UTI Flashcards
Genitourinary Infections – Risk Factors
Female
(UTI more common in females)
- ___
- sexual intercourse
- diaphragm/spermicide use
Male
- Lack of ___
- ___ enlargement
- condom ___ drainage
All
- Previous UTI
- Urologic instrumentation and catheterization
- Urinary tract obstruction
- ___ bladder
- Renal transplantation
- Structural abnormalities
- Diabetes mellitus
- Frequent sexual intercourse or new sex partner
- Lack of urination after sexual intercourse
- pregnancy
- circumcision
- prostatic
- catheter
- Neurogenic
It’s Complicated – Characteristics of Complicated UTIs
___ abnormality of urinary tract
- Obstruction (commonly due to calculi)
- Hydronephrosis
- Renal tract calculi
- Colovesical fistula
Recent urologic ___ or instrumentation
- Placement of nephrostomy tubes
- Ureteric stenting
- Suprapubic catheter
- Foley catheter
___ patients
Recurrent ___ despite appropriate treatment
___ sex
UTI in ___
- anatomical
- procedure
- immoncompromised
- infections
- male
- pregnancy
What’s an Uncomplicated UTI?
- Patient not meeting criteria for complicated UTI
- ___ women, normal ___
- Pre-menopausal, anatomy
Genitourinary Infections – Most Common Pathogens
Uncomplicated UTI
- ___ (75-95%)
- Proteus mirabilis
- Klebsiella pneumoniae
- Staphylococcus saprophyticus
Complicated UTI
- ___
- Proteus mirabilis
- Klebsiella pneumoniae
- Enterococcus spp.
- Pseudomonas aeruginosa
- other enteric GNRs
Catheter-Associated UTI
- ___
- Enterococcus spp.
- Pseudomonas aeruginosa
- other enteric GNRs
Prostatitis
- ___
- Proteus mirabilis
- Klebsiella pneumoniae
- Enterococcus spp.
- Pseudomonas aeruginosa
- other enteric GNRs
E. coli x 4
Clinical Presentation – UTI and Pyelonephritis
UTI s/s
- New onset of ___, increased urinary urgency, and increased urinary frequency
- ___ “heaviness” sensation and/or pain
- Urine may be foul smelling or turbid – not correlated with infection
- Hematuria can occur in some cases – alone does not mean complicated infection
Pyelonephritis signs and symptoms – above plus
- ___ signs of infection – fever, chills, rigors, nausea, vomiting, diarrhea
- ___ pain – costovertebral angle (CVA) tenderness
- dysuria
- Suprapubic
- Systemic
- Flank
Clinical Presentation – Complicated UTI
Signs and symptoms atypical and non-specific in some cases
- Classic UTI symptoms commonly present, but not always
- Fever
- Malaise
- Altered ___ status**
- Urinary incontinence
- Change in appetite
Catheter-associated UTI
- Classic UTI symptoms ___ not present
- Pain over ___ and ___
- ___
- Lethargy and malaise
**Altered mental status alone does not automatically mean UTI is present
- mental
- often
- kidney, bladder
- fever
T or F: Hematuria indicated complicated UTI
FALSE
Diagnosis of UTI and Pyelonephritis
Cystitis Symptoms + Pyelonephritis Symptoms + Microbiologic Criteria
- ≥10^5 of ≥ 1 bacterial species from clean void
- ≥10^3 of ≥ 1 bacterial species from a catherter placed in last ___ hrs
48
Diagnosis of UTI and Pyelonephritis – Urinalysis and Culture
Urinalysis – 4 key components related to UTI
1) ___ present (depends on how lab reports it)
2) ___ present (≥ 10 cells/hpf)
3) Leukocyte (WBC) ___ present
4) ___ may or may not be present ( ___ convert nitrates to nitrites)
- Remember – diagnosis relies on correlation with ___
- Turnaround time – ___
1) bacteria
2) WBC
3) esterases
4) Nitrite, Enterobacterales
- symptoms
- hours
Diagnosis of UTI and Pyelonephritis – Urinalysis and Culture
Urine culture
- Assists with ___ of organism and confirm ___ to antibiotic selection
- Repeat urine culture after treatment generally not recommended
- Many labs institute criteria for urine culture ordering to reduce ___ of UTI
- Turnaround time – 2-3 ___
- identification, susceptibility
- overtreatment
- days
Asymptomatic Bacteriuria – End of Humanity
