Urinary Tract Infections
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| What are the 4 classifications of UTI's | asymptomatic bacteriuria, uncomplicated cystitis (bladder), uncomplicated pyelonephritis (kidneys), complicated cystitis/pyelonephritis
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| What organs are affected in an upper UTI | Kidneys
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| What organs are affected in a lower UTI | bladder/urethra
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| 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
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| 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
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| 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)
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| 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)
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| What is asymptomatic bacteriuria | significant bacteria in the urine without any symptoms
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| what is symptomatic abacteriuria | symptoms of frequency and dysuria in the absence of significant bacteria
(AKA acute urethral syndrome, commonly associated w/ chlamydia infections)
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| 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
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| 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
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| What are 5 lab findings indicative of UTI? | bacteriuria, pyuria, hematuria, nitrite-positive urine, leukocyte esterase-positive urine
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| What bacteria count is considered criteria for a "true" infection | 100,000 or more in a clean catch specimen
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| Where do most UTI pathogens originate | translocated from bowel flora of host
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| In what circumstances are you likely to find multiple organisms causing the UTI | stones, indwelling catheters, or chronic renal abscesses
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| What is the most common pathogen in uncomplicated CA uti | E. coli
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| Other than E. coli, what are other common pathogens for UTI | staphylococcus, klebsiella, enterobacter, pseudomonas, enterococcus, proteus
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| 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)
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| What is the MOA of nitrofurantoin (Macrobid) | inactivates bacterial ribosomal proteins, inhibiting protein synth, metabolism, DNA synth, etc
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| At what CrCl is nitrofurantoin contraindicated | CrCl < 60 ml/min
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| What is the MOA of Bactrim | inhibits folate synth
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| At what resistance level should you avoid using Bactrim | if it exceeds 20%, (or if used in UTI in previous 3 months)
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| What are 2 major drug interactions w/ bactrim | ACEI's (hyperkalemia)
warfarin (increased INR)
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| What is the MOA of fosfomycin | inhibits cell wall synth (peptidoglycan)
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| What is a major DI w/ fosfomycin | metoclopramide (decreases absorption of fosfomycin)
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| Why should you avoid ampicillin and amoxicillin in empiric UTI therapy | poor efficacy and high resistance
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| Which 2 FQ's can be used to treat UTI | cipro & levo (NOT moxi - minimal urinary excretion)
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| 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
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| What specific complicated UTI is focused on by the IDSA guidelines | catheter-associated UTIs
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| 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,
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| If the organism is susceptible, what 4 antibiotics are acceptable in complicated UTI | oral beta-lactams, bactrim, nitrofurantoin, fosfomycin
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| What antibiotics used for UTI have adequate pseudomonal coverage | pip/tazo, ticar/clav, ceftazidime, cefepime, DIM-penems, aztreonam, Ag's, cipro, levo
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| If the suspected organism is MRSA, what Abx could you use | vanco, linezolid
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| what Abx would you use for an ESBL-producing organism (klebsiella, E. coli) | carbapenem, non-beta-lactam (if susceptible and non-life threatening)
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| 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)
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| How long should a catheter-associated UTI in a female <65yo be treated after removing catheter | 3 days
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| Why is asymptomatic bacteriuria treated during pregnancy | greater risk of developing pyelonephritis
increased risk of preterm birth, low birth weight, and perinatal mortality
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| which abx should be avoided in pregnancy | tetracyclines (accumlate in baby teeth and bones), FQ's
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| What are 4 non-pharm ways to avoid recurrent UTI | avoid spermicides, liberal fluid intake, postcoital voiding, cranberry juice
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| What are the 2 dosing strategies for avoiding recurrent UTI | continuous: take daily
postcoital prophylaxis: take dose after sexual intercourse
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| What 4 Abx are commonly used to prevent recurrent UTI | nitrofurantoin, bactrim, cephalexin, ciprofloxacin
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| What are 3 OTC therapies used in UTI's | phenazopyridine (urinary analgesic)
cranberry juice
lactobacillus probiotics
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| What is prostatitis | inflammation of tissues around prostate gland due to infection
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| what are the s/s of acute prostatitis | sudden onset of fever, tenderness, frequency, urgency dysuria, malaise
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| what are the s/s of chronic prostatitis | urinary difficulty, low back pain, perneal and suprapubic discomfort
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| What drugs are used to treat prostatitis | bactrim or FQ's
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| What is the recommended duration of treatment for acute prostatitis | 4wks
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| what is the recommended duration of treatment for chronic prostatitis | 6-12wks
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