UTI Flashcards
What is considered significant colony counts in urine for asymptomatic bacteruria?
≥10^5 CFU/mL or ≥10^8 CFU/L
(CFU: colony-forming unit)
Who should be screened and treated for asymptomatic bacteriuria?
- Pregnant women (4-7 days of abx based on AST)
- Patients undergoing invasive urologic procedure (mucosal trauma/bleeding) (30-60min before procedure based on AST)
Does delirium, falls or confusion suggest UTI (no urinary symptoms)?
No
What is considered as recurrent cystitis in women?
2 episodes within 6 months or 3 episodes within 12 months
Symptoms of cystitis (3 main + 6 extra)
3: dysuria, frequency, urgency
6: nocturia, abd pain, hematuria, foul-smelling urine, incomplete emptying, chills
Pyuria definition (WBC count)
> 10 WBC/mm3
When to do urine cultures?
- Recurrent/unresolved UTI
- Men with UTI
- Suspected pyelonephritis
- Pregnancy
- Catheter-associated UTI
Common bacteria causing UTI
Uncomplicated: E coli, Klebsiella, Proteus, Enterococcus faecalis, staph saprophyticus
Complicated: E coli, Klebsiella, Proteus, Enterococci, Enterobacter, Pseudomonas
1st line for uncomplicated cystitis in women
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
1st line for complicated cystitis in women / cystitis in men (no prostatitis)
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
1st line for uncomplicated pyelonephritis in women
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
Can use ciprofloxacin and co-trimoxazole for empiric treatment of UTI?
No, high local rates of resistance, only can use if AST says sensitive
1st line for cystitis with prostatitis concern in men
Ciprofloxacin 500mg BD
Co-trimoxazole BD
10-14D (6 weeks if prostatitis)
(Christine teng notes)
What is considered complicated UTI?
- 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)
What is considered nosocomial pyelonephritis?
onset of UTI ≥48h post admission
Treatment options for nosocomial / healthcare associated pyelonephritis?
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]
Define catheter-associated UTI
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
Should you start abx for catheter-associated UTI if there are no symptoms?
No
Treatment options for catheter-associated UTI
- 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
