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UTI
Urinary Tract Infections
| Question | Answer |
|---|---|
| What are the 4 classifications of UTI's | asymptomatic bacteriuria, uncomplicated cystitis (bladder), uncomplicated pyelonephritis (kidneys), complicated cystitis/pyelonephritis |
| What organs are affected in an upper UTI | Kidneys |
| What organs are affected in a lower UTI | bladder/urethra |
| What makes a UTI "complicated"? | congenital abnormalityor distortion of the urinary tract, a stone, indwelling catheter, prostatic hypertrophy, obstruction or neurologic defect that affects urine flow or urinary tract defenses |
| What is the definition of a recurrent UTI | 3 or more UTI's within one year, characterized by asymptomatic periods between symptomatic infections. Can be either relapse or reinfection |
| What is a UTI reinfection | if the infection is caused by a different organism than originally isolated and accounts for the majority of the recurrent UTI (greater than 2 wks between infections) |
| What is a UTI relapse | the development of repeated infections caused by the same initial organism and usually indicates a persistent infection source (less than 2 wks between infections) |
| What is asymptomatic bacteriuria | significant bacteria in the urine without any symptoms |
| what is symptomatic abacteriuria | symptoms of frequency and dysuria in the absence of significant bacteria (AKA acute urethral syndrome, commonly associated w/ chlamydia infections) |
| What are the risk factors for UTI's | previous UTI, sexual intercourse, delays in urination, spermicide use, obstruction, prostatic hypertrophy, urethral strictures, calculi, bladder diverticular |
| What are the S/S of UTI | hematuria, (lower):dysuria, urgency, frequency, nocturia, suprapubic tenderness, (upper): flank pain, fever, nausea, vomiting, malaise (elderly): altered mental status, change in eating habits, GI symptoms |
| What are 5 lab findings indicative of UTI? | bacteriuria, pyuria, hematuria, nitrite-positive urine, leukocyte esterase-positive urine |
| What bacteria count is considered criteria for a "true" infection | 100,000 or more in a clean catch specimen |
| Where do most UTI pathogens originate | translocated from bowel flora of host |
| In what circumstances are you likely to find multiple organisms causing the UTI | stones, indwelling catheters, or chronic renal abscesses |
| What is the most common pathogen in uncomplicated CA uti | E. coli |
| Other than E. coli, what are other common pathogens for UTI | staphylococcus, klebsiella, enterobacter, pseudomonas, enterococcus, proteus |
| What populations should be treated for asymptomatic bacteriuria | pregnant women, patients undergoing urolgic surgery, catheter-acquired bacteriuria in women, (possibly neutropenic patients and renal transplant patients) |
| What is the MOA of nitrofurantoin (Macrobid) | inactivates bacterial ribosomal proteins, inhibiting protein synth, metabolism, DNA synth, etc |
| At what CrCl is nitrofurantoin contraindicated | CrCl < 60 ml/min |
| What is the MOA of Bactrim | inhibits folate synth |
| At what resistance level should you avoid using Bactrim | if it exceeds 20%, (or if used in UTI in previous 3 months) |
| What are 2 major drug interactions w/ bactrim | ACEI's (hyperkalemia) warfarin (increased INR) |
| What is the MOA of fosfomycin | inhibits cell wall synth (peptidoglycan) |
| What is a major DI w/ fosfomycin | metoclopramide (decreases absorption of fosfomycin) |
| Why should you avoid ampicillin and amoxicillin in empiric UTI therapy | poor efficacy and high resistance |
| Which 2 FQ's can be used to treat UTI | cipro & levo (NOT moxi - minimal urinary excretion) |
| Why are oral beta-lactams usually avoided in uncomplicated pyelonephritis | they are generally less effective and require an initial dose of a long-acting parenteral antibiotic |
| What specific complicated UTI is focused on by the IDSA guidelines | catheter-associated UTIs |
| What factors may qualify a UTI as complicated | uncontrolled DM, pregnancy, hx acute pyelonephritis in past yr, symptoms for 7 or more days, hospital-acquired, renal failure, immunosupression, |
| If the organism is susceptible, what 4 antibiotics are acceptable in complicated UTI | oral beta-lactams, bactrim, nitrofurantoin, fosfomycin |
| What antibiotics used for UTI have adequate pseudomonal coverage | pip/tazo, ticar/clav, ceftazidime, cefepime, DIM-penems, aztreonam, Ag's, cipro, levo |
| If the suspected organism is MRSA, what Abx could you use | vanco, linezolid |
| what Abx would you use for an ESBL-producing organism (klebsiella, E. coli) | carbapenem, non-beta-lactam (if susceptible and non-life threatening) |
| What is the duration of treatment for complicated UTI | cystitis, prompt resolution: 7 dys pyelonephritis or delayed response cystitis: 10-14dys (if not severly ill, may consider levo x5dys) |
| How long should a catheter-associated UTI in a female <65yo be treated after removing catheter | 3 days |
| Why is asymptomatic bacteriuria treated during pregnancy | greater risk of developing pyelonephritis increased risk of preterm birth, low birth weight, and perinatal mortality |
| which abx should be avoided in pregnancy | tetracyclines (accumlate in baby teeth and bones), FQ's |
| What are 4 non-pharm ways to avoid recurrent UTI | avoid spermicides, liberal fluid intake, postcoital voiding, cranberry juice |
| What are the 2 dosing strategies for avoiding recurrent UTI | continuous: take daily postcoital prophylaxis: take dose after sexual intercourse |
| What 4 Abx are commonly used to prevent recurrent UTI | nitrofurantoin, bactrim, cephalexin, ciprofloxacin |
| What are 3 OTC therapies used in UTI's | phenazopyridine (urinary analgesic) cranberry juice lactobacillus probiotics |
| What is prostatitis | inflammation of tissues around prostate gland due to infection |
| what are the s/s of acute prostatitis | sudden onset of fever, tenderness, frequency, urgency dysuria, malaise |
| what are the s/s of chronic prostatitis | urinary difficulty, low back pain, perneal and suprapubic discomfort |
| What drugs are used to treat prostatitis | bactrim or FQ's |
| What is the recommended duration of treatment for acute prostatitis | 4wks |
| what is the recommended duration of treatment for chronic prostatitis | 6-12wks |
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