UTIs

Question 1

UTI risk factors

Answer 1

Healthy, premenopausal women
Sexual behavior and contraceptive devices
Pregnancy
Male
Badly controlled DM
Transient short-term urinary tract catheter
Asymptomatic bacteriuria
Long-term urinary tract catheter treatment

Question 2

Uncomplicated UTI

Answer 2

Normal urinary tract with normal voiding

Question 3

Microbiology of uncomplicated UTI

Answer 3

Mostly E. coli

Question 4

Complicated UTI

Answer 4

Congenital or acquired abnormality that prevents normal dispensing of bacteria from the urinary tract

Question 5

Conditions for complicated UTI (disease states)

Answer 5

Pregnancy
Uncontrolled DM
Kidney transplant
Urinary anatomical abnormalities
Acute renal failure/chronic renal failure
Immunocompromised
Noscomial bacterial infections

Question 6

Risk factors for complicated UTI

Answer 6

Lack of response to treatment, severity of illness, comorbidities like DM and immunosuppression

Question 7

Clinical implication of complicated UTI (what are the risk factors?)

Answer 7

Recurrence, SIRS/sepsis, extensive antimicrobial resistance, immunosuppression, instrumentation/catheters

Question 8

Microbiology of complicated UTI

Answer 8

Mostly E. coli and other GNR

Question 9

Diagnosis of lower tract infection: cystitis

Answer 9

Urinalysis, urine gram stain and culture

Question 10

Urinaylsis results that would suggest a UTI

Answer 10

Leukocyte esterase
Nitrile
Hematuria
WBC casts
Proteinuria
Bacteria
Pyuria

Question 11

Diagnosis of upper tract infection: pyelonephritis

Answer 11

Also UA and urine gram stain and culture

Question 12

Non-pharmacologic treatment for UTI

Answer 12

Don’t really work

Question 13

Treatment for women with acute, uncomplicated cystitis

Answer 13

Nitrofurantoin for 5 days

Bactrim for 3 days

Question 14

Treatment for subclinical pyelonephritis in women

Answer 14

PO therapy for 7-14 days

Question 15

Subclinical pyelonephritis

Answer 15

No symptoms of an upper tract infection and they appear to have uncomplicated cystitis

Question 16

Outpatient treatment of acute pyelonephritis in women

Answer 16

Ciprofloxacin PO for 7 days
Levofloxacin PO for 5 days
Bactrim PO for 14 days

Question 17

Inpatient treatment of acute pyelonephritis in women

Answer 17

Extended-spectrum cephalosporin or penicillin +/- aminoglycoside for 10-14 days

Question 18

Relapse in UTI

Answer 18

Infected with same organism

Question 19

Treatment for UTI relapse

Answer 19

Extend treatment duration (up to 6 weeks)

Question 20

Reinfection in UTI

Answer 20

Infected with different organism

Question 21

Treatment for UTI reinfection

Answer 21

3-5 days with whatever ABX is recommended in the guidelines

Question 22

Prostatitis in men: etiology

Answer 22

E. coli is the major pathogen

Question 23

Presentation of cystitis in men

Answer 23

Younger: dysuria, frequency

More typical: elderly male with dysuria, frequency, fever, lower abdominal pain, possible bacteremia in severe cases

Question 24

Presentation of pyelonephritis in men

Answer 24

Similar to presentation in women

Question 25

Physical exam in men

Answer 25

Prostate is tender and swollen

Question 26

Lab findings for prostatitis

Answer 26

UA: pyuria, bacteria, urine culture is positive | Possible bacteremia

Question 27

Acute treatment for prostatitis

Answer 27

Bactrim 160/800mg PO BID

Question 28

Chronic treatment for prostatitis

Answer 28

Also Bactrim 160/800mg PO BID

Question 29

Catheter-related UTIs treatment

Answer 29

NO ABX because asymptomatic bacteriuria is common with indwelling and condom catheters! Prevention is key by avoiding unnecessary and prolonged use of ABX, and intermittent catheterization

Question 30

Candiduria pathogens

Answer 30

Albicans and glabrata

Question 31

Presentation of candiduria

Answer 31

Asymptomatic Lower tract: dysuria, frequency, urgency Upper tract infection is rare

Question 32

Management of symptomatic candiduria

Answer 32

NO TREATMENT unless patient is high risk or undergoing a urologic procedure

Question 33

Pharmacological treatment for symptomatic candiduria

Answer 33

Albicans: fluconazole for 2 weeks Glabrata: Ampho B for 1-7 days or flucytosine for 7-10 days Krusei: Ampho B for 1-7 days

Question 34

Treatment for asymptomatic bacteriuria

Answer 34

NO ABX TREATMENT unless you're pregnant, undergoing an invasive urinary tract procedure, or getting a renal transplant

Question 35

UTIs and asymptomatic bacteriuria in pregnancy: treatment

Answer 35

Amoxicillin/clav for 7 days Amoxicillin for 7 days Cephalexin for 3-7 days

Question 36

Which ABX should you avoid in pregnant women close to delivery?

Answer 36

Nitrofurantoin and Bactrim

Question 37

Antimicrobial therapy of pyelonephritis in pregnancy

Answer 37

IV beta-lactams like ceftriaxone and cefazolin

Question 38

Which ABX are CI'ed in pregnancy?

Answer 38

TTCs, quinolones