UTI

Question 1

Elderly pts w/ UTIs present with which 3 sxs?

Answer 1

• AMS
• Change in eating habits
• GI sxs

Question 2

Patients w/ indwelling catheters or neurologic disorders may present w/ which 2 sxs?

Answer 2

• Flank pain
• Fever

Question 3

3 biochemical tests for UTI

Answer 3

• Common dipstick test
• Leukocyte esterase dipstick test (detects pyuria)
• Urine culture (most reliable)

Question 4

4 goals of UTI tx

Answer 4

• Eradicate invading organism(s)
• Prevent or treat systematic consequences of infection
• Prevent recurrence of infection
• Decrease potential for collateral damage with too broad of antimicrobial therapy

Question 5

Uncomplicated UTIs are mostly caused by what organism?

Answer 5

75-95% caused by Escherichia coli

Remainder:

• Staph saprophyticus
• Klebsiella pneumoniae
• Proteus

Question 6

Complicated infections may be associated w/ other gram negative organisms and ______.

Answer 6

Enterococcus faecalis

Question 7

Management for uncomplicated UTIs

Answer 7

• Short course (3 days) w/ trimethoprim-sulfamethoxazole (bactrim)
• 1 dose of fosfomycin
• 5 days of nitrofurantoin

Question 8

What 2 fluoroquinolones should be reserved for suspected pyelonephritis or complicated infections?

Answer 8

• Ciprofloxacin
• Levofloxacin

(Short course for 3 days)

Question 9

Tx for pregnant women w/ UTI from either E. coli or Staph sapro

Answer 9

• Amoxicillin - clavulanate x7 days (augmentin)
• Cephalosporin x7 days
• Trimethoprim-sulfamethoxazole x 7 days (avoid during 3rd trimester)

Question 10

Tx for gram + bacteria

Answer 10

• Amoxicillin
• Amoxicillin-calvulanic acid

(for 14 days)

Question 11

Tx for uncomplicated (E. coi) Acute Pyelonephritis

Answer 11

• Quinolone x7 days
• Trimethoprim - sulfa (if susceptible) x 14 days

Question 12

Tx for complicated Acute Pyelonephritis

Answer 12

• Quinolone x14 days
• Extended spectrum penicillin plus aminoglycoside

Question 13

Tx for Prostatitis

Answer 13

• Trimethoprim-sulfamethoxazole x4-6 weeks
• Quinolone x4-6 weeks

Question 14

What is a complication of treating UTI w/ Bactrim?

• Begins w/ flu-like sxs
• Facial swelling
• Tongue swelling
• Hives
• Skin pain
• Red or purple skin rash that spreads within hours to days
• Blisters on your skin and mucous membranes of your mouth, nose, eyes, and genitals
• Shedding of skin

Answer 14

Steven-Johnson Syndrome

Question 15

What can you add to your diet to prevent UTIs?

• Regulating genitourinary bacteria therefore aiding in prevention of UTIs
• Possible clinical benefit in sexually active adult women w/ recurrent UTI by decreasing adherence of bacteria to the bladder epithelial cells
• Adhesion research and clinical trials show no significant effectiveness w/ this beverage

Answer 15

Cranberry Juice

Question 16

What is used as a urinary anesthetic / analgesic?

Answer 16

Phenazopyridine HCL

• Azo dye
• Has no antimicrobial properties
• brand names: Pyridium, Azo-Standard, Uristat
• Fallback: analgesics may mask signs/sxs of UTIs not responding to antimicrobial therapy

Question 17

6 Adverse effects of Phenazopyridine HCl

Answer 17

• Red-orange discoloration of body fluids (& soft contacts)
• Rash
• Anaphylaxis
• Rare hemolytic anemia
• Methemoglobinemia
• Acute renal failure

Question 18

UTI in pregnancy

• If significant bacteriuria: when is tx recommended?
• What is the tx?

Answer 18

• Tx is recommended if pt is symptomatic OR asymptomatic
• Tx for 7 days with either: Cephalexin, Amoxicillin, or Amox/Clav