UTI/pyelonephritis Flashcards
asymptomatic bacteriuria
significant bacteria but no symptoms
pyelonephritis
infection of the kidney
uncomplicated UTI
infections to pts who are healthy and have no structural or functional abnormalities of the urinary tract
complicated UTI
infections to pts who have abnormalities of their urinary tract, a stone, a catheter, obstruction, or neurologic deficit affecting flow
signs and symptoms of acute simple cystitis
dysuria
urinary incontinence
uinary urgency
urinary frequency
foul smelling urine
hematuria
signs and symptoms of complicated UTI/ pyelonephritis
sign and symptoms of ASC
chills
fever
flank plain
costovertebral angle tenderness
N/V
abdominal pain
diagnosis
get a UA
if positive w s/sx proceed with a urine culture
gold standard
culture with sensitivities
no UTI symptoms
not at risk population
no culture
no UTI symptoms
at risk population
culture
any UTI symptom
at risk population
culture
any UTI symptoms
not at risk
evaluate pyuria and contamination
any UTI symptoms
NOT at risk
pyuria (>10 WBC)
no contamination (<100 squamous cells)
culture
any UTI symptoms
at risk
no pyuria
no culture , strong predictor of no infection
any UTI symptoms
at risk
pyuria and contamination (>100 squamous cells)
no culture
two clinical instances where a pt with ASBU should be screened
pregnant women
-pyelonephritis
-premasture delivery
-low birth weight infant
prior urologic procedure
-risk of mucosal bleeding
-post bacteremia
-sepsis
duration of therapy for pregnant women
4-7 days, shortest effective course
abx in pregnancy
asymptomatic bacteriuria
cephalexin
amoxicillin
cefdinir
amoxicillin-clave
nitrofurantoin
Trim/sulf
fosfomycin
duration of therapy for urologic procedure with mucosal bleeding risk
1-2 dose short course
uncomplicated UTI management
first line
Nitrofurantoin x 5 days
–avoid in CrCl <30m ml/min
Trimethoprim/sulfamethoxazole x 3 days
Fosfomycin single dose
uncomplicated UTI management
second line
oral bet lactam x 5-7days
– cephalexin, cefdinir
Flurooquinolones x 3 days
–cipro or levo
cather-associated UTI are grouped within
complicated UTI
complicated UTI management
first line
Trim/sulf (bactrim) x 7days
Levo 5-7 days
complicated UTI management
second line
Nitrofurantoin 7-10 days
—avoid in pyelonephritis and Crcl <30
oral beta lactam x7days
–cephalexin, cefdinir
Inpatient management of complicated UTI
first line
ceftriaxone 1 g daily
ertapenem 1 g daily if history of ESBL producing org
piper/tazo if pt has history of pseudomonas
Inpatient management of complicated UTI
stepdowm/ second line
Nitrofurantoin 7day total cours including initial IV
–avoid in pyelonephritis of Crcl < 30)
trimethoprim/sulfamethaxazole 7days
oral beta lactase 7 days
–cephalexin, cefdinir, amoxicillin-clav
inpatient management CAUTI
mild/moderate - treat as complicated UTI
Levo BID
TMP/SMX BID
alt; oral 3rd gen cephalorsporin
ceftriaxone
inpatient management CAUTI
suspicion for more serous infections
PIPeracillin-lazobactam
cefrpime
ertapenem
alternative: aminoglycoside
management of pyelonephritis
non-hospitalization
Ceftriaxone 1g one due to high e.coli resistance
–levo or cipro 5-7 days
TMP/SMX 10-14 days
management of pyelonephritis
hospitalized
no MDR= ceftriaxone 1g q24hr
risk for MDR=
piperacillin-taz
cefepime
ertapenem (esbl history)
ahminoglycosides
vancomycin
duration of the management of pyelonephritis
7 day course is considered effective when the bacteremia but ups to 14 days total may be needed w oral abx depending on agent
