UTI

Question 1

Risk factors for the development of UTIs

Answer 1

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

Question 2

Main pathogen that causes UTIs

Answer 2

E. coli (duh)

Question 3

UTI infection pathways: retrograde ascent

Answer 3

enter through urethra and migrate to the bladder

Question 4

UTI infection pathways: nosocomial infection

Answer 4

introduction of foreign body to the UT, more resistant pathogens

Question 5

UTI infection pathways: hematogenous route

Answer 5

infection originates outside of the UT (like from bacteremia or sepsis) resulting in systemic infection with subsequent UT seeding.

Question 6

The hematogenous route is more common in what patients?

Answer 6

Infants, immunocompromised patients

Question 7

UTI infection pathways: fistula

Answer 7

between the UT and GI tract/vagina

Question 8

“Lower” UTI classification

Answer 8

Bladder- cystitis
Urethra- urethritis

Question 9

“Upper” UTI classification

Answer 9

Kidney- pyelonephritis

Question 10

Complicated UTI

Answer 10

Longer treatment course

GU tract with structural/functional abnormalities

Question 11

Uncomplicated UTI

Answer 11

Occurs in anatomically normal UT with no prior instrumentation

Question 12

Bacterial persistence (colonization)

Answer 12

Documentation of negative urine cultures after UTI treatment, but because of incomplete eradication, the original infecting organism is isolated on subsequent episodes

Question 13

Bacterial colonization usually occurs in patients with what?

Answer 13

Underlying anatomical abnormalities

Question 14

UTI signs and symptoms in neonates

Answer 14

jaundice, FTT, fever, difficulty feeding, irritability, vomiting, diarrhea

Question 15

UTI signs and symptoms in infants and children <2

Answer 15

Everything’s the same as neonates, but no jaundice

Question 16

UTI signs and symptoms in children >2

Answer 16

fever, frequency, dysuria, enuresis (toilet accidents), hematuria, abdominal pain

Question 17

UTI diagnostic criteria: what do rapid urine tests look for?

Answer 17

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

Question 18

UTI diagnostic criteria: microscopy

Answer 18

crystals, RBCs, WBCs (pyuria), casts, bacteria

Question 19

UTI diagnostics: urine culture; what is the gold standard?

Answer 19

Suprapubic aspiration (SPA)

Question 20

UTI diagnostics: other methods of collecting urine for a culture

Answer 20

Transurethral catheterization, “clean catch”

Question 21

AAP definition of a UTI: clean catch

Answer 21

Significant bacteria and pyuria, >100K cfu/ml of 1 bacteria

Question 22

AAP definition of a UTI: catheterization

Answer 22

Significant bacteria and pyuria, >50K cfu/ml of 1 bacteria

Question 23

AAP definition of a UTI: SPA

Answer 23

Significant bacteria and pyuria, but literally any evidence of growth

Question 24

First-line treatments for UTIs

Answer 24

CEPHALOSPORINS
Bactrim
Beta-lactam/beta-lactamase inhibitor

Question 25

When to treat UTIs with parenteral ABX

Answer 25

Acutely ill (septic) children, infants <2 months, immunocompromised, unable to tolerate PO

Question 26

Parenteral ABX for UTI treatment

Answer 26

Ampicillin
Cefazolin (1st generation)
Cefotaxime (3rd generation)
Ceftriaxone (3rd generation)
Ceftazidime (3rd generation)
Cefepime (4th generation)
Ciprofloxacin
Gentamicin
Tobramycin

Question 27

Monotherapy with ampicillin: yay or nay?

Answer 27

Nope, not preferred

Question 28

Ceftriaxone should be avoided in what patients?

Answer 28

Neonates d/t biliary sludging

Question 29

Parenteral ABX for UTIs with anti-pseudomonas coverage

Answer 29

Ceftazadime, cefepime, ciprofloxacin, gentamicin, tobramycin

Question 30

Side effects of gentamicin and tobramycin

Answer 30

Nephrotoxicity, ototoxicity

Question 31

Side effects of ciprofloxacin

Answer 31

tendon rupture, tendonitis, and photosensitivity

Question 32

PO ABX for UTI

Answer 32

Amox/clav
Cephalexin (1st gen)
Cefixime (3rd gen)
Cefpodoxime (3rd gen)
Ceftibuten (3rd gen)
Ciprofloxacin
Nitrofurantoin
Bactrim (dose based on TMP)

Question 33

ADEs of amox/clav, cephalexin, cefixime, cefpodoxime

Answer 33

N/V/D, abdominal pain

Question 34

ADEs of ceftibuten

Answer 34

N/V/D, abdominal pain, serum sickness

Question 35

Counseling point about nitrofurantoin

Answer 35

Urine discoloration

Question 36

Bactrim ADEs

Answer 36

hematologic ADEs, interstitial nephritis

Question 37

Avoid Bactrim in what patients?

Answer 37

Patients <2 months

Question 38

Duration of UTI treatment

Answer 38

7-14 days

7 for uncomplicated, 10-14 for complicated

Question 39

Goal of UTI prophy

Answer 39

prevent irreversible damage

Question 40

Candidates for UTI prophy

Answer 40

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

Question 41

Target population of UTI prophy

Answer 41

Females, VUR grade V, bladder/bowel dysfunction

Question 42

Duration of UTI prophy

Answer 42

1-2 years or until “outgrown” or surgically repaired

Question 43

ABX used in UTI prophy

Answer 43

Amoxicillin, cephalexin, nitrofurantoin, Bactrim

Question 44

ABX for neonates/infants <2 months on UTI prophy

Answer 44

Amoxicillin

Question 45

ABX for infants >2 months on UTI prophy

Answer 45

Nitrofurantoin, Bactrim

Question 46

Avoid what ABX in UTI prophy?

Answer 46

Cephalosporins, because it will increase bacterial resistance