UTI

Question 1

What is considered significant colony counts in urine for asymptomatic bacteruria?

Answer 1

≥10^5 CFU/mL or ≥10^8 CFU/L
(CFU: colony-forming unit)

Question 2

Who should be screened and treated for asymptomatic bacteriuria?

Answer 2

1. Pregnant women (4-7 days of abx based on AST)
2. Patients undergoing invasive urologic procedure (mucosal trauma/bleeding) (30-60min before procedure based on AST)

Question 3

Does delirium, falls or confusion suggest UTI (no urinary symptoms)?

Answer 3

No

Question 4

What is considered as recurrent cystitis in women?

Answer 4

2 episodes within 6 months or 3 episodes within 12 months

Question 5

Symptoms of cystitis (3 main + 6 extra)

Answer 5

3: dysuria, frequency, urgency
6: nocturia, abd pain, hematuria, foul-smelling urine, incomplete emptying, chills

Question 6

Pyuria definition (WBC count)

Answer 6

> 10 WBC/mm3

Question 7

When to do urine cultures?

Answer 7

1. Recurrent/unresolved UTI
2. Men with UTI
3. Suspected pyelonephritis
4. Pregnancy
5. Catheter-associated UTI

Question 8

Common bacteria causing UTI

Answer 8

Uncomplicated: E coli, Klebsiella, Proteus, Enterococcus faecalis, staph saprophyticus
Complicated: E coli, Klebsiella, Proteus, Enterococci, Enterobacter, Pseudomonas

Question 9

1st line for uncomplicated cystitis in women

Answer 9

Nitrofurantoin 50mg QDS x 5 days
Alternative:
- augmentin 1g BD x5-7D
- fosfomycin 3g single dose

others but resistance:
- co-trimoxazole BD x 3D
- ciprofloxacin 250mg BD x 3D
- levofloxacin 250mg OD x 3D

Question 10

1st line for complicated cystitis in women / cystitis in men (no prostatitis)

Answer 10

LONGER DURATION 7-14 days
Nitrofurantoin 50mg QDS
Alternative:
- augmentin 1g BD
- fosfomycin 3g x 3 doses

others but resistance:
- co-trimoxazole BD
- ciprofloxacin 250mg BD
- levofloxacin 750mg OD

Question 11

1st line for uncomplicated pyelonephritis in women

Answer 11

Augmentin 1g BD x10-14D
Alternative: cefuroxime 250-500mg BD x 7-10D

Others but resistance:
- ciprofloxacin 500mg BD x 7D
- levofloxacin 750mg OD x 5D
- co-trimoxazole BD x 10-14D

Can add initial IV ciprofloxacin 400mg BD / IV cefazolin 1g Q8h / IV augmentin 1.2g Q8h then switch to PO

Question 12

Can use ciprofloxacin and co-trimoxazole for empiric treatment of UTI?

Answer 12

No, high local rates of resistance, only can use if AST says sensitive

Question 13

1st line for cystitis with prostatitis concern in men

Answer 13

Ciprofloxacin 500mg BD
Co-trimoxazole BD
10-14D (6 weeks if prostatitis)
(Christine teng notes)

Question 14

What is considered complicated UTI?

Answer 14

• Men
• Pregnant women
• Patients with relevant anatomical or functional abnormalities of the urinary tract
• Indwelling urinary catheters
• Renal diseases
• With other concomitant immunocompromising diseases (e.g. diabetes)

Question 15

What is considered nosocomial pyelonephritis?

Answer 15

onset of UTI ≥48h post admission

Question 16

Treatment options for nosocomial / healthcare associated pyelonephritis?

Answer 16

7-14 days
- IV cefepime 2g Q12h +- IV amikacin 15mg/kg/day
- IV imipenem 500mg Q6h or IV meropenem 1g Q8h
- PO levofloxacin 750mg OD / ciprofloxacin 500mg BD (for less sick pts)
[target pseudomonas, ESBL -> broad spectrum]

Question 17

Define catheter-associated UTI

Answer 17

Presence of s&sx of UTI with no other identified source of infection + 10^3 CFU/mL of ≥1 bacterial species in
- a single catheter urine specimen in pts with indwelling urethral, indwelling suprapubic or intermittent catheterisation OR
- a midstream voided urine specimen from a pt whose catheter has been removed within the prev 48h

Question 18

Should you start abx for catheter-associated UTI if there are no symptoms?

Answer 18

No

Question 19

Treatment options for catheter-associated UTI

Answer 19

• IV imipenem 500mg Q6h or IV meropenem 1g Q8h
• IV cefepime 2g Q12h +- IV amikacin 15mg/kg (1 dose)
• PO/IV levofloxacin 750mg OD x5D
• PO co-trimoxazole BD x3D (for women ≤65y without upper UTI sx after indwelling catheter has been removed)
• 7 days for prompt response, 10-14 days for delayed response