UTI Flashcards
Risk Factors for UTI
- age, gender
- neuro dysfunction, incontinence
- instrumentation or obstruction
- prior hx
- sexual activity, spermicide/diaphragm use
- pregnancy, postmenopausal
Lower UTI Definition
cystitis (bladder)
Upper UTI Definition
pyelonephritis (kidneys)
Uncomplicated UTI Definition
UTI in otherwise healthy female with no structural or functional abnormalities of urinary tract
Complicated UTI Definition
- most often assoc w/ predisposing lesion in urinary tract
- also DM, age > 65, pregnancy, immunosuppression, male
Recurrent UTI Definition
3 or more UTI per year
Reinfection
caused by new organism
Relapse
development of repeated infections caused by same initial organism
Asymptomatic Bacteriuria
significant bacteriuria (>100,000 bacteria/mL) in the absence of sxs (common > 65)
Cystitis Clinical Presentation
- frequency, urgency, painful urination
- low back or abdominal pain
- suprapubic tenderness
Pyelonephritis Clinical Presentation
- systemic sxs: fever, rigors, HA, N/V, malaise
- localized flank pain, CVA tenderness
- frequency, urgency, painful urination
UA Findings in UTI
- > 100,000 bacteria/mL in women (> 1000 in men)
- > 10 WBC/mm^3
- positive leukocyte esterase
- positive nitrites
- hematuria
- quantitative UC (>100,000 bacteria/mL)
Common Pathogens for Community Acquired UTI
- E coli (85%)
- Proteus, Klebsiella
- Staph. saprophyticus
- Enterococcus
Common Pathogens for Complicated/Nosocomial UTI
- E. coli (50%)
- Enterococcus
- Pseudomonas
- Staph
- Proteus, Klebsiella
Which patients should get a urine culture?
- complicated cystitis
- cystitis in pregnancy
- cystitis with clinical failure
- pyelonephritis
When should complicated cystitis and pyelonephritis get a urine culture?
before antibiotic is started
+/- 1-2 weeks after tx is finished
When should cystitis in pregnancy get a urine culture?
before antibiotic is started AND
1-2 weeks after tx is finished
When should cystitis with clinical failure get a urine culture?
after clinical failure AND
2 weeks after re-treatment is finished
UTI Tx Goals
- prevent or treat systemic consequences of infx
- eradicate the causative organisms
- prevent infx recurrence
Considerations for Abx Choice in UTI Tx
- UTI category
- complicating factors
- local sensitivity patterns
- pt allergies
- concurrent meds
- cost
Pathogens in Acute Uncomplicated Cystitis
- E. coli
- Proteus, Klebsiella
- Staph. saprophyticus
- Enterococci
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20%
-TMP/SMX 1 DS po bid x3 days
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20% with Sulfa Allergy
- nitrofurantoin 100 mg po bid x5 days OR
- fosfomycin 3 gm po x1
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance >20% or Sulfa Allergy
- cipro 250 mg bid, cipro ER 500 mg qd, levo 250 mg qd, moxi 400 mg qd x3 days OR
- nitrofurantoin or fosfomycin
How does fosfomycin compare to TMP/SMX or FQs?
-less effective vs. E. coli
Why must caution be used with nitrofurantoin?
chronic use assoc w/ pulm toxicity
What is the MC AE of fosfomycin?
headache
Pathogens in Pregnancy Cystitis
- E coli
- S saprophyticus
Tx of Pregnancy Cystitis
- TMP/SMX x7 days
- Amox/clav x7 days
- Cephalexin x7 days
- Nitrofurantoin x7 days
Which drug should be avoided within 2 weeks of due date in pregnancy cystitis and why?
- TMP/SMX
- potential increase in kernicterus risk for newborn
Pathogens in UTI Pt with STD Risk Factors
C. trachomatis
Tx of C. trachomatis UTI
- azithromycin 1 gm po x1
- alt: doxycycline 100 mg po bid x7 days
Tx of Recurrent Cystitis in Young Women
- eradicate then TMP/SMX SS qd long term
- or TMP/SMX 2 DS x1 at sx onset
- or TMP/SMX 1 DS x1 after sex
What is the problem with daily TMP/SMX tx of recurrent cystitis?
risk of bacterial resistance to abx
Tx of Recurrent Cystitis in Postmenopausal Women
- treat as uncomplicated UTI
- TMP/SMX 1 DS po bid x3 if no E. coli resistance
- cipro, levo, moxi x3 days if resistance
Pathogens of Male UTIs
- E coli
- Proteus, Klebsiella
Tx of Male UTIs
- TMP/SMX x10-14 days
- quinolone x10-14 days
Tx of Acute Pyelonephritis in Outpatients
- quinolone (cipro 500 mg bid, cipro ER 1000 mg qd, oflox 400 mg bid, moxi 400 mg qd) PO x7 days or levo 750 mg x5 days
- alt: amox/clav, cephalexin, TMP/SMX
Tx of Hospitalized Acute Pyelonephritis Patients
- quinolone x14 days
- amp + gent
- ceftriaxone
- piperacillin/tazobactam
What is important to give when treating a hospitalized pyelonephritis patient?
-IV abx until pt afebrile 24-48 hr then complete course with PO meds
Risk Factors for Cystitis in Males
- uncircumcised
- sexual partner with vaginal colonization
- MSM
What typically causes cystitis in men?
urinary tract abnormality
What is not recommended for tx of UTI in men?
-single dose and 3 day regimens
What is phenazopyridine (pyridium)?
- urinary analgesic
- OTC
What is the problem with phenazopyridine?
-may mask signs and sxs of UTIs not responding to abx tx
AEs of Phenazopyridine
- HA
- dizziness
- stomach cramps
- nay color urine orange or red, stain clothing
Precautions for Phenazopyridine
-do not use with CrCl < 50 mL/min
Dose of Phenazopyridine
-200 mg tid pc x2 days when used with abx
Role of Hydration in UTI Tx
- rapid dilution of bacteria
- removal of infected urine by increased voiding
- may actually dilute the antibacterial properties of urine
Role of Cranberry Juice in UTI Tx
- large amounts of cranberry juice may increase antibacterial activity of urine and prevent UTIs
- does not appear to play a significant role in tx
Hygiene UTI Prevention Options
- proper wiping
- void after sex
Role of Lactobacillus Probiotics in UTI Prevention
-may help prevent UTIs in females by decreasing vaginal pH and decreasing E coli colonization
Role of Topical Estrogen Replacement in Postmenopausal Women for UTI Prevention
- may help prevent recurrent UTIs
- after 1 month, found increase in Lactobacillus, decrease in pH and E coli colonization
