Lecture 11 - UTI

Question 1

How to pathogens generally get into body to get UTI?

Answer 1

Mostly ascending, common up from urethra

Descending not common

Question 2

Host defense mechanisms of UTI

Answer 2

Anatomy
Pee power = urination
pH of Urine
Mobilization of PMNs

Question 3

Lower Tract infection

Answer 3

Cystitis, Bladder

Signs & symptoms:
Dysuria, urgency, frequency, nocturne, and suprapubic heaviness

Question 4

Upper Tract infection

Answer 4

pyelonephritis, Kindeys

Signs & Symptoms:
Flank pain, Costovertebral angle tenderness, fever, nausea, vomiting, malaise

Question 5

What is an uncomplicated infection?

Answer 5

no structural or functional abnormalities
Not preggo
No urologic instrument
Premenopausal age

Question 6

What is complicated infection?

Answer 6

complex anatomy ie Male*
Catheter placement

Question 7

Risk factors for UTI

Answer 7

Catheterization = biggest risk
Gender
Age
Sexy time
Diaphragm/spermicide use
Hx of UTI
renal disease
diabetes
drugs

Question 8

UTI diagnosis?

Answer 8

Urinalysis and Urine culture

Question 9

When should you collect urine?

Answer 9

Mid stream is what you want

Question 10

What to look for on UA for UTI?

Answer 10

Bacteria = present
WBC > 10, indicates pyuria/inflammation

Squamous Epithelial high amount (> 4)= contamination sample

Question 11

What to look for on Urine culture for UTI?

Answer 11

Significant bacteriuria = > 10,000 CFU

Less likely UTI of < 10,000 CFU

Question 12

Situations in which lower colony counts may be sig include…

Answer 12

pts who already on abx on time of culture
Symptomatic young women
Suprapubic aspiration
Men with pyuria ( 10+ WBC per cubic mL)

Question 13

Acute uncomplicated Cystitis 1st line rec

Answer 13

Nitro 100mg BID 5 days
Bactrim DS BID 3 days (dont use if resistance > 20%)
Fosfomycin 3g Daily 1 day

Question 14

Acute uncomplicated Cystitis alternatives

Answer 14

FQ: ofloxacin, cipro, levo = 3
B lactam = amox/clav, cefdinir, cefaclor, cem/pro = 3-7 days

Question 15

Nitro clinical pearls

Answer 15

dont use CrCl < 30
dont use pyelonephritis

Question 16

fosfomycin clinical pearls

Answer 16

single dose
dont use pyelonephritis

Question 17

Bactrim clinical pearls

Answer 17

Hyperkalemia
Sulfa allergy

Question 18

Fluoroquinolone clinical pearls

Answer 18

QTc prolongation
Seizure risk
Moxi = dont get renally cleared so dont use

Question 19

if you get < 3 episodes of UC cystitis then….

Answer 19

treat as separately occurring infection

Question 20

If you get > 3 episodes/yr or 2 episodes/6 months treat as Relapse or Reinfection

Answer 20

Relapse: same organism and susceptibility, extend ABX duration

Reinfection: different pathogen/strain, retreat and consider prohlyaxis

Question 21

Prophylaxis of Reinfection UTI post sex treatment

Answer 21

Bactrim
Nitro
Cephalexin
Cipro

All for one dose

Question 22

Prophylaxis of reinfection UTI unknown cause

Answer 22

6 month treatment

Bactrim QD or TIW
Nitro QD
Cephalexin QD
fosfomycin q10 days

if infection occurs, switch to therapy and then back to prophylaxis

Question 23

Complicated Cystitis treatments

Answer 23

1. get urine culture & use susceptibilities

Durations: varies

Question 24

Pyelonephritis Outpatient Mild-moderate txm

Answer 24

Levo 750 = 5 days
Cipro 1000 or 500 BID = 7
Bactrim DS BID = 14

IF > 10% resistance to FQs, give 1 dose of IV ceftriaxone or AG

Question 25

Pyelonephritis Inpatient Severe Txm

Answer 25

Ceftriaxone** AGs Cefepime Pip/tazo Carbapenem FQs 7-14 days, IV -> PO when stable

Question 26

Asymptomatic Bacteriuria info

Answer 26

if no symptoms then shouldn't use Abx Exceptions: preggo, urological procedure w/ anticipated bleeding

Question 27

Risk of untreated ASB (asymptomatic Bacteriuria) in preg

Answer 27

potential to cause serious adverse effects, prematurity, low birth weight and still birth

Question 28

UTI in pregnancy treatments

Answer 28

Amox Amox-clav Cephalexin Babies love beta lactams = 4-7 day treatment Avoid nitro at term***. Avoid Bactrim at 1st term and post 38week*** Avoid Tetracyclines & FQs*** Premature brith = primary risk

Question 29

Prostatitis symptoms

Answer 29

Acute: fever, chills, malaise, tenderness, myalgia Chronic > 3 months difficulty peeing, lower back pain, discomfort

Question 30

Prostatitis treatment

Answer 30

Bactrim, cipro, levo Acute = 2-4weeks, Chronic = 4-6wks chronic ** Avoid Nitro **

Question 31

Candiduria treatment

Answer 31

Fluconazole 200 Daily Likely related to catheterization...remove and re-eval 0 days most patients, 7-14 days if treating

Question 32

Urinary Aanalgesics Phenazopyridine

Answer 32

Common ADRs: red/orange discoloration Indication: Max of 2 days Dont use CrCl < 50, can mask symptoms UTI

Question 33

Preventive Care for UTI

Answer 33

Better hydration Pee after sex Cranberry juice = sus evidence Lactobacillus = probiotic