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41 Cards in this Set
- Front
- Back
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lower UTI |
-superficial or mucosal -urethritis (urethra) -cystitis (bladder) |
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upper UTI |
-invasive -pyelonephritis (more severe infection in kidney) |
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uncomplicated UTI |
-not due to functional or structural abnormality -short course tx -no sequelae |
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complicated UTI |
-due to predisposing abnormality -longer course tx -leads to bacteremia and recurrences |
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asymptomatic UTI |
-significan bacteriuria ->10^8 CFU/L in 2 separate clean voided urine specimens, both yielding the same organism, in the absence of symptoms |
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acute UTI |
symptoms appear over days to weeks |
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chronic UTI |
UTI symptoms continue for months |
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recurrence of UTI |
UTI that reappears after sterilization of the urine
2 types: -reinfection -relapse |
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reinfection of UTI |
80% infection from a different species organisms reintroduced from fecal reservoir -treat like cystitis
defined as _> 3 UTI/yr |
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relapse of UTI |
20% persistence of the same organism that caused the original infection usually within 1-2 wks organism may be buried in deep tissue (eg kidneys) -treat like pyelonephritis |
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etiology of community-acquired UTI |
E coli (51%) K pneumo proteus mirabilis staph enterococcus faecalis |
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etiology of hospital-acquired UTI |
E coli pseudomonas aeruginosa proteus enterobacter serratia enterococcus MRSA/MSSA
E coli and hard gram negatives |
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routes of UTI infection |
ascending -most common in females (95%) -urethra colonized by bacteria from rectum and vagina ascend to bladder
hematogenous -rare (<3%) -bacteremia -organism disseminated from primary site |
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normal host defenses to prevent UTI |
1. mucopolysaccharide lining of bladder (uromucoid - prevents bacterial adherence) 2. Tamm-Horsfall mucoprotein - binds E coli fimbriae in Loop of Henle to prevent adherence 3. Bladder emptying and flushing - mechanical protection, flushing dilutes organisms 4. normal commensal peri-urethral flora - competitive for attachment sites & nutrients 5. acidic urinary and vaginal environments - inhibits bacterial growth 6. prostatic antibacterial factor - inhibits growth, decreases w age |
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predisposing factors for UTI |
1. obstruction -tumor, stricture, stone, prostatic hypertrophy 2. post-void residual -neurologic diseases, drugs, poor micturation habits 3. vesico-ureteral reflux -congenital maflormation or pregnancy 4. women -intercourse/diaphragms/spermicides increase colonization w E coli due to alterations in normal fora -rectum close to vagina, improper wiping 5. men -anal intercourse, BPH, congenital 6. other -pregnancy, menopause, immunosuppression, diabetes |
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signs and symptoms of cystitis |
frequency urgency dysuria nocturia fever (rare) |
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signs and symptoms of pyelonephritis |
CVA tenderness flank pain rigors fever chills |
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goals of therapy for UTI |
-eradicate invading organism -prevent or treat systemic consequences -prevent recurrence of infection |
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first line therapy for lower UTI in young females |
NItrofurantoin 50-100mg po qid x 5d
excellent for E coli and S saprophyticus
can also use fosfomycin 3g x 1 dose |
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2nd line therapy for lower UTI in young females |
cefixime 400mg po daily x 5-7d
SMX/TMP 1 DS bid x 3d
TMP 100mg po bid x 3 d
Cipro 500mg XL po daily or 250mg bid x 3d
significant E coli resist. to SMX, TMP, Cipro |
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risk factors for recurrent UTI in young women |
-increased frequency of sexual intercourse -spermicide use during the past year -new sex partner during past year -first UTI at or before 15yrs -mother w history of UTIs |
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risk factors for recurrent UTI in post-menopausal women |
-urinary incontinence -history of UTI before menopause -postvoiding residual urine |
