Urinary Tract Infections
how soon do you feel better with antib Tx for UTI
24-48 h
Hematuria with low UTI?
40-60% of patients
A bacterial count of ≥10 in 5 cfu/mL for asymptomatic or catheterised persone
A bacterial count of ≥10 in 5 cfu/mL is a cut-off for infection 100, 000
what are nitrates
A positive nitrite test indicates that the cause of the UTI is a gram negative organism, most commonly Escherichia coli. The reason for nitrites' existence in the presence of a UTI is due to a bacterial conversion of endogenous nitrates to nitrites.
Amoxacillin-clavulanic acid brand name
Augmentin
Low UTI includes:
Cystitis, urethritis ( dysuria frequency syndrom)
The most common causative organism of UTI in fem and males.
Fem - E. coli Males- Proteus species:P. vulgaris, P. mirabilis, and P. penneri Procoli
what pregnant fem. can use for UTI
Fosfomycin. The antibiotic fosfomycin (Monurol) may be prescribed as a 1-dose treatment for women who are pregnant. Not quinolons
Tx of UTI in men /days
In men, the infection may involve the prostate gland and treatment is usually given for at least seven days.
dysuria present only with UTI?
Painful urination can be caused by other problems, such as a vaginal yeast infection or sexually transmitted infection.
Upper UTI include:
Pyelonephritis, Renal abscess
negative nitrates and positive WBC in urine , what infection?
Staph or some enterococci Best done on well-concentrated urine such as first AM void. For nitrites to be present, urine should be held in bladder for ≥ 1 hour for nitrate-to-nitrite conversion to take place; dietary nitrate intake must be adequate. False negative possible with low colony-count infections
Bactrim resistance and DD interaction
Trimethoprim (such as Proloprim or Trimpex) is sometimes used alone in those allergic to sulfa drugs. TMP-SMX can interfere with the effectiveness of oral contraceptives. High rates of bacterial resistance to TMP-SMX exist in many parts of the United State
Nocturia with low UTI ?
Yes
D-s of cathet induced UtI
catheter has been removed within the previous 48 hours and by the presence of symptoms or signs compatible with UTI with no other identified source of infection along with 1000 or more colony-forming units (CFU)/mL of 1 or more bacterial species
Main symptom with low UTI
dysuria- painful urination Cystitis/Lower UTI Symptoms: The most common symptoms associated with lower UTI include dysuria or acute pain, frequent urination, urgency, and incontinence. Occasionally, hematuria, cloudy urine, or foul-smelling urine may be present -
Treatment of uncomplicated UTI in females
. Guidelines recommend three options for first-line treatment of acute uncomplicated cystitis: fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole (in regions where the prevalence of Escherichia coli resistance does not exceed 20 percent). Beta-lactam antibiotics, amoxicillin/clavulanate, cefaclor, cefdinir, and cefpodoxime are not recommended for initial treatment because of concerns about resistance. Fluoroquinolones (also simply called quinolones) are now becoming as widely used as TMP-SMX. They are the standard alternatives to TMP-SMX
Tx of low UTI
1. 3d mostly: Bactrim,Cipro, or amoxi/clava ( Augmentin) 2.Amoxi, or Levo, or nitrofura ( Macrobid), or trimehoprim (Primasol) or Fosfomycin ( Monurol) 3g/ for 1d 3. Pregnant: Amoxi, Nitrofura, cephalex ( C/Alex) Keflex for 7-10d Tx of complicated cystitis ( male, stones, urologic abnormality, pregnancy). The same only for 7-14d., no quinolons in pregnant
Tx of upper UTI ( pyelo)
14 d vs 6 week course of : Bactrim, quinolons, Augmentin, Genta or Tobra. Outpatient oral antibiotic therapy with a fluoroquinolone is successful in most patients with mild uncomplicated pyelonephritis Indications for inpatient treatment include complicated infections, sepsis, persistent vomiting, failed outpatient treatment, or extremes of age . In hospitalized patients, intravenous treatment is recommended with a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin. The standard duration of therapy is seven to 14 days. Urine culture should be repeated one to two weeks after completion of antibiotic therapy. Treatment failure may be caused by resistant organisms, underlying anatomic/functional abnormalities, or immunosuppressed states. Lack of response should prompt repeat blood and urine cultures and, possibly, imaging studies. A change in antibiotics or surgical intervention may be required.
nitrate test
A positive nitrite test indicates that the cause of the UTI is a gram negative organism, most commonly Escherichia coli. The reason for nitrites' existence in the presence of a UTI is due to a bacterial conversion of endogenous nitrates to nitrites. False negative nitrite tests in urinary tract infections occur in cases with a low colony forming unit count, or in recently voided or dilute urine. In addition, a nitrite test does not detect organisms unable to reduce nitrate to nitrite, such as enterococci, staphylococci (Staphylococcus saprophyticus), Acinetobacter or adenovirus
Aminoglycozides for UtI
Aminoglycosides (gentamicin, tobramycin, amikacin) are given by injection for very serious bacterial infections. They can be given only in combination with other antibiotics. Gentamicin is the most commonly used aminoglycoside for severe UTIs. They can have very serious side effects, including damage to hearing, sense of balance, and kidneys.
