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Urinary Tract Infections

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
Created by: 1450725958



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