UTI Flashcards
Most common organism causing UTI
E. coli causes 85% of cases
Other potential pathogens that may cause UTIs
Staph saprophyticus Enterococcus P. aeruginosa Klebsiella pneumonia Proteus Enterobacter
what does it mean when a patient has a “complicated” UTI
structural or functional abnormality of urinary tract
all male patients with UTIs are assumed to have complicated UTIs
S/S of Lower UTI (cystitis)
dysuria nocturia gross hematuria suprapubic tenderness increased frequency and urgency
S/S of Upper UTI (pyelonephritis)
Fever
N/V
Malaise
Often severe flank pain
How may elderly patients present?
elderly patients may not present with common S/S of UTIs, but may present with altered mental status
if a patiet has a UTI, what should urinalysis show?
Pyuria - >10 WBC in urine Bacturia - >10^5 CFU/ml Nitrites leukocytes estrase
Drugs used to treat uncomplicated cystitis
Nitrofurantoin 100mg BID for 3 (macro) to 7 (Macro or Mono/Macro) days Bactrim DS BID for 3 days Fosfomycin 3gm once Cipro/Levofloxacin for 3 days Augmentin for 3 days
Nitrofurantoin common ADRs
GI ADRs urine discoloration Rare: pulmonary toxicity agranulocytosis hepatitis neuropathy
Nitrofurantoin other comments
good for treatment and ppx
watch in patients with lower renal function
Bactrim common ADRs
GI upset
Rash
Diarrhea
hyperkalemia
Bactrim other comments
E. coli is starting to develop resistance
still thought to be highly effective
also used for ppx
Fosfomycin ADRs
Headache
Nausea
Vaginitis
Runny nose
Fosfomycin other comments
use as a single dose
Cipro/levofloxacin ADRs
N/V/D
Rhinitis
Cipro/Levofloxacin other comments
good broad spectrum
watch in pregnancy and children
Augmentin ADRs
diarrhea
nausea
rash
vaginitis
Augmentin other comments
watch resistance!!!!
what should not be used for uncomplicated cystitis
amoxicillin and ampicillin
what is collateral damage?
Ecological adverse effects of antimicrobial therapy, such as selection of drug-resistant organisms or colonization or infection with multi-drug resistant organisms
when should fluoroquinolones be used for C. diff?
only in more severe cases!! Reserve to decrease resistance development
Drugs used to treat uncomplicated pyelonephritis
Ciprofloxacin for 7 days
Bactrim DS for 14 days
May give first dose IV
treatment of uncomplicated pyelonephritis in hospitalized patients
IV therapy!! fluoroquinolone aminoglycoside (+/- ampicillin) extended-spectrum cepalosporin or beta-lactam carbapenem
treating UTIs in pregnant women
treatment recommended for bacturia, whether pt is symptomatic or not.
do not use Bactrim in 3rd trimester
use Nitrofurantoin
Avoid tetracyclines and fluoroquinolones
treatment for UTI in asymptomatic patients with a urinary catheter
hold ABX
remove catheter if possible
treatment for UTI in symptomatic patients with a urinary catheter
start ABX
remove catheter if possible
if not possible, replace with a new catheter
UTI treatment in male patients
treat as if complicated!! treat for 2-6 weeks
monitor for BPH
