UTI’s

Question 1

UTI

Answer 1

Inflammation and infection involving the kidneys, ureters, bladder, and or urethra

Question 2

UTI Causes

Answer 2

Lower UTIs: Cystitis, urethritis
Upper UTIs: Pyeloneprhitis, renal abscess
E. Coli is the most common causative agent

Question 3

Signs/Symptoms of a lower UTI

Answer 3

**Dysuria is the key symptoms
Frequency
Nocturia
Urgency
Hematuria: occurs in 40-60% of patients

Question 4

Lower UTI Lab/Diagnostics

Answer 4

UA:Usually shows Pyuria > 10 WBC
Presence of nitrate by dipstick is very specific but not a sensitive test for bacteriuria
Esterase detection by dipstick is very sensitive but not specific

Question 5

Lower UTI Management

Answer 5

Uncomplicated
Macrobid 100 mg PO be ID times five days
Bactrim POB ID times three days (avoid if resistance is greater than 20%)
Fosfomycin 3 g PO times one

No flouroquinolones should be reserved for use in patients who have no alternative

Question 6

Upper UTI Signs/Symptoms

Answer 6

Flank, low back, or abd pain may be present
Fever and chills often present and usually indicate upper UTI
N/V
Mental status changes in the elderly

Question 7

Upper UTI Lab/Diagnostics

Answer 7

WBC casts seen on UA

ESR elevated with pyelonephritis

Question 8

Upper UTI Management

Answer 8

Cipro 500mg PO BID x 7 days
Levofloxacin - OK but not moxifloxacin
Ceftriaxone 1 gm IV every 24 hours

No Bactrim ( high resistance) or macrobid ( does not reach therapeutic concentrations in the kidneys

Question 9

Healthcare Associated Pyelonephritis Management

Answer 9

Use antipseudomonal agent other than flouroquinolone

Ampicillin and an aminoglycoside, cefepime, imipenem, meropenem, Zosyn