UTI Flashcards
(20 cards)
What symptomatic differences are there between Cystitis and Pyelnopephritis?
Cystitis: Dysuria, frequency, urgency, suprapubic pain, hematuria, malaise, and altered mental status
Pyelonephritis: Fever, chills/rigor, flank pain, nausea/vomiting, costoverterbral angle tenderness, and WBC casts in the urine
What complicating factors exist for UTI?
Structural or functional abnormalities within the GI tract Renal failure Urinary tract obstruction Indwelling catheter Ureteral stent or nephrostomy Recent urinary instrumentation Renal transplant Diabetes Pregnancy Pyelonephritis within the last year Symptoms for over 7 days without treatment Multidrug resistant pathogen Hospital-acquired infection Kidney stones
What organisms are found in uncomplicated UTI’s?
E coli usually
Can also be proteus mirabilis, klebsiella pneumoniae, or staphylcoccus saphrophyticus
What organisms are found in complicated UTI’s?
E coli PLUS: Pseudomonas aeruginosa Serratia Providencia Enterococcus Staphylococcus Candida
Resistance threshold for Cystitis and Pyelonephritis?
Cystitis: 20%
Pyelonephritis: 10%
Do not use a drug if the resistance threshold is above these two
What options do we have for uncomplicated cystitis?
Nitrofurantoin macrocrystals (5 days, 100 mg BID)
Bactrim (3 days)
Fosfomycin (3g single dose)
Fluoroquinolones (Cipro and Levo - 3 days)
Beta lactams (3-7 days) - last line
Which drug is not used in CrCL less than 60?
Nitrofurantoin
Which drugs are cystitis only?
Nitrofurantoin
Fosfomycin
What drug interactions do you worry about with Bactrim?
Warfarin
Phenytoin
Digoxin
What drug interactions do you worry about with Fluoroquinolones?
Cations inhibit absorption
Warfarin
What collateral damage do you worry about with Fluoroquinolones?
MRSA
Fluoroquinolone-resistant gram negative bacteria bacilli
ESBL-producing Klebsiella
C diff
What collateral damage do you worry about with broad spectrum beta lactams?
ESBL producing Klebsiella
B lactam resistant Acinebacter
C diff infection
How do you manage pyelonephritis?
Depends if hospitalized or non-hospitalized
Hospitalized - Initial dose of IV ceftriaxone or aminoglycoside, then use B lactam for 10-14 days (Augmentin), Bactrim for 14 days, or Levofloxacin for 5 days
Non-hospitalized: IV therapy (Cephalosporin or penicillin with aminoglycoside, or if pseudomonas ifs a concern use Cefepime or Piperacillin/tazobactam) - treat for 10-14 days
How do you diagnose a complicated infection? How is treatment adjusted?
symptoms plus urine culture (over 10^5 in women, 10^4 in men)
Treatment adjusted by initiating broad spectrum beta lactam or fluoroquinolones for 7-14 days
Also modify complicating factors (ie remove kidney stones)
Pregnancy - what do you use?
Preferred: B lactams, nitrofurantoin, fosfomycin
DO NOT USE Bactrim, cipro, or levo bc they have teratogenicity risk
Use for 7 days!
Catheter associated UTI - what do you use?
If catheter is in place for 2 weeks, replace catheter to hasten symptom relief and reduce risk for recurrence
Treat with extended spectrum cephalosporin or penicillin
Duration: 3 days in women with cystitis and catheter removal
7 days with catheter exchange
10-14 days if delayed response
Recurrent episodes - how do we treat?
Less than 3 episodes a year - treat as new infection
More than 3 episodes a year - use long-term prophylaxis (6 months):
Bactrim 1/2 tab daily
TMP alone 100 mg daily
Ciprofoxacin daily
Nitrofurantoin PO daily
Also get monthly urine cultures, treat with full course of therapy if symptoms occur then resume prophylaxis.
If recurrent UTI’s are associated with sexual activity, what do you do?
Encourage post-coital voiding Prophylactic antibiotic within 2 hours after intercourse Bactrim 1 whole tablet Nitrofurantoin 100 mg PO Ciprofloxacin 125 mg
When do we treat ASB?
Pregnant women
Prior to urologic procedures that involve mucosal bleeding
OTC measures for UTI?
Phenazopyridine - pain relief, does nothing to treat infection, only use for 1-2 days (200 mg TID)
Cranberry juice/probiotics - do not recommend
Probiotics - may keep vaginal pH in normal range, regulating bacteria to prevent UTI’s
Conflicting results for the last 2
