UTI treatments

Question 1

Define a urinary tract infection

Answer 1

The presence of microbes in the urine, not due to contamination.
Organisms can invade surrounding tissues.

Question 2

Define Cystitis

Answer 2

Infection and inflammation of the bladder

Question 3

Define Pyelonephritis

Answer 3

UTI that affects kidneys and upper urinary tract

Question 4

Compare funguria and bacteriuria

Answer 4

bacteria in pee, may be asymptomatic where individual has 2 positive urine cultures with same organism
Other is fungi/yeast in pee

Question 5

Differentiate between Complicated and Uncomplicated UTIs

Answer 5

Uncomplicated - in healthy person with normal genitourinary systems

Complicated - Infection interferes with urinary flow due to anatomical abnormalities e. g congenital defects, stones, indwelling catheters making individual prone to infections

Question 6

Differentiate between recurrent, reinfections and relapse.

Answer 6

Recurrent: 2 or more UTIs in 6 months OR 3 upwards in 12 months. Due to reinfections or relapse. Have asymptomatic periods in between

Relapse: Repeated infection caused by SAME organism

Re infection: Repeated due to DIFFERENT organisms

Question 7

What is the pathophysiology of UTIs?

Answer 7

°Normal flora proliferation
Ascend up urinary tract via
°hematogenous route
°lymphatic system

Question 8

Symptoms of lower UTI

Answer 8

Dysuria Urinary urgency and frequency
Bloody urine/gross hematuria Supra-pubic tenderness

Question 9

Symptoms of upper UTI

Answer 9

°Flank pain
°Fevers/chills/vomiting

Question 10

What is the assumption of UTI in young women

Answer 10

No urine culture is needed despite bacteriuria and funguria
Assume cystitis

Question 11

What are some concerns related to UTIs

Answer 11

-Emerging antimicrobial resistance
-Elevated cotrimoxazole resistance
-Elevated fluoroquinolone resistance

Question 12

UTI diagnosis includes… you’re doing good, keep coming

Answer 12

°Urine cultures from immunocompromised/history of instrumentation/elderly
°Microscopic hematuria without pyuria (high WBCs) check for malignancy, renal TB
°Bacteriuria= pyelonephritis/corticomedullary abscesses/perinephric abscesses
°NO VISUAL PEE INSPECTION
°Urinalysis
°Urine culture
°FBC (won’t differentiate upper and lower)

Question 13

Symptoms of pyelonephritis

Answer 13

Fever 38. 3
N/V
Severe flank pain
°Dehydration symptoms= G- bacteremia
Tachycardia
dry mucous membrane
clammy extremities
symptomatic orthostasis

Question 14

What are UTI assumptions in elderly woman

Answer 14

Present with supra pubic pain
May be asymptomatic
Cystitis is usually accompanied by upper UTIs too

Question 15

Differentiate between Acute Urethritis and Cystitis

Answer 15

URETHRITIS
°Dysuria and urinary hesitancy
°Fever (rare in cystitis)
°Urethral discharge
°bladder related symptoms
CYSTITIS
•Inflamed bladder mucosal
•Urinary incontinence, gross hematuria
•Supra-pubic tenderness
•Lower back pain

Question 16

Catheter related infections symptoms include

Answer 16

Fever and leukocytosis
Pyuria
Polymicrobial infections

Question 17

What are the risk factors of Asymptomatic bacteriuria in pregnancy

Answer 17

Sexual activity
Increasing age and parity
Diabetes
low socioeconomic class
history of UTIs
structural abnormalities

Question 18

Pregnant women with asymptomatic bacteriuria are predisposed to

Answer 18

Preterm labor
Low birth weight
Anemia
Hypertension
Intrauterine growth retardation

Question 19

Complicated UTIs in DM

Answer 19

Renal and perirenal abscess
fungal infection
papillary necrosis
emphysematous cystitis
emphysematous pyelonephritis

Question 20

Goals of treating UTIs

Answer 20

Eradicate causative agent
prevent recurrent/relapse/reinfections
classify infection to guide treatment
is hospitalization necessary

Question 21

Nonpharm treatment of UTIs include

Answer 21

Cranberry juice
8 glasses of water a day

Question 22

When is hospitalization necessary in UTI treatment

Answer 22

Complicated pyelonephritis Structural abnormalities
Metabolic diseases Immunocompromised

Question 23

Complete UTI
What is the 1st line oral and 1st line parenteral treatment

Answer 23

ORAL
°Ciprofloxacin 500mg q12h 1-14days
°Levofloxacin 750mg/kg q24h 5days

PARENTERAL
°Ciprofloxacin 400mg/kg IV q12h 7-14days
°Levofloxacin 750mg/kg IV q24h 5 days
°Piperacillin/tazobactam 3. 375g IV q6h 7-14 days
°Meropenem 1g IV q8h 7-14days

Question 24

Treat uncomplicated UTI in pregnant women with either e. coli or Staphylococcus saprophyticus

Answer 24

Amoxycillin-clavunate 7 days
Cephalosporin 7days
Cotrimoxazole 7days

Question 25

Treat uncomplicated acute pyelonephritis caused by G- and G+

Answer 25

G-
°FQs
°Cotrimoxazole

G+
°Amoxycillin
°Amoxycillin-clavunate

Question 26

How do you manage fungal infection

Answer 26

Remove or replace catheter to clear funguria
°Amphotericin b 0. 3 mg/kg IV
OR
°Fluconazole 200mg orally then 100mg orally once a day for 4-7days