UTIs Flashcards by Jordan Cyr

What is the most common outpatient and hospital acquired infection?

UTIs

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What are examples of conditions caused by UTIs?

urethritis
cystitis
prostatitis
pyelonephritis

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Which patients commonly experience UTIs?

females, especially of child-bearing age

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What are lower UTIs?

infection of the bladder
-cystitis

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What are upper UTIs?

infection involving the kidneys
-pyelonephritis

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What are uncomplicated UTIs?

no structural or functional abnormalities

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Which patients tend to experience uncomplicated UTIs?

premenopausal females of childbearing age (15-45 years), otherwise normal healthy

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What are complicated UTIs?

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

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True or false: all UTIs in males are considered complicated

true

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True or false: children with recurrent UTI should be investigated for urinary tract abnormality

true

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How do UTIs develop?

usually develops by ascending route
colonization of vaginal vestibule followed by colonization of urethra
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

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What is a major determinant for bacterial entry into bladder for some women?

sexual intercourse

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What is a rare way that you can develop a UTI? Which organisms are likely the cause of this?

hematogenous
S. aureus, enterococci

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Describe the normal defence mechanisms of the urinary tract.

low pH (inhibit and kill bacteria)
extremes in osmolality (inhibit and kill bacteria)
high urea and high organic acid concentrations (inhibit and kill bacteria)
urination washes out of bladder
prostatic secretions in males have antibacterial properties
bladder is coated with urinary mucus which discourages bacterial adherence

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What is a probable reason as to why males get UTIs less frequently?

prostatic secretions have antibacterial properties

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What are predisposing factors for UTIs?

age
gender
pregnancy
use of spermicides and diaphragms
urinary tract obstruction-including drugs like anticholinergics
incomplete bladder emptying
neurologic dysfunction-stroke, diabetes, spinal cord injury
vesicoureteral reflux
renal disease

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Which organisms most frequently cause uncomplicated UTIs?

E.coli (80-90%)
others: Staph saprophyticus, K. pneumoniae, Proteus, Enterococcus

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Which organisms frequently cause complicated UTIs?

similar organisms (E.coli-50%) but more varied
-enterobacter
-pseudomonas aeruginosa
-staph aureus
may be more resistant

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How can you diagnose UTIs?

urinalysis: bacteruria and pyruria
urine culture: midstream clean-catch method
catherization
suprapubic bladder aspiration
urine dipstick for nitrite (not all bacteria convert nitrates to nitrites)
urine dipstrick for leukocyte esterase (esterase activity of WBC)

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What are the normal levels of bacteria and WBCs in urine?

bacteria: 10 to the 8 CFU/L
WBC: >10 WBC/mm3

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What is something you should keep in mind with C & S of urine?

recommendation is young healthy women shouldnt get C & S and you should treat empirically
thus, samples are from complicated patients an tx failure so the antibiograms will show resistance but the drugs still work

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What is the clinical presentation of lower UTIs (cystitis)?

dysuria
urgency
frequency
nocturia
suprapublic heaviness/pain
gross hematuria

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What is the clinical presentation of upper UTIs (pyelonephritis)?

flank pain
fever
nausea
vomiting
malaise
costovertebral tenderness

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What are the symptoms of someone who is acutely ill with a UTI?

sepsis
hypotension
renal dysfunction
severe nausea and vomiting
need hospitalization and IV for 48-72hr until pt is afebrile

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What should be taken into consideration for UTI treatment?

site of infection (cystitis vs pyelonephritis) renal function causative organism concurrent disease ability to penetrate urine or kidneys drug interactions adverse effects and allergies cost

What is first line treatment for uncomplicated UTIs in females? List the dosing.

TMP/SMX: 1 DS BID x 3 days TMP: 100mg BID or 200mg QD x 3 days Nitrofurantoin: 50-100mg QID or Macrobid 100mg BID x 5 days alt: cephalexin 250mg QID x 7 days alt: fosfomycin 3g single dose

What is second line treatment for uncomplicated UTIs in females?

amoxiclav: 500mg TID, 875mg BID x 3-7 days norfloxacin: 400mg BID x 3 days ciprofloxacin: 250mg BID or 500mg ER OD x 3 days

Does acute uncomplicated UTIs require antibiotic therapy?

no, self-limiting disease however, slightly increased risk for complications and its uncomfortable

What is considered to be recurrent UTIs?

2 uncomplicated UTI within 6 months OR 3 or more positive urine cultures in prior 12 months

What is considered to be recurrent UTIs?

2 uncomplicated UTI within 6 months OR 3 or more positive urine cultures in prior 12 months

What is the time frame for reinfection of a UTI?

occurs after 2 weeks (MedSask guidelines use 4 weeks) of completing antibiotic therapy

True or false: UTI reinfection is caused by the same organism as the previous infection

false caused by a different organism -if E.coli was original infection, it can be E.coli again but a new strain

What is the time frame for relapse of a UTI?

2 weeks (2-4wks) of completing antibiotic therapy

True or false: UTI relapse is caused by the original organism

true

What is the treatment of recurrent UTIs?

culture to guide therapy re-assess for upper tract infection re-treat for 7-14 days same antibiotic choices, tailor based on C & S

When can prophylaxis be initiated for UTIs?

short course self treatment at onset of symptoms if less than 3 infections per year

What are the treatment options for prophylaxis of UTIs? What are the dosings?

