UTI Flashcards
What is a UTI ?
Microorganisms infecting any part of the urinary tract WITH the presence of symptoms NOT JUST COLONIZATION
What are the different types of UTI?
1
2
3
4
- LOWER UTI (most common)
- Upper UTI
- Urosepsis
- Prostatitis
A lower UTI (cystitis) presents with ______, _______, ________, ________, __________
burning, frequency, urgency, pain, hematuria
Upper UTI (pyelonephritis aka kidney infection) presents with +/- lower UTI symptoms PLUS ________, ______, _____ etc
flank pain, fever, chills, N/V, CVA tenderness
Prostatitis is a type of UTI common in
MEN
An uncomplicated UTI is defined as a UTI in ____________ female patients __________ structural/ functional abnormalities or _____________
non-pregnant female patients WITHOUT // immunocompromised
Most common pathogens for a uncomplicated UTI
1.
2.
3.
4.
5.
- E.Coli (70-90%)
- P. mirabilis
- K. pneumoniae
“PEK” - S. SAPROPHYTICUS
- Enterococcus spp
A complicated UTI is defined as a patient having structural or functional abnormalities that interfere with normal flow of urine and the following:
- Male
- Children
- Pregnant
- Diabetes
- Catheters
- Immunocompromised
Most common pathogens for complicated UTI
1.
2.
3.
4.
5.
- Ecoli (~50%)
- P. mirabilis
- Enterococcus faecalis
- Staphylococcus
- Pseudomonas
Acinetobacter
Asymptomatic bacteria is defined as
Bacteriuria in the absence of symptoms
common pathogens E. coli etc
Recurrent UTI is defined as
Recurrent UTI causative pathogens are:
2 episodes of uncomplicated UTI in past 6 months
3 episodes of uncomplicated UTI in past 12 months
Same as initial pathogens
Urinary tract infection most common route is _________ colonization of urethra by fecal flora, can ascend to bladder and kidneys
Ascending
List some risk factors of UTI
1.
2.
3.
4. Diabetes
5. Catheter, renal dysfx
6. neurologic dysfunction
7. previous antibiotic use
8. sexual intercourse
- Age young very old
- Females
- Pregnancy
Diagnosis of UTI is based on _______ +/- urine culture and urinalysis
symptoms
Indication for urine culture:
1.
2.
3.
4.
- ALWAYS for pyelonephritis and or complicated UTI
- ALWAYS for pregnancy or diagnostic uncertainty
- bacterial prostatitis
- uncomplicated cystitis only if failure to respond or early recurrence or relapse
Examples of non pharm therapy for UTI
1.
2.
3.
- Surgical for deformities
- fluid hydration
- cranberry juice extract
probiotics low evidence
Treatment of UNCOMPLICATED UTI
1st line therapy
1.
2.
3.
- Nitrofurantoin po x 5 days
- tmp-smx (or tmp alone) po x 3 days
- fosfomycin 3 g PO x 1 dose (only available as powder) good for ESBL / pseudomonas
2nd Line
1. FQ (Cipro/Levo/Norflox) Po x 3D
2. Beta-lactams 3-7 d (lower efficacy)
Ampicillin or Amoxicillin alone should be avoided in UTI treatment because ?
HIGH E.Coli resistance
Asymptomatic bacteriuria treatment?
Bacteriuria without symptoms does not need to be treated
E.Coli most common
The only time patients with asymptomatic bacteriuria should be treated are if
1.
2.
- Pregnant
- Undergoing endourological procedures
Treatment of COMPLICATED UTI
1st line therapy
1.
2
3.
4.
1.Tmp-smx
2. FQ x 7-14d
3. amox-clav
4. cefixime
Pyelonephritis Empiric Treatment
Outpatient uncomplicated (Mild-Mod)
1.
FQ (cipro/levo) x 5-7d
2nd line
Amox clav
tmp-smx
tmp
Pyelonephritis Empiric Treatment
Inpatient
1.
2.
3.
4.
- AMG IV (+ ampicillin if enterococcus suspected) x 10-14 d
- Carbapenem IV +/- ampicillin (if not using imipenem) x 7-14 d
- FQ IV
- 3rd gen cephalosporin (cefepime) +/- ampicillin or piptaz IV x10-14d
The following two classes of antibiotics should be used when considering additional coverage for ESBL hospital-acquired UTI
1.
2.
- Carbapenem (pref Ertapenem IV)
- AGs
The following antibiotics should be used when considering additional coverage for Pseudomonas spp hospital-acquired UTI
1.
2.
3.
4.
5.
- pip-taz
- meropenem
- imipenem
- cipro/levo
- cefepime
The following antibiotics should be used when considering additional coverage for resistant enterococcus hospital-acquired UTI
1
2
3
- vancomycin IV
- linezolid
- daptomycin
The treatment of acute or chronic prostatitis involves either of these two medications:
1.
2.
- FQ
- TMP-SMX
Ceftriaxone then doxycycline if STI related
The following are common pathogens for prostatitis:
Ecoli, P. aeruginosa,
Others can be STI related, and these two are:
1
2
- N. Gonorrhea
- C. trachomatis
Recurrent UTI infections, defined as >2 infections in 6 months or >3 in 12 months can be treated via these 3 methods
1.
2.
3.
- short course self therapy
- post-intercourse
- long term prophylaxis
First line options for post intercourse prophylaxis include the following:
1.
2.
3.
- TMP SMX
- Macrobid
- FQ (norflox/cipro)
TMP, Cephalexin
First line options for long-term low dose prophylaxis for recurrent UTI include the following:
1
2
3
1 TMP SMX (1st)
2 macrobid
3 FQ (norflox/cipro)
TMP, cephalexin, FOSFOMYCIN, vaginal estrogens
Which of the following medications is safe for use in UTI pregnant patient?
a. Nitrofurantoin
b. TMP-SMX
c. FQ
d. AG
e. Amox/Clav
E
Candida spp and other fungi may cause UTIs in patients with _____________
indwelling urinary catheters
In patients with diabetes and candiduria, ________ is the preferred treatment
Fluconazole
A patient with asymptomatic catheter UTI should be treated? T or F
FALSE, do not treat if patient is asymptomatic
CULTURE and remove catheter
Mild/Mod symptoms: FQ or ceftriaxone
