UTI Flashcards
Urinary Tract Infections
What are characteristics that would make a UTI complicated?
- UTI in pregnancy
- Recent urologic procedure or instrumentation
- Anatomical abnormality of urinary tract
- Recurrent infections despite appropriate treatment
- Immunocompromised patients
- Male sex
URARIm
Procedures - nephrostomy tubes, catheters, stenting
Abnormalities - calculi obstructions, hydronephrosis, colovesical fistula
What are the most common pathogens in UTIs?
Escherichia coli
proteus mirabilis, klebsiella pneumoniae, enterococcus, pseudomonas aeruginosa
How do uncomplicated UTIs present?
- increased urgency
- increased frequency
- suprapubic heaviness
- foul-smelling urine
- hematuria
How do complicated UTIs present?
- fever
- malaise
- altered mental status
- urinary incontinence
- change in appetite
+/- uncomplicated symptoms
How does pyelonephritis present?
- systemic signs of infection
- flank pain - CVA tenderness
- uncomplicated symptoms
fever, chills, rigors, vomiting, diarrhea
How does catheter-associated UTI present?
- classic UTI symptoms often not present
- pain over kidney and bladder
- fever
- lethargy and malaise
What criteria need to be met to diagnose a UTI?
- symptoms present + microbio criteria
> 100000 of at least 1 bacterial species from a clean void
> 1000 of at least 1 bacterial species from a catheter placed within the past 48 hours
- What is asymptomatic bacteriuria (ASB)?
- When should ASB be treated?
- What are some risks of overtreating asymptomatic bacteriuria?
- ASB is when there is bacteria in the urine, but no symptoms of infection
- ASB should only be treated if the patient is pregnant
- Overtreating ASB leads to increased antimicrobial resistance
What are the key components to a urinalysis that are relate to UTI?
- bacteria present
- WBC present
- Leukocyte esterase present
- +/- Nitrite
enterobacterales converts nitrates to nitrites
Which drugs can only be used in outpatient uncomplicated UTI?
- nitrofurantoin (5 days)
- fosfomycin
Which drugs can be used in complicated or uncomplicated outpatient UTI?
- cephalexin, cefadroxil, cefpodoxime
- amox/clav
TMP/SMX and ciprofloxacin can be used, BUT they have a higher resistance rate to e. coli compared to the other agents. (at least in Lafayette)
What is the duration of treatment for uncomplicated outpatient UTI?
3-7 days
What is the duration of treatment for outpatient complicated UTI?
7-14 days
What are the empiric inpatient treatment options for UTI?
- ampicillin + gentamicin
- cefazolin +/- gentamicin
- ceftriaxone
- cefepime
- gentamicin
What should the duration of therapy be for a patient that develops bacteremia?
7-14 days
bacteremia does not = longer duration
What are the recommended treatment options for prostatitis?
- fluoroquinolones
- TMP/SMX
- some B-lactams
Need an option with high level of free drug, low protein binding
What is the duration of treatment for prostatitis?
2-4 weeks
What are the definitions of recurrent UTI?
- 3 or more infections in 1 year
- 2 or more infections in 6 months
When looking at susceptibility results, which abx you base the susceptibility for all by mouth cephalosporins off of?
Cefazolin – unless that specific abx has been tested on its own
Is it appropriate to use narrow-spectrum abx once a complicated inpatient case has started to get better?
YES
