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
