UTI Flashcards
what kind of bacteria most commonly cause UTI
E coli and other gram negative bacteria
cystitis
infection of the bladder
pyelonephritis
infection of the kidney
pathophysiology of cystitis/pyelonephritis
colonization of pathogen in the urethra with ascension to bladder
inflammatory response with neutrophil infiltration and relase of inflammatory cytokines
injury of uroepithelium by bacterial toxins and inflammatory cytokines
if colonization ascend to renal pelvis adn calyces causing pyelonephritis
increase risk of bacteremia and urosepsis
urine dip stick testing focus on the presence of ____ & ___
leukocytes and nitrites
what’s the criteria to treat UTI?
1 point each for:
dysuria
leukocytes
nitrites
0-1 no treatment
2-3 culture, and treat empirically
recurrent UTI
2 uncomplicated UTI in 6 months or
3 in 12 months
reinfection of UTI
occurs after 2 weeks of abx, typically caused by a Different organism
relapse UTI
same organism within 2 weeks after finishing abx
___ is always require before antimicrobial treating someone in LTC or NH
culture
1st line of treatment for UTI include
TMP/SMX
Trimethoprim
Nitrofurantoin (Macrobid)
Amoxicillin (if susceptible)
2ne line of treatment for UTI include
Ciprofloxacin (pseudomonas only)
Levofloxacin
Amoxicillin/Clavulanate
complicated UTI should be treated for the duration of______
7-10days if bladder symptoms,
10-14 days if kidney or systemic symptoms
how to treat recurrent UTI
Hydrate with water>1.5L per day=decreases recurrence
* Culture and re-treat for7-14 days usually with a differentagent (alternatives shorter 3day patient self-
treatment with early symptom appearance)
* Prophylaxis for frequent recurrence: post-coital or continuous low-dose,reassess after 6months
1st line treatment for pregnant women with UTI
Cephalexin
Nitrofurantoin
Fosfomycin (single dose)
2nd line treatment for pregnant women with UTI
Amoxicillin (treatx 7days, confirm sensitivity, avoid in areas with > 2 0 % resistance) good for E.coli and Group B strep
* TMP/SMX,Trimethoprim
_____ (abx) should be avoid for pregnant women with UTI in __ weeks
Nitrofurantoin: OK 1st and 2nd trimesters but avoid at term (36-42 weeks), during labour and in neonates due to possible hemolytic anemia
TMP/SMX: OK for 2nd trimester. Caution in 1st trimester -> limits folic acid to the fetus and potentially lead to neural tube defects (use only if no safer alternatives + with supplemental folic acid). A void in 3rd trimester (last 6 weeks)-> sulfonamides may displace bilirubin from albumin binding sites causing kernicterus in infants, especially preterm infants
Avoid fluoroquinolones especially in first trimester and use safer alternatives, only use if potential benefit justifies risk to the fetus and other alternatives cannot be used.
1st line of treatment for UTI in children
TMP/SMX(unlesslocalresistance>20%)
2nd line of treatment for UTI in children
Amoxicillin
Cephalexin
Cefadroxil
Trimethoprim(compounded)
___ abx is contraindicated in children
Fluoroquinolones are contraindicated <18 yrs
except in life-threatening or multi-drug resistant situations
treatment duration for children with UTI
7 -14 days
1st line of treatment for pyelonephritis
TMP/SMX(Iflocalresistanceis<20%) * Trimethoprim(same)
* Norfloxacin
* Ciprofloxacin(onlywithpseudomonas) * Levofloxacin
2nd line of treatment for pyelonephritis
Amoxicillin/Clavulanate
which abx is not effective for pyelonephritis
Nitrofurantoin and fosfomycin are not effective for pyelonephritis
symptoms of pyelonephritis should improve after ___ (how long) after treatment
72 hours
if not, refer for IV treatment and further renal investigation). Any worsening is an immediate referral. Close monitoring is essential
