UTI Flashcards
Risk factors for UTI
for both genders
- Previous UTIs
- urologic instrumentation and catheterization
-Urinary tract obstruction
- Neurogenic bladder
- renal transplantation
- structural abnormalities
- Diabetes mellitus
- Frequent sexual intercourse or new sex partner
- lack of urination after sexual intercourse
Specific to females
- pregnancy, sexual intercourse, diaphragm/ spermicide use
Specific for males
- lack of circumcision
- prostatic enlargement
- condom catheter drainage
Characteristics of complicated UTIs
- anatomical abnormalities of urinary tract (Kidney stones, hydronephrosis (swelling of kidneys), Colovesical fistula)
- recent urologic procedure or instrumentation (placement of nephrostomy tubes, ureteric stenting, suprapubic catheter, foley catheter)
- immunocompromised patients
- recurrent infections despite appropriate treatment
- male sex
- UTI in pregnancy
Most common pathogens for uncomplicated UTI, Complicated, Catheter associated, and prostatitis
For all UTIs the most common pathogen is E. Coli
Uncomplicated specific: proteus, klebsiella, staph
Complicated: proteus, klebsiella, staph, Enterococcus spp., pseudomonas aeruginosa
Catheter associated: Enterococcus spp., pseudomonas aeruginosa
Prostatitis: proteus, klebsiella, staph, Enterococcus spp., pseudomonas aeruginosa
Clinical presentation of UTI
New onset of dysuria, increased urinary urgency and increased urinary frequency
suprapubic heaviness
urine smell bad - not related to infection
hematuria - does not mean complicated infection
Clinical presentation of Pyelonephritis
Systemic signs of infection - fever, chills, rigors, nausea, vomiting, diarrhea
Flank pain - Costovertebral angle tenderness
Clinical presentation of complicated UTI and Catheter associated UTI
Complicated
- classic UTI symptoms present - not always
- fever
- malaise
- altered mental status
- urinary incontinence
- change in appetite
Catheter associated
- classic UTI symptoms often not present
- pain over kidney and bladder
- fever
- lethargy and malaise
Diagnosis of UTI and pyelonephritis - microbiologic criteria and what labs should we get
Must have symptoms and Microbiologic criteria to be diagnosed
Microbiologic criteria:
> or equal to 10^5 of > or equal to 1 bacterial species from a clean void
> or equal to 10^2 of > or equal to 1 bacterial species from a catheter (placed in last 48 hours)
Labs to get
Urinalysis
and
Urine culture
Asymptomatic Bacteriuria (ASB)
Bacteria present but not causing symptoms
DOES NOT REQUIRE TREATMENT
one of most common misdiagnosed infections which leads to greater resistance
4 characteristics of ideal oral antibiotic use for UTI
Medium to high bioavailability
medium to high renal excretion
low risk for resistance and adverse effects
high likelihood of susceptibility
Commonly used oral agents for UTI treatment and duration
General duration for uncomplicated is 3-7 days and for complicated/pyelo 7-14 days
-Nitrofurantoin 100mg PO BID x5 days (Uncomplicated only)
-Fosfomycin 3gm PO x 1 dose (uncomplicated only
-Cephalexin 500mg PO BID x3-7 days (uncomplicated) and 500-1000mg PO TID-QID x 7-14 days (complicated/pyelo)
-Cefadroxil 500mg PO BID x 3-7 days (uncomplicated) and 1000mg PO BID x 7-14 days (complicated/pyelo)
-Cefpodoxime: 200mg PO BID 3-7 days (uncomplicated) and 200-400mg PO BID x 7-14 days (complicated/pyelo)
-Amoxicillin/Clavulanate: 500/125mg or 875/125mg PO BID x 3-7 days (uncomplicated) and 875/125mg PO BID x 7-14 days (complicated/pyelo)
Options but not best due to resistance rates to E. Coli:
-TMP/SMX 1 DS PO BID x 3 (uncomplicated) x 7-14days (complicated/pyelo)
-Ciprofloxacin 250mg PO BID x 3 days (Uncomplicated) and 500-750mg PO BID x 7 days (Complicated/pyelo)
Empiric UTI treatment for hospitalized patients
- should be based on local resistance rates
- Ampicillin 2 gm IV Q6H + Gentamicin 5mg/kg (AdjBW) IV Q24H
- Cefazolin 1-2gm IV Q8H + Gentamicin 5mg/kg (AdjBW) IV Q24H
- Ceftriaxone 1-2gm IV Q24H
- Cefepime 1gm IV Q8-12H
- Gentamicin 5mg/kg (adjBW) IV Q24H
Prostatitis treatment
Recommend treatment options
- FQ
- TMP/SMX
- Cephalexin
- Amoxicillin/Clavulanate
Treatment duration 2-4 weeks
Recurrent UTI Definition, considerations, and possible treatment
3 or more infections in 1 year
2 or more infection in 6 months
Potential causes
- sexual intercourse
-postmenopausal women
- urologic abnormality
Posibble treatment can be narrowest spectrum option - nitrofenitoin
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coliSusceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Which antibiotic would you
look at to determine
amoxicillin susceptibility?
