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pr3151_pharmacotherapeutics > UTI > Flashcards

UTI Flashcards

1
Q

What is the difference between ASB and UTI

A

ASB refers to the isolation of significant colony of bacteria in urine from person without symptoms of UTI. UTI refers to isolation of significant colony counts of bacteria in urine from persons with symptoms of UTI

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2
Q

Does ASB need to be treated with antibiotics?

A

No

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3
Q

What are the 2 groups of patients who need treatment for ASB and why?

A

Pregnant women - to prevent pyelonephritis, preterm labour and low infant body weight

Patients going for urologic procedure in which mucosal trauma is expected - prevents bacteuremia and urosepsis

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4
Q

When should ASB treatment be screened and initiated for the 2 groups?

A

Pregnant women - Screen at first visits between 12-16 weeks gestation and treat for 4-7 days
Urologic procedure - Screen prior to procedure and treat as SAP

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5
Q

Describe the pathogenesis of UTI

A

Ascending - colonic / fecal flora colonise periurethral area and ascend to bladder and kidneys

Descending - organisms at distant primary site travel through blood stream and go into urinary tract. Cause UTI

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6
Q

Who are at a higher risk of UTIs?

A

Females - shorter urethra
Use of spermicides and diaphragm as contraceptives

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7
Q

What is the natural host defence mechanism the body takes to fight against UTI?

A

Micturition with increased diuresis
Antibacterial properties of urine and prostatic secretion
Anti adherence mechanism of bladder
Inflammatory response with PMNs; allowing phagocytosis to occur

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8
Q

List some of the risk factors associated with UTI

A

Females
Sexual intercourse
Abnormalities of urinary tract
Neurological disturbances
Anticholinergic drug
Catheterization and other mechanical related instrumentation
DM
Pregnancy
Use of diaphragms and spermicides
Genetic
Previous UTI not resolved

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9
Q

What are some preventive technique that a patient can undertake to minimize the future risk of getting UTI?

A

Drink lots of fluid (unless patient has fluid restrictions)

Urinate frequently and go when you feel the urge

Urinate shortly after sex

Wear loose fitting clothes and cotton underwear to keep area dry; avoid tight fitting jeans and nylon underwear

Wipe from front to back upon urinating for women

Modify birth control techniques

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10
Q

What is the difference between complicated and uncomplicated UTI

A

Complicated UTI refers to UTI with potential for serious outcome
Uncomplicated UTI refers to women who are health, premenopausal, nonpregnant and have no history suggestive of abnormal urinary tract

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11
Q

List some examples of uncomplicated UTI

A

UTI in men
UTI in pregnancy and children
Catheter associated UTI
Presence of complicating factors such as functional and structural abnormalities, GI instrumentation, DM and immunocompromised

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12
Q

What are the subjective evidence of a lower UTI?

A

Dysuria
Urgency
Frequency
Nocturia
Suprapubic heaviness
Gross hematuria

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13
Q

What are some other symptoms suggestive of an upper UTI?

A

Fever
Rigors
Headache
N/V
Malaise
Flank pain
Renal punch positive
Abdominal pain

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14
Q

Should urine culture be done for all patients?

A

No. Only do it for those who are pregnant; recurrent UTI; pyelonephritis; catheter associated UTI and men with UTI

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15
Q

What are some indications of a UTI upon receiving a UFEME report?

A

WBC > 10/ mm3 indicative of pyuria
RBC positive
Microorganisms such as yeast or bacteria
WBC casts - mass of cells and proteins usually found in renal tubules only –> indicative of upper UTI

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16
Q

Upon conducting a Dipstick, what are some key components to look for?

A

Leukocyte esterase
Nitrates

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17
Q

Can false negatives occur with Dipstick?

A

Yes. Can occur in presence of gram-positive and P.Aeruginosa bacteria; decrease urinary pH, frequent voiding and diluted urine

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18
Q

List the likely pathogen for uncomplicated UTI

A

E.coli
Staphylococcus saprophyticus
Enterococcus fecalis
Klebsiella pneumoniae
Proteus spp.

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19
Q

List the likely pathogens associated with complicated UTI

A

E.Coli
Enterococci
Proteus spp
Klebsiella spp.
P.Aeruginosa

20
Q

Define nosocomial / healthcare associated UTI

A

UTI occurring in patients who are
- Hospitalized in last 90 days
- Current hospitalization more than 2 days ago
- Residence in nursing homes
- Recent antimicrobial use

21
Q

Before choosing an antibiotic, what are the 3 things to consider

A

Is there a need to treat?
Organism factors?
Types of UTI?

22
Q

What are the agents use for Cystitis in women? For each agent; list the dose, frequency and duration of treatment

A

PO Co-trimoxazle 960mg BD for 3 days

PO Nitrofurantoin 50mg QD for 5 days

PO Fosfomycin 3g single dose

23
Q

What are the alternative agents for women with cystitis? List the dose, frequency and duration of treatment

A

PO Beta Lactams
- Cefuroxime 250mg BD for 5-7 days
- PO Amoxicillin clavulanate 625mg BD for 5-7 days

PO Fluroquinolones
- Levofloxacin 250mg daily
- Ciprofloxacin 250mg BD for 3 days

24
Q

What do I do for complicated cystitis in women?

