UTI

Question 1

Common pathogens

Answer 1

E. coli

Complicated UTI may also have gram (+) and resistant gram (-)

Question 2

Female risk factors

Answer 2

More common

Pregnancy
Sex
Diaphragmatic/spermicide use

Question 3

Male risk factors

Answer 3

Uncircumcised
Prostatic enlargement
Condom catheter drainage

Question 4

Both risk factors

Answer 4

Previous UTI
Urologic instrumentation and catheterization
Urinary tract obstruction
Neurogenic bladder
Renal transplantation
DM
Frequent sex or new sex partner
Lack of urination after sex

Question 5

Complicated UTI

Answer 5

Anatomical abnormality of urinary tract
- Obstruction (calculi), hydronephrosis, colovesical fistula

Recent urologic procedure or instrumentation
- Nephrostomy tubes, uretic stenting, suprapubic catheter, foley catheter

Immunocompromised
Recurrent infections
Male
UTI in pregnancy

Question 6

Uncomplicated UTI

Answer 6

No complicated UTI criteria

Pre-menopausal women with normal anatomy

Question 7

UTI symptoms

Answer 7

Dysuria

Increased frequency and urgency

Turbid or foul urine–>not correlated with infection

Hematuria–>alone does not mean complicated UTI

Question 8

Pyelonephritis symptoms

Answer 8

Systemic–> fever, chills, rigor, malaise, N/V/D

Flank pain–> CVA tenderness

Question 9

Complicated UTI symptoms

Answer 9

Systemic–> fever, malaise

Altered mental status–>alone does not mean UTI

Urinary incontinence

Changes in appetite

Question 10

Catheter-associated UTI

Answer 10

Pain with kidney and bladder

Fever

Lethargy, malaise

Question 11

Symptoms + microbiologic criteria

Answer 11

≥ 10^5 of ≥ 1 bacterial species from clean void

≥ 10^3 of ≥ 1 bacterial species from a catheter (placed in last 48 hours)

Question 12

Urinalysis–> 4 components (hours)

Answer 12

Bacteria present

WBC (> or equal to 10 cells/hpf)

Leukocyte esterase present

Nitrate may/may not be present
- Enterobacterales convert nitrates to nitrites

Question 13

Urine culture–>2-3 days

Answer 13

Identifies organism + susceptibility to antibiotics

Question 14

Asymptomatic bacteriuria

Answer 14

Does not require treatment unless PREGNANCY
- most common misdiagnosed infections for UTI

Question 15

Treatment–>OUTPATIENT

Answer 15

Beta-lactams:
- Cephalexin, Cefpodoxime, Cefadroxil
- Amoxicillin, Augmentin
- Duration: 3-7 days (uncomplicated), 7-14 days (complicated)

Bactrim: duration 3 days (uncomplicated), 7-14 days (complicated/pyelo)

Cipro/Levo: duration 3 days (uncomplicated), 7 days (complicated/pyelo)

Nitrofurantoin–> UNCOMPLICATED ONLY
- Duration 5 days

Fosfomycin–>UNCOMPLICATED ONLY

IF ≥ 20% RESISTANCE, NO LONGER RECOMMENDED

Question 16

Treatment–>INPATIENT

Answer 16

Ampicillin 2 g IV q6h + gentamicin 5 mg/kg IV daily

Ceftriaxone 1-2 g IV q24h

Cefazolin 1-2 g IV q8h +/- gentamicin 5 mg/kg IV daily

Cefepime 1 g IV q8-12h

Gentamicin 5 mg/kg IV daily

IV IS RECOMMENDED WHEN WAITING CULTURE & BASE IT OFF LOCAL SUCEPT.

Question 17

Recurrent UTIs

Answer 17

What?
- 3 or more infections in 1 year
- 2 or more infections in 6 months

FIND THE CAUSE:
- Sex or diaphragm/spermicide
- Postmenopausal
- Urologic abnormalities

Treatment: prophylaxis
- Nitrofurantoin
- Bactrim

Question 18

Characteristics of ideal or antibiotic for UTI

Answer 18

Medium-high bioavailability (> 50%)
Medium-high renal excretion (> 50%)
Low risk for damage or adverse events
High likelihood of susceptibility

Question 19

Prostatitis treatment–>high free drug to penetrate prostate

Answer 19

FQs
Bactrim
B-lactams (cephalexin, augmentin)

Duration: 2-4 weeks