UTI Flashcards

1
Q

Screening and Tx of asymptomatic bacteriuria (ASB) is only indicated for 2 adult populations. Which 2 adult populations are they?

A
  1. Pregnant women
  2. Patients going for urologic procedure in which mucosal trauma/ bleeding is expected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Do we associate mental state changes/ decreased feeling of well-being with ASB?

A

No.

But possible for pt to have symptomatic bacteriuria AND delirium → give empiric Abx therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name the types of lower UTI (4) and upper UTI (1)

A

Lower UTI:
- Cystitis
- Urethritis
- Prostatitis
- Epididymis

Upper UTI:
- Pyelonephritis (kidneys)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List some examples of pathogens involved in the ascending and descending (hematogenous) route of infection for UTI

A

Ascending: E. coli, Proteus, Klebsiella

Descending: Staphylococcus aureus, Mycobacterium Tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for UTI? (11)

A
  • Females > males (1 y/o - adult)
  • Sexual intercourse
  • Abnormalities of urinary tract (eg prostatic hypertrophy, kidney stones, urethral strictures, vesicoureteral reflux)
  • Neurological dysfunctions (eg stroke, diabetes, spinal cord injuries)
  • Anticholinergic drugs
  • Catheterization and other mechanical instrumentation
  • Diabetes
  • Pregnancy
  • Use of diaphragms and spermicides
  • Genetic association (positive family history)
  • Previous UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non-pharmacological Tx to prevent UTIs?

A
  • Drink lots of fluid to flush the bacteria (6-8 glasses/day), unless you have a condition that requires fluid restriction
  • Urinate frequently
  • Urinate shortly after sex
  • For women: wipe from front to back after using the toilet
  • Wear cotton underwear and loose-fitting clothes so that air can keep the area dry. Avoid tight-fitting jeans and nylon underwear which trap moisture
  • Use of diaphragm and spermicide, unlubricated condoms or spermicidal condoms increase irritation and can increase bacterial growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define complicated UTI and list out several complicating factors. What type of people get complicated UTI?

A

Complicated UTI: UTI associated with conditions that ↑ potential for serious outcomes, risk for Tx failure

Eg UTIs in men, children and pregnant women

Complicating factors:
- Functional and structural abnormalities of urinary tract
- Genitourinary instrumentation (eg catheter)
- DM
- Immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define uncomplicated UTI. What type of people get complicated UTI?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the subjective s/sx for lower urinary tract infection (cystitis)? (6)

A
  • Dysuria
  • Urgency
  • Frequency
  • Nocturia
  • Suprapubic heaviness or pain
  • Gross hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the subjective s/sx for upper urinary tract infection (pyelonephritis)?

A
  • Fever
  • Rigors
  • Headache, n/v
  • Malaise
  • Flank pain, costovertebral tenderness (renal punch)
  • Abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some s/sx that especially elderly may experience if infected with UTI?

A

Elderly frequently do not experience specific urinary s/sx but can present with altered mental status, less alert, more drowsy, change in eating habits or GI s/sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 different lab results obtained from UFEME (urinalysis)?

What can you say about WBC?

A

WBC, RBC (non-specific), microorganisms, WBC casts

WBC > 10 x 10^9 cells/L
Signifies inflammation, but may or may not be due to infection, BUT absence of pyuria = unlikely UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In which type of pts do we take urine cultures?

A
  • Pregnant women
  • Recurrent UTI
  • Pyelonephritis
  • Catheter-associated UTI
  • All men with UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogens in uncomplicated cystitis in women

A
  • E. coli (> 85%)
  • Staphylococcus saprophyticus (5-15%)
  • Enterococcus faecalis
  • Klebsiella pneumoniae
  • Proteus spp.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathogens in complicated/ healthcare-associated UTI?

A
  • E. coli (~50%)
  • Enterococci
  • Proteus spp
  • Klebsiella spp
  • Enterobacter spp
  • P. aeruginosa (consider covering if pt has health-care associated risk factors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some healthcare-associated risk factors? (cover for P. aeruginosa if pt has these risk factors)

A

When pts have recent/ frequent exposure to healthcare settings.

