UTI

Question 1

what kind of bacteria most commonly cause UTI

Answer 1

E coli and other gram negative bacteria

Question 2

cystitis

Answer 2

infection of the bladder

Question 3

pyelonephritis

Answer 3

infection of the kidney

Question 4

pathophysiology of cystitis/pyelonephritis

Answer 4

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

Question 5

urine dip stick testing focus on the presence of ____ & ___

Answer 5

leukocytes and nitrites

Question 6

what’s the criteria to treat UTI?

Answer 6

1 point each for:
dysuria
leukocytes
nitrites
0-1 no treatment
2-3 culture, and treat empirically

Question 7

recurrent UTI

Answer 7

2 uncomplicated UTI in 6 months or
3 in 12 months

Question 8

reinfection of UTI

Answer 8

occurs after 2 weeks of abx, typically caused by a Different organism

Question 9

relapse UTI

Answer 9

same organism within 2 weeks after finishing abx

Question 10

___ is always require before antimicrobial treating someone in LTC or NH

Answer 10

culture

Question 11

1st line of treatment for UTI include

Answer 11

TMP/SMX
Trimethoprim
Nitrofurantoin (Macrobid)
Amoxicillin (if susceptible)

Question 12

2ne line of treatment for UTI include

Answer 12

Ciprofloxacin (pseudomonas only)
Levofloxacin
Amoxicillin/Clavulanate

Question 13

complicated UTI should be treated for the duration of______

Answer 13

7-10days if bladder symptoms,
10-14 days if kidney or systemic symptoms

Question 14

how to treat recurrent UTI

Answer 14

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

Question 15

1st line treatment for pregnant women with UTI

Answer 15

Cephalexin
Nitrofurantoin
Fosfomycin (single dose)

Question 16

2nd line treatment for pregnant women with UTI

Answer 16

Amoxicillin (treatx 7days, confirm sensitivity, avoid in areas with > 2 0 % resistance) good for E.coli and Group B strep
* TMP/SMX,Trimethoprim

Question 17

_____ (abx) should be avoid for pregnant women with UTI in __ weeks

Answer 17

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.

Question 18

1st line of treatment for UTI in children

Answer 18

TMP/SMX(unlesslocalresistance>20%)

Question 19

2nd line of treatment for UTI in children

Answer 19

Amoxicillin
Cephalexin
Cefadroxil
Trimethoprim(compounded)

Question 20

___ abx is contraindicated in children

Answer 20

Fluoroquinolones are contraindicated <18 yrs
except in life-threatening or multi-drug resistant situations

Question 21

treatment duration for children with UTI

Answer 21

7 -14 days

Question 22

1st line of treatment for pyelonephritis

Answer 22

TMP/SMX(Iflocalresistanceis<20%) * Trimethoprim(same)
* Norfloxacin
* Ciprofloxacin(onlywithpseudomonas) * Levofloxacin

Question 23

2nd line of treatment for pyelonephritis

Answer 23

Amoxicillin/Clavulanate

Question 24

which abx is not effective for pyelonephritis

Answer 24

Nitrofurantoin and fosfomycin are not effective for pyelonephritis

Question 25

symptoms of pyelonephritis should improve after ___ (how long) after treatment

Answer 25

72 hours
if not, refer for IV treatment and further renal investigation). Any worsening is an immediate referral. Close monitoring is essential