UTI Flashcards
Risk Factors for UTI
- age, gender
- neuro dysfunction, incontinence
- instrumentation or obstruction
- prior hx
- sexual activity, spermicide/diaphragm use
- pregnancy, postmenopausal
Lower UTI Definition
cystitis (bladder)
Upper UTI Definition
pyelonephritis (kidneys)
Uncomplicated UTI Definition
UTI in otherwise healthy female with no structural or functional abnormalities of urinary tract
Complicated UTI Definition
- most often assoc w/ predisposing lesion in urinary tract
- also DM, age > 65, pregnancy, immunosuppression, male
Recurrent UTI Definition
3 or more UTI per year
Reinfection
caused by new organism
Relapse
development of repeated infections caused by same initial organism
Asymptomatic Bacteriuria
significant bacteriuria (>100,000 bacteria/mL) in the absence of sxs (common > 65)
Cystitis Clinical Presentation
- frequency, urgency, painful urination
- low back or abdominal pain
- suprapubic tenderness
Pyelonephritis Clinical Presentation
- systemic sxs: fever, rigors, HA, N/V, malaise
- localized flank pain, CVA tenderness
- frequency, urgency, painful urination
UA Findings in UTI
- > 100,000 bacteria/mL in women (> 1000 in men)
- > 10 WBC/mm^3
- positive leukocyte esterase
- positive nitrites
- hematuria
- quantitative UC (>100,000 bacteria/mL)
Common Pathogens for Community Acquired UTI
- E coli (85%)
- Proteus, Klebsiella
- Staph. saprophyticus
- Enterococcus
Common Pathogens for Complicated/Nosocomial UTI
- E. coli (50%)
- Enterococcus
- Pseudomonas
- Staph
- Proteus, Klebsiella
Which patients should get a urine culture?
- complicated cystitis
- cystitis in pregnancy
- cystitis with clinical failure
- pyelonephritis
When should complicated cystitis and pyelonephritis get a urine culture?
before antibiotic is started
+/- 1-2 weeks after tx is finished
When should cystitis in pregnancy get a urine culture?
before antibiotic is started AND
1-2 weeks after tx is finished
When should cystitis with clinical failure get a urine culture?
after clinical failure AND
2 weeks after re-treatment is finished
UTI Tx Goals
- prevent or treat systemic consequences of infx
- eradicate the causative organisms
- prevent infx recurrence
Considerations for Abx Choice in UTI Tx
- UTI category
- complicating factors
- local sensitivity patterns
- pt allergies
- concurrent meds
- cost
Pathogens in Acute Uncomplicated Cystitis
- E. coli
- Proteus, Klebsiella
- Staph. saprophyticus
- Enterococci
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20%
-TMP/SMX 1 DS po bid x3 days
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20% with Sulfa Allergy
- nitrofurantoin 100 mg po bid x5 days OR
- fosfomycin 3 gm po x1
Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance >20% or Sulfa Allergy
- cipro 250 mg bid, cipro ER 500 mg qd, levo 250 mg qd, moxi 400 mg qd x3 days OR
- nitrofurantoin or fosfomycin