  • Recent hospitalisation
  • Recent antimicrobial use
  • Recent invasive urological procedures
  • Use of long-term urinary catheters
17
Q

Empiric abx Tx for cystitis in women? (first-line and alternatives?)

A

First-line:
- PO co-trimoxazole 800/160mg bid x 3d
- PO nitrofurantoin 50mg qid x 5d
- PO fosfomycin 3g single dose

Alternatives:
PO beta-lactams x 5-7d
- PO cefuroxime 250mg bid
- PO amoxicillin-clavulanate 625mg bid
PO fluoroquinolones x 3d
- PO ciprofloxacin 250mg bid
- PO levofloxacin 250mg daily

18
Q

What is the empiric abx Tx for complicated cystitis in women? (first-line and alternatives?)

Duration of Tx?

A

(same as previous card)
First-line:
- PO co-trimoxazole 800/160mg bid x 3d
- PO nitrofurantoin 50mg qid x 5d
- PO fosfomycin 3g EOD x 3 doses

Alternatives:
PO beta-lactams x 5-7d
- PO cefuroxime 250mg bid
- PO amoxicillin-clavulanate 625mg bid
PO fluoroquinolones x 3d
- PO ciprofloxacin 250mg bid
- PO levofloxacin 250mg daily

Treat longer duration eg 7-14 days

19
Q

What can you say about the use of FQs in complicated/ uncomplicated UTI?

A

Avoid giving FQs as it is the only PO option for P. aeruginosa + debilitating SEs

20
Q

Pathogens involved in community-acquired pyelonephritis in women?

A
  • E. coli (> 85%)
  • Staphylococcus saprophyticus (5-15%)
  • Enterococcus faecalis
  • Klebsiella pneumoniae
  • Proteus spp.
21
Q

Tx for community-acquired pyelonephritis in women? (PO)

Should we do urine culture and AST?

A

Yes, while waiting for urine culture and susceptibility results…

If pts can take PO:
PO fluoroquinolones:
- PO ciprofloxacin 500mg bd x 7d
- PO levofloxacin 750mg od x 5d

  • PO co-trimoxazole
    160/800mg bd x 10-14d

PO beta-lactam x 10-14d:
- PO cefuroxime 250-500mg bid
- PO amoxicillin-clavulanate 625mg tds

22
Q

Tx for community-acquired pyelonephritis in women? (pts severely ill requiring hospitalisation/ unable to take PO)

A

For severely ill pts requiring hospitalisation/ unable to take oral drug:
- IV ciprofloxacin 400mg bid
- IV cefazolin 1g q8h
- IV amoxicillin-clavulanate 1.2g q8h
AND/ OR
- IV/ IM gentamicin 5mg/kg
THEN
- Switch to PO when pt improves/ able to take oral

23
Q

What is the Tx duration for UTI in pregnancy? (ASB/ cystitis and pyelonephritis)

A

Treat for 4-7 days for asymptomatic bacteriuria or cystitis.

Treat for 14 days for pyelonephritis

24
Q

Tx for UTI pregnancy?

What must you take note about co-trimoxazole, nitrofurantoin and AGs?

A

PO beta-lactams x 5-7d:
- PO cefuroxime 250mg bid
- PO amoxicillin-clavulanate 625mg bid

  • PO fosfomycin 3g single dose
  • PO co-trimoxazole 800/160mg bid x 3d
  • PO nitrofurantoin 50mg qid x 5d

Co-trimoxazole: avoid in first and third trimester
Nitrofurantoin: avoided at term; 38-42 weeks
AGs must be used with caution (cranial nerve toxicity in fetus reported with older AGs like kanamycin, streptomycin, but not for newer AGs)

25
Q

What pathogens should we cover in community-acquired UTI in men?

A

Treat it as per complicated UTI;
- E. coli (~50%)
- Enterococci
- Proteus spp
- Klebsiella spp
- Enterobacter spp
- P. aeruginosa

26
Q

Duration of Tx for community-acquired UTI in men?

