UTIs Flashcards
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)
