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Infectious Disease > UTIs > Flashcards

UTIs Flashcards

1
Q

Clinical Presentation of Cystitis (bladder)

A
  • Irritative voiding symptoms (frequency, urgency, dysuria)
  • Gross hematuria (blood in urine)
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2
Q

Clinical Presentation of Pyelonephritis (kidney)

A
  • Fever, flank pain, shaking, chills
  • N/V
  • Irritative voiding symptoms (frequency, urgency, dysuria)
  • Gross hematuria (blood in urine)
  • CVA tenderness
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3
Q

Atypical Presentation of UTI in Elderly

A
  • Altered mental status
  • Change in appetite
  • GI sxs
  • Incontinence
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4
Q

Macroscopic Urinalysis (UA)

A
  • Leukocyte esterase: detects presence of WBC, pyuria (pus in urine)
  • Nitrites: detects bacteria that reduce nitrate to nitrite (Enterobacteraceae)
  • pH: alkaline urine (pH 8.5-9) can mean presence of urease-producing bacteria (Proteus, Klebsiella)
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5
Q

Microscopic Urinalysis (UA)

A
  • WBC: >5-10 suggests pyuria
  • Presence of Bacteria: urine is normally sterile, so any bacteria in urine can mean UTI
  • Squamous Epithelial Cells: Normal is 0-5 (clean catch), higher indicates a contaminated sample
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6
Q

Most Common Pathogen Causing UTI

A

E. coli

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7
Q

Uncomplicated UTI

A
  • Occurs in healthy, non-pregnant, non-immunocompromised women
  • Caused by a single pathogen
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8
Q

Complicated UTI

A
  • Anything that is not “uncomplicated” (males, pregnancy, immunocompromised, etc.)
  • Often caused by multiple pathogens
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9
Q

First-Line Agents for Treatment of Uncomplicated Cystitis

A
  • Nitrofurantoin (Macrobid)
  • Trimethoprim/Sulfamethoxazole (Bactrim)
  • Fosfomycin
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10
Q

Nitrofurantoin Duration for Uncomplicated Cystitis

A

5 days

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11
Q

Nitrofurantoin Spectrum of Coverage

A
  • Staphylococcus saphrophyticus
  • Enterococci (including VRE)
  • E. coli (including ESBL)
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12
Q

Can nitrofurantoin be used in pyelonephritis and prostatitis?

A

No

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13
Q

Nitrofurantoin Renal Cutoff

A

Avoid in CrCl < 30

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14
Q

Nitrofurantoin ADRs

A
  • Acute pulmonary sxs (onset: hours to weeks)
  • Pulmonary fibrosis (>6 months)
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15
Q

Nitrofurantoin in Pregnancy

A

Safe in pregnancy EXCEPT at term (38-42 weeks)

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16
Q

TMP/SMX Duration for Uncomplicated Cystitis

A

3 days

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17
Q

TMP/SMX Spectrum of Coverage

A
  • Staphylococcus saphrophyticus
  • E. coli
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18
Q

Can TMP/SMX be used in pyelonephritis and prostatitis?

A

Yes

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19
Q

When to avoid TMP/SMX

A
  • If local E. coli resistance > 20%
  • If used for UTI in previous 3 months
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20
Q

TMP/SMX ADRs

A
  • Rash
  • Hyperkalemia
  • Bone marrow suppression
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21
Q

TMP/SMX in Pregnancy

A

AVOID in 1st and 3rd trimester

Safe in 2nd trimester

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22
Q

Fosfomycin Duration for Uncomplicated Cystitis

A

1 dose

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23
Q

Fosfomycin Spectrum of Coverage

A
  • Enterococcus faecalis (including VRE)
  • E. coli (including ESBL)
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24
Q

Can fosfomycin be used in pyelonephritis?

A

No

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25
Q

Fosfomycin ADRs

A
  • Diarrhea
  • Nausea
  • Dyspepsia
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26
Q

Fosfomycin in Pregnancy

A

Safe in pregnancy (even at term)

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27
Q

Second Line Agents for Uncomplicated Cystitis

A

Beta-lactams

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28
Q

Beta-Lactams Duration for Uncomplicated Cystitis

A

3-7 days

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29
Q

Beta-Lactams in Pregnancy

A

Drug of choice for uncomplicated cystitis in pregnancy

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30
Q

How to predict susceptibility of PO cephalosporins for UTI due to E. coli, Klebsiella, and Proteus?

A
  • Use cefazolin susceptibility as predictor
  • If cefazolin is susceptible, can use any generation of PO cephalosporin
  • If cefazolin is not susceptible, can not use any PO cephalosporin
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31
Q

Last Line Therapy for Uncomplicated Cystitis

A

Fluoroquinolones

32
Q

Fluoroquinolone Duration of Therapy for Uncomplicated Cystitis

A

3 days

33
Q

When to avoid fluoroquinolones

A

If local E. coli resistance > 10%

34
Q

Fluoroquinolones BBW

A
  • Tendonitis/tendon rupture
  • Peripheral neuropathy
  • CNS effects
35
Q

Fluoroquinolones in Pregnancy

A

AVOID in any trimester

36
Q

Complicated Cystitis Duration of Treatment

A

10-14 days

37
Q

Catheter-Associated UTI

A
  • Asymptomatic patients: do NOT treat
  • Symptomatic patients: remove/change catheter and treat for 10-14 days (if prompt resolution of sxs, 7 days of treatment)
  • May present with non-specific sxs: fever, pelvic discomfort, altered mental status
38
Q

Cystitis in Pregnancy

A
  • ALWAYS treat both asymptomatic and symptomatic infections
  • DOC: beta-lactams (amoxicillin, Augmentin, cephalexin)
  • May consider Bactrim or Nitrofurantoin in 1st trimester if no other suitable alternatives
  • AVOID fluoroquinolones
39
Q