Qualitative characteristics of Bacteria in Urine for the diagnosis of UTI
Any amount of bacteria in the urine may suggest UTI in a symptomatic patient, but the threshold for the classic definition of bacteriuria is 5+, which is roughly equivalent to 100,000 colony-forming units (CFUs)/mL - pyuria (>5-10 WBC/hpf) AND positive urine culture ≥100,000 colonies
Cathet UTI and cath is still needed...., how to obtain specimen
If catheterization can be discontinued, the culture can be obtained in a voided midstream urine specimen. If an indwelling catheter has been in place for longer than 2 weeks at the onset of the UTI and is still indicated, it should be replaced, and the urine culture should be obtained from the freshly placed catheter.
s/s of upper UtI
In addition to the urinary symptoms seen in cystitis, patients may also present with fever and chills ( indicative of upper) suprapubic pain, costovertebral angle tenderness (flank pain), , elevated WBC count, nausea, and vomiting, mental status changes in elderly. ESR is increased in addition to other labs. C&S can be pos/neg. Urine cultures are positive in 90 percent of patients with acute pyelonephritis, The use of blood cultures should be reserved for patients with an uncertain diagnosis, those who are immunocompromised, and those who are suspected of having hematogenous infections.
nitrofurantoin contraindications
Nitrofurantoin should be avoided if there is suspicion for early pyelonephritis, and is contraindicated when creatinine clearance is <60 mL/minute.
nitrofurantoin for UTI
Nitrofurantoin. Nitrofurantoin (Furadantin, Macrodantin) is an antibiotic that is used specifically for urinary tract infections as an alternative to TMP-SMX or a quinolone. Unlike many of the other drugs, however, it is usually taken for 7 - 10 days, even in cases of simple cystitis. It is not useful for treating kidney infections. Nitrofurantoin frequently causes stomach upset and interacts with many drugs. Other chronic or serious medical conditions may also affect its use. It should not be used in pregnant women within 1 - 2 weeks of delivery, in nursing mothers, or in those with kidney disease.●Nitrofurantoin monohydrate/macrocrystals (100 mg orally twice daily for 5 days);
quinolons SE
QT prolongation, can not be given with Sotalol ( antiarrh. BB, which also prolongs QT) Quinolones are contraindicated if a patient has epilepsy, QT prolongation, pre-existing CNS lesions, or CNS inflammation, or the patient has suffered a stroke. .Quinolones are associated with an increase risk of tendinitis and tendon rupture in all age groups.
tetracyclines for UTI
TETRACYCLINES Tetracyclines include doxycycline, tetracycline, and minocycline. Treatment with tetracycline or doxycycline may be used for infections that are caused by Mycoplasma or Chlamydia . Tetracyclines have unique side effects among antibiotics, including skin reactions to sunlight, possible burning in the throat, and tooth discoloration. They cannot be taken by children or pregnant women
beta-lactams for UTI
The beta-lactam antibiotics share common chemical features and include penicillins, cephalosporins, and some newer similar drugs. Penicillins (Amoxicillin). Until recent years, the standard treatment for a UTI was 10 days of amoxicillin, a penicillin antibiotic, but it is now ineffective against E. coli bacteria in up to 25% of cases. A combination of amoxicillin-clavulanate (Augmentin) is sometimes given for drug-resistant infections. Amoxicillin or Augmentin may be useful for UTIs caused by Gram-positive organisms, including Enterococcus species and S. saprophyticus . Cephalosporins. Antibiotics known as cephalosporins are also alternatives for infections that do not respond to standard treatments or for special populations. They are often classed as first, second, or third generation. Cephalosporins used for treatment of UTIs include cephalexin (Keflex), cefadroxil (Duricef) cefuroxime (Ceftin),loracarbef (Lorabid), and cefixime (Suprax, among others. Other Beta-Lactam Drugs. Other beta-lactam antibiotics have been developed. For example, pivmecillinam (a form of mecillinam), is commonly used in Europe for UTIs.
diagnosis of UTI
The combination of new-onset frequency and dysuria, with the absence of vaginal discharge, is diagnostic for a urinary tract infection. 1.pyuria ( > 10 WBC) 2.Nitrates pos ( only with Gram neg) 3. Esterase posit ( can be pos with vaginitis) A urinalysis, but not urine culture, is recommended in making the diagnosis in female with s/s postive for uncomplicated Low UT infection. Urine cultures are recommended in women with suspected pyelonephritis, women with symptoms that do not resolve or that recur within two to four weeks after completing treatment, and women who present with atypical symptoms, is pregnant. For asymptomatic patient bact count >=10 to 5 ( 10 ooooo) is a cut off For catheterised patient bact count >=10 ooooo is cut off . Between 10% and 30% of patients who undergo short-term catheterization (ie, 2-4 days) develop bacteriuria and are asymptomatic . Between 90% and 100% of patients who undergo long-term catheterization develop bacteriuria Significant pyuria is generally represented by more than 50 white blood cells (WBCs) per high-power field (HPF). Colony counts on a urine culture range from 100-10,000/mL.
does neg leucocyte esterase exclude UTI?
the absence of leukocyte esterase and nitrite cannot be used to exclude UTI. Positive test results on L. esterase are clinically significant, negative results are not clinicall significant. The sensitivity of leukocyte esterase test for pyuria increased as the number of white blood cells on clinical microscopy increased.
When urine cultures are recommended for female and males
Urine cultures are recommended in women with suspected pyelonephritis, women with symptoms that do not resolve or that recur within two to four weeks after completing treatment, and women who present with atypical symptoms. In people suspected to have a simple bladder infection, urine culture is often recommended if they: Have never had a bladder infection before Have symptoms that are not typical for bladder infection Have had "resistant" bladder infections before (meaning the infections did not get better with standard antibiotics) Have frequent bladder infections Do not begin to feel better within 24 to 48 hours after starting antibiotics Are pregnant
sensetivity and specificity of esterase in urine ( low/high)
high senset Low specificity
in which populations it is considered a complicated UTI
men elderly pregnant
quinolons contraindications
pregnancy and <18 yo, stroke, seizures, QT