Asymptomatic bacteriuria (ASB) does NOT require treatment outside of a few specific cases:
- ___
ASB diagnosed as UTI is one of the most common misdiagnosed infections (~40%) with a tendency to overdiagnose and overtreat
Almost 80% of antibiotic use for ___ patients is unnecessary
- ASB exceedingly common in this patient population
Overdiagnosing → Overtreating → Antimicrobial resistance
- pregnancy
- catheterized
Characteristics of an Ideal Oral Antibiotic for UTI
1) Medium to high ___
2) Medium to high ___ excretion
3) Low risk for “collateral damage” and adverse effects
4) High likelihood of ___
- bioavailability
- renal
susceptibility
Commonly Used Oral Agents for UTI Treatment
___ (uncomplicated only)
Sulfamethoxazole/trimethoprim
Fluoroquinolones – ___ , ___
___ (uncomplicated only)
Beta-lactams
- ___
- Cefadroxil
- Cefpodoxime
- Amoxicillin/clavulanate
- ___ (only after susceptibility is confirmed)
- Nitrofurantoin
- ciprofloxacin, levofloxacin
- fosfomycin
- cephalexin
- amoxicillin
Guideline Recommendations for UTI Treatment - Duration
complicated/pyelonephritis
- ___ - ___ days
uncomplicated
- ___ - ___ days
- nitrofurantoin: ___ days
- SMZ/TMP and ciprofloxacin: ___ days
- 7-14
- 3-7
- 5
- 3
The threshold of ___ % is the resistance prevalence at which the agent is no longer recommended for empirical treatment
- probably wouldnt use ___ and ___ if treating E. coli
- 20%
- SMZ/TMP, ciprofloxacin
Are beta-lactams actually less effective?
IDSA guidelines state beta-lactam antibiotics are less effective for both uncomplicated UTI and pyelonephritis
- most data comes from 1980s-1990s
- but they chose janky Abx that were dosed inappropriate
- did not consider local resistance rates
So in conclusion…
- beta-lactams work just fine
Empiric UTI Treatment for Hospitalized Patients
- Important to base empiric treatment selection on local susceptibility rates to common pathogens
- Often, ___ antibiotic therapy is initiated while awaiting urine and blood culture results
Examples of commonly used options for empiric therapy
- ___ 2 grams IV Q6H + ___ 5 mg/kg (AdjBW) IV Q24H
- ___ 1-2 grams IV Q8H +/- ___ 5 mg/kg (AdjBW) IV Q24H
- ___ 1-2 grams IV Q24H
- ___ 1 gram IV Q8-12H
- ___ 5 mg/kg (AdjBW) IV Q24H
- IV
- ampicillin + gentamicin
- cefazolin +/- gentamicin
- ceftriaxone
- cefepime
- gentamicin
Considerations for UTI Treatment in Hospitalized Patients
___ can occur in patients with complicated UTI and pyelonephritis
- Estimated 15-40% of patients develop bacteremia
- “Urosepsis” is a commonly used term
- Bacteremia ≠ ___ antibiotic duration
- Duration resembles complicated UTI – __ - __ days
De-escalate to narrowest antibiotic option once urine culture with susceptibilities return
- It is OK to use a narrow spectrum antibiotic once susceptibilities return even if patient was critically ill upon admission
- Bacteremia
- longer
- 7-14
Considerations for Prostatitis Treatment
General approach to treatment similar to UTI
Must consider antibiotic penetration into the prostate
- No active transport of antibiotics into the prostate tissue
- Need an option with high level of free drug, low protein binding
Recommended treatment options
- ___
- ___ / ___
- Some beta-lactams ( ___ , ___ / ___)
Treatment duration: __ - __ weeks
- FQs
- Sulfamethoxazole/trimethoprim
- cephalexni, amoxicillin/clavulanate
- 2-4
Considerations for Recurrent UTI Management
Definition of recurrent UTI
- __ or more infections in 1 year
- __ or more infections in 6 months
Important to consider potential causes for recurrent infections
- Sexual intercourse and diaphragm/spermicide use
- ___ women
- Urologic abnormality
May consider ___ antibiotic if no correctable cause identified
- Select narrowest spectrum option
- 3
- 2
- Postmenopausal
- prophylactic
T or F: increased daily water intake in premenopausal women can reduce recurrent urinary tract infections
TRUE