A

Increase duration of antibiotics to 7-14 days OR increase fosfomycin dose to 3 doses

25
Q

For community acquired pyelonephritis, what are some agents I can consider? List the dose, frequency and duration.

A

PO Fluoroquinolones
- Ciprofloxacin 500mg BD for 7 days
- Levofloxacin 750mg for 5 days

26
Q

What are some alternatives to consider for community acquired pyelonephritis? List the dose, frequency and duration

A

PO Co-trimoxazole 960mg BD for 10-14 days

PO Cefuroxime 250-500mg BD for 10-14 days
PO Amoxicillin clavulanate 625mg TDS for 10-14 days

27
Q

IF patients do become severely ill and require hospitalisation, what can you do for their regime for CA-acquired pyelonephritis?

A

Initiate IV therapy and switch to oral once patient is stable.
- IV Ciprofloxacin 400mg BD
- IV Cefazolin 1g q8h
- IV Amoxicillin-clavulanate 1.2g q8h

28
Q

Define healthcare associated pyelonephritis.

A

Onset of UTI > 48h post-admission
Hospitalized and underwent invasive urologic procedure in last 6 months

29
Q

Why are broad spectrum antibiotics preferred for HA-associated UTI

A

Risk of P.Aeruginosa and resistant strains of bacteria

30
Q

What are some possible empiric therapy for HA-Assoc pyelonephritis in more severe patients? List the dose, duration and frequency.

A

IV cefepine 2g q12h +/- IV Amikacin 15mg/kg/day

IV meropenem 1g q8h

IV Imipenem 500mg q8h

Duration: 7-14 days

31
Q

What are some possible empiric therapy for HA-Assoc pyelonephritis in less sick patients? List the dose, duration and frequency.

A

Can consider PO therapy
- PO Levofloxacin 750mg daily

  • PO Ciprofloxacin 500mg BD
32
Q

What should I consider before starting treatment for community acquired UTI in men?

A

Any concern for prostatitis; defines the duration of therapy

33
Q

How should males be treated for those with no concern for prostatitis?

A

Similar to complicated cystitis (i.e. longer duration of 7-14 days)

34
Q

In cases of prostatitis or pyelonephritis, how should males be treated ?

A

PO Ciprofloxacin 500mg BD

PO Co-trimoxazole 960mg BD

Duration should be 6 weeks

35
Q

Define catheter associated UTI

A

Presence of symptoms or signs compatible with UTI with no other identified source of infection along with 103 cfu/mL of > 1 bacteria species in a single catheter urine specimen in patients with indwelling urethral/ indwelling suprapubic/ intermittent catheterization or midstream voided urine specimen from patient whose catheter has been removed within previous 48h

36
Q

List some of the risk factors associated with catheter associated UTI

A

Poor quality of catheter care
Duration of catheterisation
Renal function impairment
Females
DM
Colonisation of drainage bag, catheter and periurethral segment

37
Q

Is antibiotics necessary for all catheter related UTI?

A

No. Not needed for ASB and only indicated for indwelling catheter to hasten symptoms resolution and risk of subsequent infection

38
Q

What are some symptoms associated with catheter related UTI?

A

New onset or worsening fever, rigor, malaise, altered mental status, lethargy with no altered cause, flank pain, renal punch positive, and pelvic discomfort

39
Q

How should I treat mild catheter associated UTI?

A

PO/ IV Levofloxacin 750mg for 5 days

40
Q

What are some empiric therapy for catheter associated UTI?

A

IV Cefepime 2 q12h +/- IV Amikacin 15mg/kg in a single dose

IV Imipenem 500mg q6h

IV Meropenem 1g q8h

41
Q

What is the criteria for use of co-trimoxazole to treat catheter associated UTI? How long should co-trimoxazole be used?

A

Women less than 65 years old, with no upper UTI and already removed indwelling catheter

3 days

42
Q

What is some non-pharmacological advice to prevent catheter associated UTI?

A

Avoid unnecessary catheter use
If catheter still indicated, use for minimal duration
Use closed system
Ensure aseptic insertion technique
Do not recommend prophylactic antibiotics, topical antibiotics and chronic suppressive antibiotics

43
Q

What are some antibiotic to avoid during pregnancy?

A

Fluoroquinolones - renal cartilage damage

Aminoglycosides - Neuro toxicity

Nitrofurantoin - Avoid in last trimester

Co-trimoxazole - avoid in 1st and last trimester

44
Q

What is the duration of beta lactams used for UTI in pregnancy?

A

ASB/ Cystitis: 4-7 days
Pyelonephritis : 14 days

45
Q

For patients with UTI symptoms, what are some other adjunctive therapy I can recommend?

A

Pain: NSAIDS, Paracetamol
Vomiting: Rehydration

Urinary symptoms:
- Urine alkalinization
- Phenazopyridine 100-200mg TDS

46
Q

For phenazopyridine, what are some adverse drug reactions and contraindications associated to the drug

A

ADR: N/V , Orange red discolouration of urine

Avoid in G6PD deficient

47
Q

How should I advice a patient upon providing them medication?

A

Signs and symptoms take 24-72 hours to resolve

For pregnant women, repeat culture should be recommended to check for bacteriological clearance

pr3151_pharmacotherapeutics (9 decks)

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