Term
| What is the epidemiology of UTIs? |
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Definition
Only more common in males when newborn, then more common in females.
Elderly - male prevalence incr with age. Equal > 65 |
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Term
| What is the difference between complicated and uncomplicated UTIs? |
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Definition
- uncomplicated - young, healthy, no structural complication
- Complicated - predisposed lesion, catheter. Males considered complicated. |
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Term
| What are the types of recurrent UTIs? |
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Definition
- Reinfection - different organims
- relapse - same organism |
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Term
| What anatomic sites can a UTI take place? |
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Definition
- Lower UTI: Cystitis (bladder), Urethritis, Prostatitis
- Upper UTI: pyelonephritis |
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Term
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Definition
- Uncomplicated: E.coli (85%), S. saprophyticus (15%), some enterococcus
- Complicated: E.coli (50%), some enterococci
**Enterococci seen in both! |
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Term
| What are the routes of UTI infection? |
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Definition
- Ascending - usually colonization from rectum. Organism travels into bladder up ureter. Reflux between bladder and kidney
- Hematogenous - rare
- Lymphatic - rare |
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Term
| What are host defense factors for UTI? |
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Definition
- Urine - pH, osmolality, urea, acids
- Urine flow
- inhibitors of adherence - Tamm-Horsfall protein, polysaccharide, Ig
- prostatic secretions |
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Term
| What are the clinical characteristics of an uncomplicated UTI? |
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Definition
- Sexually active women
- community acquired, localized
- Self-limiting |
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Term
| What are the clinical characteristics of a complicated UTI? |
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Definition
- Men and elderly women
- Nosocomial
- Structural abnormalities
- Still localized
- Bacteremia |
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Term
| What are the clinical characteristics of an uncomplicated pyelonephritis? |
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Definition
- All ages, greater in women
- Community acquired
- Healthy
- SYSTEMIC sx
- Bacteremia
**See fever, nausea, flank pain |
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Term
| What are clinical findings in ELDERLY patients with a UTI? |
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Definition
- Altered mental status
- Eating habits change
- GI sx |
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Term
| What is the key to diagnosis of a UTI? |
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Definition
- Appropriate urine collection
- Macro and microscopic evaluation
- Culture**Most specific! |
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Term
| What are the accepted methods for urine collection? |
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Definition
- Midstream clean catch
- Catheterization
- bladder aspiration |
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Term
| What biochemical tests look for UTI? |
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Definition
- Urinalysis - specific gravity
- Nitrite dipstick - gram(-) reduce nitrite. Rare false positives
- Leukocyte esterase (LE) dipstick - neutrophil granules. Indicates pyuria - used w/ nitrite |
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Term
| What is adjunctive therapy for UTI? |
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Definition
- Fluid hydration - not too fast
- Urinary acidification - minimal evidence
- Analgesic - phenazopyridine 200mg TID. LIMIT duration! |
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Term
| What does cranberry juice do? |
|
Definition
| Inhibit bacterial adhesion - so many different products, we can't recommend it. But it's safe. |
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Term
| How does bactrim work for UTIs? |
|
Definition
- Good urinary conc.
- Renally adjusted
- Increased Resistance rates** |
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Term
| How are FQNs used for UTIs? |
|
Definition
- High urinary conc, EXCEPT AVELOX/MOXI
- Renally adjusted
- Avoid in children/pregnancy
- Resistance uncommon |
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Term
| How does PCN work for UTIs? |
|
Definition
- Poor PK
- GOOD for renal dosing
- AVOID augmentin
- HIGH levels of resistance
**TX of choice: Ampicillin in susc & no allergy |
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Term
| How does a cephalosporins work for UTIs? |
|
Definition
- High urine conc.
- Renally dosed
- 2nd and 3rd gen good for urosepsis, complicated kidney infection, and nosocomial UTI
- NO enterococcal activity |
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Term
| How is nitrofurantoin used for UTIs? |
|
Definition
- Does not eradicate E. coli
- DO NOT USE if CrCl < 40
- 7 day course only
- Minimal resistance
- Activity against VRE! |
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Term
| What is the only FDA approved one day Tx for uncomplicated cystitis? |
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Definition
Fosfomycin tromethamine
Lacks data!
Minimal AE
Not as effective as bactrim and FQN - expensive |
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Term
| What is short course therapy for UTI? |
|
Definition
3 days - improved compliance, reduced cost/resistance, AE
**DO use short dose, but DO NOT use one dose |
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Term
| What are the preferred empiric Tx for UTIs? |
|
Definition
- Uncomplicated cystitis - Bactrim or FQN short term
- Pregnancy - Augmentin, Ceph, Bactrim (not 3rd trim) x7 days
- Pyelonephritis - FQN or Bactrim x14 days. Augmentin if gram(+)
- Prostatitis - 4-6 weeks |
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Term
| What are some recommended tx for acute uncomplicated cystitis? |
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Definition
- Nitrofurantoin monohydrate/macrocrystals 100 mg BID x5
- Bactrim BID x3
- Fosfomycin x1 dose
- FQN x3 days (Not avelox)
**Tx failure in abacteriuria = chlamydia. Azith 1g or Doxy! |
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Term
| When is asymptomatic bacteriuria treated? |
|
Definition
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Term
| What are Txs of choice in acute pyelonephritis? |
|
Definition
- Bactrim and FQNs
- Severely ill will require broad spectrum
- MINIMUM 2 weeks |
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Term
| What are Txs of choice in UTIs in males? |
|
Definition
- Bactrim or FQNs
- AVOID nitrofurantoin
- DO NOT use short dose - use 10-14 days |
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Term
| How are recurrent UTIs treated? |
|
Definition
- Reinfection - 80%
- Relapse - 20% - prolonged tx. Most common cause of persistent bacteriuria in men |
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Term
| How are UTIs treated in pregnancy? |
|
Definition
- Sulfonamides - NOT in 3rd trimester
- Amox or Augmentin
- Cephalexin
- Nitrofurantoin (NOT first choice)
**DO NOT USE FQN
**Duration x7 |
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Term
| How is a catheter UTI treated? |
|
Definition
- Duration is biggest risk factor
- Only in sympomatic: x7-14 days. 5 days if community acquired.
- Do NOT treat funguria - colonization. Can remove catheter and treat. |
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Term
| How is prostatitis treated? |
|
Definition
- E.coli 50-80%
- Acute: FQ or Ceph and augmentin combos. Can + AGs. 2-4 weeks
- Chronic: FQN preferred 4-6 weeks. Suppression w/ Bactrim. |
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