Urinary Tract Infections (Final)

catheter-related UTIs

*complicated* - possibly colonized, remove catheter & re-check urine - agent selection based on risk factors for resistant gram (-) pahogens & clinical picture *- tx duration 10-14 days*

protective properties of urine

- acidic pH - high osmolality - high concentration of urea

typical presentation of uncomplicated pyelonephritis

- all ages, commonly women - healthy - systemic symptoms - bacteremia

antimicrobial stewardship

- empiric amoxicillin & Augmentin should be avoided due to high resistance - nitrofurantoin preferred due to minimal resistance & decreased "collateral damage" - FQs (levo & cipro) are effective, but should be reserved for pyelonephritis due to high risk for "collateral damage" - moxifloxacin is ineffective for UTIs

urine culture

- greater than 100,000 organisms - *not required* - performed for patients ending up in the hospital b/c they are ill or those who do not improve upon initial treatment

typical presentation of complicated uti

- middle-age men, elderly women - functional, metabolic, or structural abnormality - localized symptoms - bacteremia?

agent selection drug factors

- pk/pd - dosing interval - tissue penetration - toxicity - cost

agent selection host factors

- primary pathogens - allergies - age - pmh - pregnant - drug/drug interactions

typical presentation of uncomplicated uti

- sexually active young woman - healthy - localized symptoms - self-limited

other causative organisms

- staph saprophyticus - gram (-) rods: klebsiella, proteus mirabilis, pseudomonas

adjunctive therapy phenazopyridine HCl

- used as urinary antiseptic, analgesic - taken with food for 2 days *-does not kill bacteria* - discolors urine red/orange - not in patients w/crcl < 50 - risk of methemoglobinemia & hemolytic anemia

done!

:)

complicated pyelonephritis clinically

UTI with evidence of kidney involvement & w/clinical decompensation - at least (2/4) SIRS criteria - septic shock (hypotensive) - bacteremic

leukocyte esterase is a surrogate marker for __________ in the urine, signifying pyuria

WBCs, typically signifies presence of UTI

sanford vs. guidelines uncomplicated cystitis & pyelonephritis

align well

complicated uti

anyone who is not a young, healthy, non-pregnant women (so, yes! men are complicated)

___________ infection is most common for uncomplicated infections

ascending

prostatitis chronic infection

back pain, less acute, hard to cure

ascending infection

bacteria enter from the urethra & move into the bladder/kidney

hematogenous infection

bacteria enter the kidney or bladder from the bloodstream (i.e. s. aureus)

urinalysis

cloudy, blood positive?, nitrite positive?, leukocyte esterase positive

sanford vs. guidelines complicated cystitis & pyelonephritis

differ!!

pyelonephritis treatment

drug of choice - ceftriaxone 1-2g IV q24h x 10-14 days alternatives - cipro or levo (cover pseudomonas), aminoglycosides, broad spectrum beta-lactams (consider if risk factors for pseudomonas or hypotensive)

s&s of cystitis

dysuria (painful urination) frequency, urgency hematuria suprapubic fullness

inpatient treatment complicated cystitis treatment *memorize, b/c sanford guide isn't aligned w/guidelines*

elderly women or men drugs of choice - bactrim ds: 1 tab po BID for at least 7 days - ciprofloxacin 250 mg po BID for at least 7 days - levofloxacin 250 mg po QD for at least 7 days alternative - ceftriaxone 1g IV Q24 hours

most common causative organism

eschericia coli "e. coli", a gram (-) organism

outpatient treatment uncomplicated pyelonephritis treatment

evidence of kidney involvement without clinical decompensation drugs of choice: cipro 500 mg po BID x 7 days, levo 750 mg po QD x 5 day -- avoid if community resistance > 10% alternatives: ceftriaxone 1g iv q24 x 10-14 days, bactrim ds po bid x 4 days

PO beta lactams are acceptable for bacteremia. t/f

false, oral FQs can be used though

prostatitis acute symptoms

fever, tenderness, constitutional & urinary symptoms

s&s of pyelonephritis

flank pain fever/chills costovertebral tenderness n/v malaise increased wbc

bladder infection

lower uti, cystitis

patient counseling fosfomycin used for uncomplicated cystitis

mix with cool water & drink entire dose

sanford vs. guidelines moxifloxacin

moxifloxain is a tx option, typically not used to tx UTI due to poor urinary penetration

inflammation of the prostate due to infection

prostatitis

patients should be advised to drink 6-8 glasses of water daily. t/f

true

urine is sterile. t/f

true

UTIs are the most commonly occurring bacterial infections. t/f

true most common in females, less common in males until they reach age >65

aminoglycosides can be used as monotherapy in UTI. t/f

true!!!

kidney infection

upper uti, pyelonephritis

presence of microorganisms in the urinary tract not attributed to contamination

urinary tract infection

urine microscopy

wbc >5-10 if crystals present, proteus spp. involved

uncomplicated uti

young, healthy, non-pregnant women

outpatient treatment uncomplicated cystitis treatment

young, healthy, non-pregnant women drugs of choice: nitrofurantoin 100 mg x 5 days , bactrim ds 1 tab po BID x 3 days, avoid if resistance is >20% in local areas alternative: fosfomycin 3g po x 1 dose