First-Line Agents for Outpatient Treatment of Pyelonephritis

A
  • Ciprofloxacin
  • Levofloxacin
  • TMP/SMX DS
40
Q

Ciprofloxacin Duration for Pyelonephritis

A

7 days

41
Q

Levofloxacin Duration for Pyelonephritis

A

5 days

42
Q

TMP/SMX Duration for Pyelonephritis

A

14 days

43
Q

Clinical Pearls of Ciprofloxacin and Levofloxacin for Pyelonephritis

A

If local E. coli resistance > 10%, give one dose of IV antibiotic (such as ceftriaxone or gentamicin)

44
Q

Clinical Pearls of TMP/SMX DS for Pyelonephritis

A

If local E. coli resistance > 20%, give one dose of IV antibiotic (such as ceftriaxone or gentamicin)

45
Q

First-Line Agents for Inpatient Treatment of Pyelonephritis (with NO risk for drug resistance)

A
  • Ceftriaxone IV
  • Ciprofloxacin IV
  • Levofloxacin IV
  • Gentamicin IV
  • Tobramycin IV
46
Q

Duration of Inpatient Treatment of Pyelonephritis (with NO risk for drug resistance)

A

7-14 days

47
Q

Clinical Pearls of Ceftriaxone for Pyelonephritis

A

Active against enterobacteraceae

48
Q

Clinical Pearls of Ciprofloxacin and Levofloxacin for Pyelonephritis

A

Consider if E. coli resistance rates < 10%

49
Q

Gentamycin and Tobramycin Clinical Pearls for Pyelonephritis

A
  • No gram-positive coverage
  • Add ampicillin if concerned about enterococcus
50
Q

First-Line Agents for Inpatient Treatment of Pyelonephritis (with risk for drug resistance)

A
  • Piperacillin/tazobactam (Zosyn)
  • Cefepime
  • Ertapenem
  • Meropenem
51
Q

Duration of Inpatient Treatment of Pyelonephritis (with risk for drug resistance)

A

7-14 days

52
Q

Clinical Pearls of Piperacillin/Tazobactam for Pyelonephritis

A

Broad coverage, including Enterococcus, PEK, and Pseudomonas

53
Q

Clinical Pearls of Cefepime for Pyelonephritis

A
  • Broad coverage, including PEK and Pseudomonas
  • No activity against Enterococcus
54
Q

Clinical Pearls of Ertapenem for Pyelonephritis

A
  • DOC for ESBL-producing Enterobacteraceae
  • NO activity against Enterococcus or Pseudomonas
55
Q

Clinical Pearls of Meropenem for Pyelonephritis

A

Broad coverage, including Enterococcus, ESBl-producing Enterobacteraceae, and Pseudomonas

56
Q

Asymptomatic Bacteriuria

A

Presence of bacteriuria in patient without symptoms of UTI

57
Q

When to Treat Asymptomatic Bacteriuria

A

Do NOT treat unless:

  • Pregnant
  • Undergoing urological surgical procedure associated with mucosal trauma
58
Q

Treatment of Asymptomatic Bacteriuria in Pregnancy

A
  • DOC: beta-lactams
  • Duration: 4-7 days
59
Q

Treatment of Asymptomatic Bacteriuria in Urological Surgery

A

Give 1-2 doses of antimicrobial 30-60 mins before procedure

60
Q

Recurrent UTI

A
  • At least 2 UTIs within 6 months
  • At least 3 UTIs within 1 year
61
Q

Reinfection

A
  • Caused by a different organism
  • Majority of recurrent UTIs
62
Q

Relapse

A

Caused by the same initial organism

63
Q

Lifestyle Modifications for Recurrent UTIs

A
  • Change contraceptive method if using spermicides
  • Postcoital voiding
  • Do not routinely delay voiding
  • After voiding, wipe front to back
  • Increase daily water intake to at least 1.5 L
64
Q

Is cranberry recommended for UTI?

A

No

65
Q

Antimicrobial Prophylaxis for Recurrent UTI

A

May be considered if all non-pharmacologic strategies attempted/considered

66
Q

Drugs used for Antimicrobial Prophylaxis of Recurrent UTI

A
  • TMP/SMX
  • Nitrofurantoin
  • Cephalexin
  • Given at half the dose of normal tx dose
67
Q

Continuous Prophylaxis of Recurrent UTI

A

Taken daily for up to 6-12 months

68
Q

Postcoital Prophylaxis of Recurrent UTI

A

Single dose taken after sex

69
Q

Most Common Pathogen causing Bacterial Prostatitis

A

E. coli

70
Q

Risk Factors for Bacterial Prostatitis

A
  • Hx of lower UTI
  • Urinary instrumentation (catheter)
  • Urethritis
71
Q

Clinical Presentation of Acute Bacterial Prostatitis

A
  • Fever, chills, N/V
  • Pain in urogenital regions
  • Urinary sxs
72
Q

Clinical Presentation of Chronic Bacterial Prostatitis

A
  • Pain in urogenital regions
  • Urinary sxs
  • Sexual dysfunction sxs
73
Q

Drugs for Treatment of Acute Bacterial Prostatitis

A
  • Ciprofloxacin
  • Levofloxacin
  • TMP/SMX DS
74
Q

Duration of Treatment of Acute Bacterial Prostatitis

A

6-8 weeks

75
Q

Drugs for Treatment of Chronic Bacterial Prostatitis

A
  • Ciprofloxacin
  • Levofloxacin
  • TMP/SMX DS

+ Alpha Blockers

76
Q

Duration of Treatment of Chronic Bacterial Prostatitis

A

Up to 6 months

Infectious Disease (15 decks)

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