A

Treat for 10-14 days, need longer duration if prostatitis is confirmed (6w)

27
Q

Tx for community-acquired UTI in men? (cystitis with no concern for prostatitis)

A

Cystitis with no concern for prostatitis → regimen as per complicated cystitis in women:
First-line:
- PO co-trimoxazole 800/160mg bid
- PO nitrofurantoin 50mg qid
- PO fosfomycin 3g EOD x 3 doses

Alternatives:
PO beta-lactams
- PO cefuroxime 250mg bid
- PO amoxicillin-clavulanate 625mg bid
PO fluoroquinolones
- PO ciprofloxacin 250mg bid
- PO levofloxacin 250mg daily

28
Q

Tx for community-acquired UTI in men? (cystitis with concern for prostatitis/ pyelonephritis)

A
  • PO ciprofloxacin 500mg bd
  • PO co-trimoxazole 160/800mg bd
29
Q

Define nosocomial UTI.

A

Nosocomial: onset of UTI >48h post hospital admission

30
Q

What pathogens must we cover for nosocomial/ healthcare associated UTI?

Must we do a culture?

A
  • Pseudomonas aeruginosa
  • Other resistant bacteria (ESBL-E. coli and ESBL-Klebsiella) should be considered and broad spectrum beta-lactam may be used

Yes, a culture is needed. Tx should be modified when result of culture and AST comes out

31
Q

Tx duration for nosocomial/ healthcare associated UTI?

A

Treat for 7-14 days

32
Q

Tx regimen for nosocomial/ healthcare associated UTI?

A
  • IV cefepime 2g q12h +/- IV amikacin 15mg/kg/d
  • IV imipenem 500mg q6h or IV meropenem 1g q8h
  • PO levofloxacin 750mg (for less sick pts)
  • PO ciprofloxacin 500mg bid (for less sick pts)
33
Q

Define CA-UTI

A

Presence of UTI s/sx with no other identified source of infection along with 10^3 cfu/mL ≥ 1 bacterial species in pts with:
- Indwelling urethral
- Indwelling suprapubic
- Intermittent catheterisation
- Midstream voided urine specimen in pt whose catheter has been removed within past 48h

34
Q

What are the pathogens to cover for CA-UTI?

A

(Same as nosocomial/ healthcare-associated UTI):
Pseudomonas aeruginosa
Other resistant bacteria (ESBL-E. coli and ESBL-Klebsiella)

35
Q

Tx duration for CA-UTI?

A

Treat for 7 days if prompt resolution of s/sx (deferverse in 72h)
Treat for 10-14 days if delayed response

36
Q

Tx regimen for CA-UTI? (what is the FIRST thing you need to consider doing?)

A

First, consider removing catheter

Abx:
- IV imipenem 500mg q6h or IV meropenem 1g q8h
- IV cefepime 2g q12h +/- IV amikacin 15mg/kg (1 dose or daily)
- PO/ IV levofloxacin 750mg x 5d (mild CA-UTI)
- PO co-trimoxazole 960mg bid x 3d (for women ≤ 65 y/o with CA-UTI without upper urinary tract s/sx after indwelling catheter has been removed

37
Q

What are the steps to prevent CA-UTI?

Would you recommend topical antiseptic or abx for prophylactic tx?

A
  • Avoid unnecessary catheter use
  • Use for minimal duration
  • Long-term indwelling catheters changed before blockage likely to occur
  • Use closed system
  • Ensure aseptic insertion technique
  • Topical antiseptic or abx NOT recommended
  • Prophylactic abx and antiseptic NOT recommended
  • Chronic suppressive abx NOT recommended
38
Q

List some adjunctive tx for UTI and what they treat

A

Paracetamol or NSAIDs: pain and fever

Rehydration: vomiting

Phenazopyridine: relieve urinary s/sx (do not use in G6PD deficiency)

Urine alkalization: relief discomfort in mild UTI but unproven benefit

39
Q

What should we monitor for UTI?

A

Resolution of s/sx:
- Improvement or resolution by 24-72h after abx use
- If pt fails to respond clinically within 2-3 days/ has persistent positive blood/ urine cultures, further investigation needed (check for bacterial resistance, possible obstruction, renal abscess, other diseases)

Repeat culture NOT NEEDED to document clearance of infection, ONLY for pregnant women

Drug ADEs