TMP/SMX: 1 tab or 1/2 DS tab qhs 3x per week or post-coital if associated with intercourse TMP: 100mg qhs or post coital Macrobid: 100mg qhs or post coital

What is a second line option for prophylaxis of UTIs?

FQ: 3x weekly or every other day or post coital

Is cranberry juice good for UTIs?

may be effective for prevention of women or children that get frequent UTIs, NOT FOR TREATMENT not well studied in all patient populations and it was studied in large amounts

Which people should never use cranberry juice to prevent UTIs?

people who often get kidney stones

What is a therapy that a post-menopausal woman with recurrent cystitis could attempt?

vaginal estrogen

What is the criteria needed that allows a pharmacist to prescribe for UTIs?

not first episode not pregnantme uncomplicated not relapse

What is recommended for any UTI of a man?

urine cultures

What are the drugs for UTIs in males? How long is treatment?

same as females 2 weeks -evidence that 7 days of SMX/TMP or ciprofloxacin is effective

What are the treatments for pyelonephritis if it is non-obstructive and mild?

TMP/SMX x 14d TMP x 14d norfloxacin or ciprofloxacin x 7d levofloxacin x 5d amoxicillin/clavulanate x 10-14d

What are the treatments for severe pyelonephritis?

gentamicin 4-7mg/kg q24h +/- ampicillin 1-2g q4-6h ciprofloxacin 400mg IV q12h levofloxacin 250-500mg q24 ceftriaxone 1-2g IV q24h (or cefotaxime) +/- gentamicin

What are the causative organisms of bacterial prostatitis?

e. coli (75%) other gram negatives: K. pneumoniae, P. mirablis, less frequently P. aeruginosa, enterobacter, serratia

How is bacterial prostatitis diagnosed?

urine culture in chronic prostatitis-quantitative localization culture

What is bacterial prostatitis?

inflammation of the prostatic gland and surrounding tissue due to infection can be caused by reflux of infected urine

What are risk factors for bacterial prostatitis?

indwelling catherization urethral instrumentation TURP with infected urine

What are the symptoms of acute bacterial prostatitis?

fever chills tenderness/pain malaise myalgia frequency urgency nocturia retention

What are the symptoms of chronic prostatitis?

urinating difficulty low back pain perineal and surprapubic pressure

What are the treatments of acute bacterial prostatitis?

TMP/SMX TMP norfloxacin levofloxacin ciprofloxacin

What are the treatments of severe bacterial prostatitis?

ampicillin or ceftriaxone IV PLUS gentamicin or tobramycin or amikacen

What is the duration of therapy for acute prostatitis?

minimum 2 weeks total course should be 4 weeks to prevent chronic infection

What are the treatments for chronic prostatitis?

FQs have better cure rate than TMP/SMX

What is the duration of therapy for chronic prostatitis?

4-12 weeks

Why is there a higher rate of UTIs in pregnancy?

dilated renal pelvis and ureters decreased ureteral peristalsis reduced bladder tone

What can happen to the newborn of a woman who left a UTI untreated in pregnancy?

prematurity LBW stillbirth

What is recommended that all pregnant women do?

routine screening at 12-16 weeks or first prenatal visit and at 28 weeks

What must a women who is positive for UTI do at the end of treatment?

treat for 3-7 days and follow-up culture to document eradication

What is first line treatment of UTIs in pregnancy?

cephalexin 250-500mg QID x 7 days amoxicillin 500mg TID x 7 days nitrofurantoin 100mg BID x 5 days

At what point in pregnancy should nitrofurantoin be avoided?

36-42 weeks gestation and during labour

What is second line treatment of UTIs in pregnancy?

TMP/SMX or TMP -avoid in 1st trimester and in last 6 weeks of pregnancy

When do we treat or screen for asymptomatic UTIs?

pregnancy pre-operative genitourinary procedures

True or false: there is high elevation of asymptomatic UTIs in elderly

true

At what rate does bacteruria occur per day of catheterization?

What is the MOA of nitrofurantoin?

damages bacterial DNA/proteins

What is the spectrum of nitrofurantoin?

e.coli staphylococci enterococcus faecalis citrobacter klebsiella

What are the adverse effects of nitrofurantoin?

GI upset nausea headache darkens urine (not dangerous) RARE: SJS/TEN

What can occur with long term use of nitrofurantoin?

neuropathy pulmonary fibrosis hepatic fibrosis

What are CIs of nitrofurantoin?

do not use in renal dysfunction -CrCl < 30ml/min do not use in late pregnancy -risk of neonatal hemolysis at 36-42 weeks patients with G6PD deficiency

What is a drug interaction of nitrofurantoin?

increase K with spironolactone

How should nitrofurantoin be taken?

with food -increases absorption and decreases GI se

What is the MOA of fosfomycin?

inhibits cell wall formation, bactericidal -different MOA from BLs

True or false: resistance is high to nitrofurantoin and fosfomycin

false

What is the spectrum of fosfomycin?

enterobacteriaciae including ESBLs enterococcus DOES NOT RELIABLY COVER PS. AERUGINOSA

What are the adverse effects of fosfomycin?

GI upset diarrhea headaches hypokalemia