UTIs Flashcards
(44 cards)
define UTI
- Defined as presence of significant bacteriuria and characteristic signs and symptoms
what are the risk factors for UTIs?
iatogenic/ drugs- catheter, antibiotic use, spermacides
behavioral- voiding dysfunction, frequent or recent sex
physiologic- female, pregnant
genetic- familal tendency, vaginal mucus properties
what can pyleonephritis lead to?
AKI/sepsis- if it becomes systemic
who/ what is classified as an uncomplicated UTI?
- Caused by a usual pathogen in a person with a normal urinary tract and normal kidney
function
– Female (not elderly)
– First presentation
– No signs of pyelonephritis
– Not pregnant
what classifies as a complicated UTI?
- Pregnant
- Male
- Children
- Elderly
- Pyelonephritis
- Recurrent
- Factors present that predispose to persistent or re-current infection or treatment failure
– Abnormal urinary tract
– Virulent organism
– Impaired host defences
– Poorly controlled diabetes
mellitus,
– Immunosuppressive treatment
– Impaired renal function.
what are the typical symptoms of uncomplicated UTI?
- Dysuria
- Frequency
- Suprapubic tenderness
- Urgency
- Polyuria
- Haematuria
why would you suspect an upper UTI?
- +/- UTI Symptoms
- Fever
- Flank, loin or lower back pain
- Can lead to renal failure and
septicaemia - Empirical antibiotics +/-
admission to hospital required
how do you diagnose a UTI?
- Clinical history and symptoms
- Near patient tests?
– Appearance of urine – smell? cloudy? blood?
– Urine microscopy
– Dipstick tests – leucocyte and nitrite - Urine culture
why are urine dipsticks not used?
Dipsticks become more unreliable with increasing age over 65 years. Up to half of older adults, and most with a urinary catheter, will have bacteria present in the bladder/urine without an infection. This “asymptomatic bacteriuria” is not harmful, and although it causes a positive urine dipstick, antibiotics are not beneficial and may cause harm
how do you manage an uncomplicated lower UTI?
- Empirical Antibiotics
– Nitrofurantoin MR 100mg twice daily for THREE days or 50mg QDS - First line treatment option
- Contraindicated in significant renal impairment
- Activity affected by urinary pH
– OR Trimethoprim 200mg twice daily for THREE days
what do complicated UTIs need?
- Complicated infection requires 5- 10 day treatment courses to eradicate bacteriuria
when do you have to be cautious with nitrofurantoin in renal impairment?
- Caution in renal impairment
– eGFR less than 45ml/minute/1.73m2
– Ineffective (inadequate concentration in the urine….site of action)
– 30-45ml/minute/1.73m2 – only if multi-drug resistant(risk/benefit)
– Increased risk of peripheral neuropathy
what patients are already at risk of peripheral neuropathy?
- DM
- Anaemia
- Folate deficiency
- Electrolyte
imbalances
what are some side effects of nitrofuratoin?
– GI
– Pulmonary – cough, chest pain, dysphonea,
hypoxemia….(<1%) – withdraw + corticosteroid
when would you be cautious with trimethoprim in renal impairment?
- Caution in severe renal impairment (accumulation - less of an issue with 3
day courses)
– GFR 15-25 ml/min – normal dose for 3 days then half dose
– GFR <15 ml/min – half normal dose
what is trimethoprim contraindicated with?
- CI with blood dyscrasias – antifolate effects
what interactions does trimethoprim have?
- Interactions (bigger issue with long-term treatment)
– Methotrexate (folate antagonist)
– Azathioprine (increased risk of haematological toxicity)
– Phenytoin (increased levels)
– Digoxin (increased levels)
– Warfarin? (often the case with all Abx)
what should be done if patient is resistant to first line antibiotics?
urine culture
define pyelonephritis
Infection within the renal pelvis, with or without active infection of the renal parenchyma
what are the symptoms of pyelonephritis?
UTI + loin pain and/or fever
what are the common pathogens of pyelonephritis?
Common pathogens:
* Escherichia coli
* Klebsiella pneumonia.
* Proteusspecies
* Pseudomonasspecies
* Enterococcus species
who would you be extra cautious about with pyelonephritis?
- Pregnancy
- Elderly…care homes
- Lack of improvement following antibiotic therapy (24 hours)….close monitoring
- Immunocompromised
- Renal impairment
- Diabetes
what is the management of pyelonephritis?
Primary care
* Co-amoxiclav 625mg TDS 7 days or
* Ciprofloxacin 500mg BD 7 days
* Cautions with above agents???
Secondary Care
* Optionsinclude, gentamicin, tazocin®, meropenem, teicoplanin,
ciprofloxacin
what is defined as a relapsed UTI?
- Same strain of organism within 2 weeks of finishing treatment