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treatment for reinfection of UTIs related to sexual activity |
use antibiotics pre- or post-coitus
SMX/TMP 1 SS Nitrofurantoin 50-100mg Cefixime 400mg |
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treatment of reinfection of UTI unrelated to sexual activity |
-patient-initiated upon TI symptoms (same as cystitis treatment)
daily prophylaxis (usually hs) for 6mth -SMX/TMP 1 SS daily or 3x/wk -TMP 100mg hs |
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non-pharm to prevent UTIs |
-adequate fluid intake (6-8 glasses/d) -cranberry juice or concentrate tablets -vitamin C (acidification of urine) -urinate frequently -post-coital urination -avoid coffee, tea, carbonated drinks, alcohol -appropriate hygiene & cleanliness of genital -avoid douching -wear cloth undergarments |
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when to treat asymptomatic bacteriuria |
treat only: -pregnant women -prior to surgery requiring removal of prosthetic material -prior to gyneo/urological related surgery |
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drug treatment for asymptomatic bacteriuria |
cefixime 400mg po cipro 500mg po SMX/TMP 1 DS po norfloxacin 400mg po ampicillin 1g IV +/- gent 1.5mg/kg IV x single dose
given 1-2 h pre-op |
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lower UTI: pregnancy |
-screening for bacteriuria at 12-16 wks gestation -treat even if asymptomatic (low birth wt, pyelonephritis, preterm labour)
-5-7d therapy and be recultured one week after completion of treatment |
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UTI drugs safe in pregnancy |
amox/clav 875mg po bid cefixime 400mg po daily nitrofurantoin 50-100mg qid -avoid 36-42wks after 3rd timester fosfomycin 3g x 1 dose SMX/TMP 1 DS po bid -avoid in 1st and 3rd trimester |
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lower UTI: elderly females |
-cystitis causes less morbidity/mortality in this age-group -there is a high rate of relapse and reifnection due to non-modifiable risk factors -DO NOT treat asymptomatic
use 7 day regimen |
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pyelonephritis: uncomplicated mild infection |
use 10-14 d
cefixime 400mg po daily x 10-14d amox/clav 875mg po bid x 10-14d cipro 500mg po bid or 1g XL po daily x 7d SMX/TMP 1 DS po bid x 14d |
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pyelonephritis: uncomplicated ER/Hospitalized/Septic/Pregnant |
entamicin 5-7mg/kg IV q24h +/1 ampicillin 1-2g IV qid ceftriaxone 1-2g IV q24h
initial ABx therapy is parenteral since patients are at risk for sepsis -stepdown to oral when afebrile for 48 hours, and able to take po therapy
total antibiotic course 10-14d |
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pyelonephritis: complicated - afebrile, systemiclayy well |
total course 7-14d
cefixime 400mg po daily amox/clav 875mg po bid cipro 500mg po bid or 1g XL po daily SMX/TMP 1 DS po bid |
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pyelonephritis: complicated - febrile, systemically unwell |
total course: 7-14 d
gentamicin 5-7mg/kg IV q24h + ampicillin 1-2g IV q6h ceftriaxone 1-2 g IV q24h |
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pyelonephritis: complicated - hemodynamically unstable/septic |
total course 7-14 d
pip/tazo 3.375 po q6h +/- gentamicin 5-7mg/kg IV q24h
*add gentamicin if septic shock, recent abx use, ESBL, AmpC, carbapenemase GNB |
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catheter-associated UTI asymptomatic |
benefit of empiric treatment not proven -if pt has clean, intermittent self-catheterization, consider treating 10-14d -indwelling catheter - change catheter, reculture in 7 d, treat if symptomatic |
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catheter-associated UTI symptomatic |
change catheter and treat as pyelonephritis |
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lower UTI: men |
should be cultured treat as complicated UTI
investigate for: -structural abnormality (<50yo) -prostate involvement (>50yo) |
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acute bacterial prostatitis |
-sudden onset of chills, fever, low back pain, urinary urgency, frequency, nocturia, dysuria, malaise -rectal exam: tender, swollen prostate, firm and warm to touch -enterobacteriaceae, enterococcus, pseudomonas aeruginosa |
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drug treatment for acute bacterial prostatitis |
duration 2-4wk
cipro 500-750mg po ofloxacin 400mg po bid SMX/TMP 1 DS bid
treat for 4wk if pt symptomatic at 2 wk still -need IV use amp + gent or pip/tazo |
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chronic bacterial prostatitis |
-symptoms > 3mth -same pathogens and treatment as acute but for 4-6wk |
