UTI's Flashcards
UTI’s are most common in….
common in females- especially of child-bearing age
UTI”s are classified as….
Classified as upper and lower UTI
Lower UTI- infection of the bladder (cystitis)
Upper UTI- infection involving the kidneys (pyelonephritis) Any tissue at all
Also classified as uncomplicated or complicated
Uncomplicated Charcteristics
No structural or functional abnormalities
Premenopausal females of childbearing age (15 – 45 years), otherwise normal and healthy
Complicated
Predisposing lesion of the urinary tract- congenital abnormality or distortion of urinary tract, stone, indwelling catheter, prostatic hypertrophy, obstruction or neurological deficit that interferes with normal urinary flow
All UTI in males considered complicated
Most children with recurrent UTI should be investigated for urinary tract abnormality
Pathogenesis
Usually develops by ascending route
Colonization of vaginal vestibule followed by colonization of urethra
Sexual intercourse is a major determinant for bacterial entry into bladder for some women
Bacteria enter urine, multiply and cause bladder infection
Bacteria may spread up ureters to kidney especially if there is vesicoureteral reflux or reduced urethral peristalsis
Haematogenous (through blood stream) – rare e.g. Staph. aureus, Enterococci
Risk Factors
Age (most common: mainly child bearing aged women)
Gender
Pregnancy
Use of Spermicides and diaphragms (suggest to use other forms of contraception)
Instrumentation of urinary system
Urinary tract obstruction- including drugs like anticholinergics (cause urinary retention)
Incomplete bladder emptying
Neurologic dysfunction – stroke, diabetes, spinal cord injury
Vesicoureteral reflux
Renal disease
Common Organisms
S. pneumoniae
S. aureus
E. coli
Enterococcus species
Pseudomonas aeruginosa
Uncomplicated UTI Main Organims
E. Coli
Complicated Organisms
(E. coli 50%), but more varied ( Enterobacter spp.,Pseudomonas aeruginosa, Staph aureus) and may be more resistant
Are urine cultures accurate?
- Often NO
Lower UTI Clinical Presentation
dysuria (painful urination), urgency (cannot hold bladder), frequency (more frequent than normal)
- maybe hematuria and suprapubic pain
Upper UTI symptoms
flank pain (lower side of ribs), fever, nausea, vomiting, malaise, costovertebral tenderness (cannot prescribe)
Uncomplicated TX First Line
TMP/SMX 1 DS bid x 3 days (not a wrong choice)
TMP 100mg bid or 200mg daily x 3 days (if sulfa allergy)
Nitrofurantoin* 50 -100mg QID or Macrobid 100mg BID x 5 days
Second Line
Amoxi- Clav –> 500/125 mg BID or 875/125 mg TID for 3-7 days
Norfloxacin 400 mg bid x 3 days
Ciprofloxacin 250mg bid or 500mg ER once daily x 3 days
Recurrent UTI
2 uncomplicated UTI within 6 months or three or more positive urine cultures in prior 12 months
Reinfection Definition
Occurs after 2 weeks(medSask guidelies use 4 weeks) of completing abx therapy
Caused by a different organism*
Relapse Define
Occurs within 2 weeks (2-4weeks) of completing abx tx
Caused by original organism
Recurrence TX
Culture
Re-assess for upper tract infection
Re-treat for 7 to 14 days
Same antibiotic choices, however tailor based on C&S
Non-antibitic Tx
- Cranberry Juice - not effective; maybe prevantative
- Topical(vaginal) estrogen effective in post-menopausal woman will not benefit woman who are already on hormonal tx already
Pharmacists can prescribe when….
Not first episode
Not pregnant
Has to be uncomplicated
Cannot be a relapse can be a recurrent infection
UTI in MEN
- Complicated UTI
- Uncommon
- Same drugs as women
- Traditionally tx for 2 weeks
- Now –> 7 days TMP/SMX or cirpofloxacin as effective
Pyelonephritis Non-obstructive, mild Tx
TMP/SMX (14d), TMP (14d), norfloxacin, ciprofloxacin(7d), levofloxacin(5d), amoxicillin/clavulanate (10 – 14d)
Polynephritis Non-obstructive, sevre
Gentamicin 4-7 mg/kg q 24 h + ampicillin 1 -2 g q 4-6h (IV) (covers all organisms)
Ciprofloxacin 400mg IV q 12 h
Levofloxacin 250-500mg q 24h
-
- Ceftriaxone 1-2g IV q24h (or cefotaxime)+ gentamicin (septic shock, very ill)
Bacterial Prostatitis Organims and Diagnosis
E. coli 75%
Other gram negative organisms – K. pneumoniae, P. mirabilis, less frequently P. aeruginosa, Enterobacter spp., Serratia spp.
-
Urine culture
In chronic prostatitis – quantitative localization culture
Bacetrial prostatis is…
Inflammation of the prostate gland and surrounding tissue due to infection
Reflux of infected urine into prostate gland
Acute Prostatis Sx
fever, chills, tenderness/pain, malaise, myalgia, frequency, urgency, nocturia and retention
Chronic Prostatitis SX
urinating difficulty, low back pain, perineal and suprapubic pressure
TX of Bacterial Prostatis ACute
Acute – antibiotics penetrate prostate due to acute inflammatory reaction that alters cellular membrane and permeability
TMP/SMX, TMP, norfloxacin, levofloxacin , ciprofloxacin
Severe cases – ampicillin or ceftriaxone IV PLUS gentamicin or tobramycin or amikacin
Total duration minimum 2 weeks; total course should be 4 weeks to prevent chronic infection
Tx Chronic Prostatitis
4 – 12 weeks
Fluoroquinolones have better cure rate than TMP/SMX
More difficult to get antibiotic penetration into prostate
Pregnancy UTI
Routine screening at 12-16 weeks or first prenatal visit and at 28 weeks
If positive treat for 3-7 days and follow-up culture to document eradication (do a follow up culture)
If untreated -prematurity, low birth weight and stillbirth
UTI Preganancy First Line
Cephalexin 250-500mg QID x 7 days
Amoxicillin 500mg tid x 7 days
Nitrofurantoin 100mg bid x 5 days
Avoid at term (36-42 weeks gestation and during labor and in neonates) –> can cause hemolytic anemia in neonate
UTI Pregnancy Second Line
TMP/SMX or TMP - avoid in first trimester and in last 6 weeks of pregnancy
(Inhibits folic acid synthesis, important for neural tube defects)
