UTI

Question 1

Most common organism causing UTI

Answer 1

E. coli causes 85% of cases

Question 2

Other potential pathogens that may cause UTIs

Answer 2

Staph saprophyticus
Enterococcus
P. aeruginosa
Klebsiella pneumonia
Proteus
Enterobacter

Question 3

what does it mean when a patient has a “complicated” UTI

Answer 3

structural or functional abnormality of urinary tract

all male patients with UTIs are assumed to have complicated UTIs

Question 4

S/S of Lower UTI (cystitis)

Answer 4

dysuria
nocturia
gross hematuria
suprapubic tenderness
increased frequency and urgency

Question 5

S/S of Upper UTI (pyelonephritis)

Answer 5

Fever
N/V
Malaise
Often severe flank pain

Question 6

How may elderly patients present?

Answer 6

elderly patients may not present with common S/S of UTIs, but may present with altered mental status

Question 7

if a patiet has a UTI, what should urinalysis show?

Answer 7

Pyuria - >10 WBC in urine
Bacturia - >10^5 CFU/ml
Nitrites
leukocytes
estrase

Question 8

Drugs used to treat uncomplicated cystitis

Answer 8

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

Question 9

Nitrofurantoin common ADRs

Answer 9

GI ADRs
urine discoloration
Rare: pulmonary toxicity
agranulocytosis
hepatitis
neuropathy

Question 10

Nitrofurantoin other comments

Answer 10

good for treatment and ppx

watch in patients with lower renal function

Question 11

Bactrim common ADRs

Answer 11

GI upset
Rash
Diarrhea
hyperkalemia

Question 12

Bactrim other comments

Answer 12

E. coli is starting to develop resistance
still thought to be highly effective
also used for ppx

Question 13

Fosfomycin ADRs

Answer 13

Headache
Nausea
Vaginitis
Runny nose

Question 14

Fosfomycin other comments

Answer 14

use as a single dose

Question 15

Cipro/levofloxacin ADRs

Answer 15

N/V/D

Rhinitis

Question 16

Cipro/Levofloxacin other comments

Answer 16

good broad spectrum

watch in pregnancy and children

Question 17

Augmentin ADRs

Answer 17

diarrhea
nausea
rash
vaginitis

Question 18

Augmentin other comments

Answer 18

watch resistance!!!!

Question 19

what should not be used for uncomplicated cystitis

Answer 19

amoxicillin and ampicillin

Question 20

what is collateral damage?

Answer 20

Ecological adverse effects of antimicrobial therapy, such as selection of drug-resistant organisms or colonization or infection with multi-drug resistant organisms

Question 21

when should fluoroquinolones be used for C. diff?

Answer 21

only in more severe cases!! Reserve to decrease resistance development

Question 22

Drugs used to treat uncomplicated pyelonephritis

Answer 22

Ciprofloxacin for 7 days
Bactrim DS for 14 days
May give first dose IV

Question 23

treatment of uncomplicated pyelonephritis in hospitalized patients

Answer 23

IV therapy!!
fluoroquinolone
aminoglycoside (+/- ampicillin)
extended-spectrum cepalosporin or beta-lactam
carbapenem

Question 24

treating UTIs in pregnant women

Answer 24

treatment recommended for bacturia, whether pt is symptomatic or not.
do not use Bactrim in 3rd trimester
use Nitrofurantoin
Avoid tetracyclines and fluoroquinolones

Question 25

treatment for UTI in asymptomatic patients with a urinary catheter

Answer 25

hold ABX

remove catheter if possible

Question 26

treatment for UTI in symptomatic patients with a urinary catheter

Answer 26

start ABX
remove catheter if possible
if not possible, replace with a new catheter

Question 27

UTI treatment in male patients

Answer 27

treat as if complicated!! treat for 2-6 weeks

monitor for BPH