A. Ampicillin
B. Amoxicillin/clavulanate
C. Cefazolin
D. Ceftriaxone
E. Nitrofurantoin
A
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coliSusceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Which antibiotic would you
look at to determine Cephalexin susceptibility?
A. Ampicillin
B. Amoxicillin/clavulanate
C. Cefazolin
D. Ceftriaxone
E. Nitrofurantoin
C
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coliSusceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Which antibiotic would you
look at to determine Cefpodoxime susceptibility?
A. Ampicillin
B. Amoxicillin/clavulanate
C. Cefazolin
D. Ceftriaxone
E. Nitrofurantoin
C - EXAM Q
for any oral cephalosporing susceptibility should be based on cefazolin for E. Coli
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
How would you classify LN’s
UTI?
A. Uncomplicated
B. Complicated
C. Catheter associated
A
LN is a 26-year-old female who presents to urgent care for a 2-day onset of dysuria,
increased urinary frequency, increased urinary urgency, and suprapubic pain.
▪No pertinent past medical history
▪No history of previous UTI
▪Sexually active with 1 partner (uses condoms)
▪Home medications: Oral contraceptive
▪Urinalysis
▪WBC: 25-50 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Moderate
Local E. coli
Susceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
What would you recommend
for treatment?
A. SMX/TMP 1 DS PO BID x 3 days
B. Ciprofloxacin 250mg PO BID x 3 days
C. Cefidinir 300mg PO BID x 5 days
D. Cephalexin 500mg PO TID x 5 days
D
AB is a 55-year-old male who presents to the emergency department for a
3-day onset of dysuria, urinary incontinence, fever (101 F), and altered
mental status. Patient is admitted to the general medical unit.
▪PMH: HTN, T2DM
▪History of 3 UTIs in the past year, both due to E. coli
▪Home medications: Metformin, semaglutide, lisinopril
▪Allergies: Sulfa drugs (hives)
▪Urinalysis
▪WBC: >100 cells/hpf
▪WBC esterase: Positive
▪Nitrites: Positive
▪Bacteria: Many
How would you classify AB’s UTI?
A. Uncomplicated
B. Complicated
C. Catheter associated
B
B is a 55-year-old male who presents to the emergency department for a
3-day onset of dysuria, urinary incontinence, fever (101 F), and altered
mental status. Patient is admitted to the general medical unit.
▪Pertinent lab values
▪WBC 16,000 cells/mL
▪Hgb 13.8 g/dL
▪Plt 210,000/mm3
▪Na 139 mmol/L
▪K 4.2 mmol/L
▪Cl 103 mmol/L
▪CO2 22 mmol/L
▪BUN 11 mg/dL
▪SCr 1.1 mg/dL
Local E. coli
Susceptibility Rate
Ampicillin 56%
Amoxicillin/clavulanate 88%
Cefazolin 92%
Ceftriaxone 93%
Ciprofloxacin 79%
SMX/TMP 78%
Nitrofurantoin 97%
Gentamicin 92%
What would you
recommend for
empiric IV treatment?
A. Ampicillin alone
B. Ciprofloxacin IV
C. Ampicillin + Gentamicin
C
AB receives 2 days of IV ampicillin and IV gentamicin. His fever resolves
and his labs return to normal values. A urine culture was obtained upon
admission and the results return.
What is your
recommendation?
A. Amoxicillin 500mg PO TID x 5 days
B.Ciprofloxacin 500mg PO BID x 5 days
C. Cefadroxil 1000mg PO BID x 5 days
D.Cephalexin 500mg PO QID x 5 days
I choose A but all options are appropriate
AB receives 2 days of IV ampicillin and IV gentamicin. His fever resolves
and his labs return to normal values. A urine culture was obtained upon
admission and the results return.
▪You recommend cefadroxil 1000 mg PO BID x 5 days
▪The provider states that they are very concerned because the patient
came in and looked “very sick”. They state cefadroxil is a narrow spectrum
antibiotic and they are not sure if it is appropriate. They typically like to
use ciprofloxacin in these cases.
▪How would you respond?
A. Agree with the provider. It sounds reasonable
B. Politely discuss that BL are appropriate options when selected and dosed appropriately. additionally, the isolate is susceptible
C. Become enraged
D. Check the time. Its 4:01pm go home
B
