months, immunocompromised, unable to tolerate PO
Parenteral ABX for UTI treatment
Ampicillin
Cefazolin (1st generation)
Cefotaxime (3rd generation)
Ceftriaxone (3rd generation)
Ceftazidime (3rd generation)
Cefepime (4th generation)
Ciprofloxacin
Gentamicin
Tobramycin
Monotherapy with ampicillin: yay or nay?
Nope, not preferred
Ceftriaxone should be avoided in what patients?
Neonates d/t biliary sludging
Parenteral ABX for UTIs with anti-pseudomonas coverage
Ceftazadime, cefepime, ciprofloxacin, gentamicin, tobramycin
Side effects of gentamicin and tobramycin
Nephrotoxicity, ototoxicity
Side effects of ciprofloxacin
tendon rupture, tendonitis, and photosensitivity
PO ABX for UTI
Amox/clav
Cephalexin (1st gen)
Cefixime (3rd gen)
Cefpodoxime (3rd gen)
Ceftibuten (3rd gen)
Ciprofloxacin
Nitrofurantoin
Bactrim (dose based on TMP)
ADEs of amox/clav, cephalexin, cefixime, cefpodoxime
N/V/D, abdominal pain
ADEs of ceftibuten
N/V/D, abdominal pain, serum sickness
Counseling point about nitrofurantoin
Urine discoloration
Bactrim ADEs
hematologic ADEs, interstitial nephritis
Avoid Bactrim in what patients?
Patients <2 months
Duration of UTI treatment
7-14 days
7 for uncomplicated, 10-14 for complicated
Goal of UTI prophy
prevent irreversible damage
Candidates for UTI prophy
Neonates/infants being evaluated for anatomic/functional UT abnormalities
Children with vesicoureteral reflux (VUR)
Children with dysfunctional voiding
Immunocompromised
Children with recurrent UTIs despite normal anatomy/function
Target population of UTI prophy
Females, VUR grade V, bladder/bowel dysfunction
Duration of UTI prophy
1-2 years or until “outgrown” or surgically repaired
ABX used in UTI prophy
Amoxicillin, cephalexin, nitrofurantoin, Bactrim
ABX for neonates/infants <2 months on UTI prophy
Amoxicillin
ABX for infants >2 months on UTI prophy
Nitrofurantoin, Bactrim
Avoid what ABX in UTI prophy?
Cephalosporins, because it will increase bacterial resistance
