UTI Kang

Define UTI

presence of microbes in urinary tract that cannot be accounted for by contamination

What is uncomplicated UTI

infection in bladder (cystitis) in absence of fever

What is complicated UTI

pyelonephritis, fever, prostatitis, catheter associated infection, bacteremic

What are the pathophysiologies of UTI

ascending: bacteria enter urethra and go into bladder descending: bacteria in blood enter bladder

Risk factors for UTI characteristics of patient

age: female post menopausal men BPH, female, pregnancy, catheterization, use of spermicides

Risk factors for UTI conditions

DM, neurological dysfunction, urinary obstruction

What bacteria primarily causes UTI

e. Coli, NOT staph aureus

Symptoms of pyelonephritis

common: suprapubic pain, urinary frequency/urgency, dysuria (painful urination) condition specific: CVA tenderness, flank pain, fever

Symptoms of cystitis

suprapubic pain, dysuria, urinary frequency/urgency

What is the gold standard for collecting urine culture

mid stream catch

What are the types of urine sampling for cultures

mid stream catch and catheterization

What tests are diagnostic of UTI

microscopic tests WBC > 5 pyuria in absence of squamous epithelial cells

How can you classify a patient with urosepsis

2 or more temp > 38 or <36
HR > 90
RR > 20
WBC >12k or bands >10%

First line options for cystitis

nitrofurantoin, bactrim, fosfomycin

Nitrofurantoin dosing

macrobid 100 mg PO BID for 5 days

Macrobid vs macrodantin

macrobid has both monohydrate and macrocrystal, macrodantin only has macrocrystal

Dosing frequency for macrodantin

QID

Nitrofurantoin is indicated for

cystitis ONLY

Who is eligible for macrobid

CrCl >30

Bactrim dosing cystitis

160-800 mg PO BID for 3 days

Indication of bactrim

cystitis, pyelonephritis and prostatitis

When should you not use bactrim

e coli resistance >20% previous UTI treatment with bactrim in 3 mo

ADR for bactrim

hyperK, rash, bone marrow suppression at high doses 15mg/kg

Fosfomycin dose

dissolve 3 grams in 120 ml of water for ONE dose

Fosfomycin vs bactrim

fosfomycin is less effective

Fosfomycin indication

cystitis and prostatitis

Adr for fosfomycin

diarrhea, nausea, dyspepsia

Beta lactam place in therapy for UTI

second line for uncomplicated

Duration of therapy with beta lactams

5-7 days

Fluoroquinolones place in therapy for UTI

last line for uncomplicated

When should you avoid using FQ

e coli resistance > 10%, previous use of FQ in last 12 mo

FQ dosing

cipro 250 mg BID for 3 days female 5 days male

levofloxacin 250 mg QD for 3 days female 5 days male

Treatment for sepsis in complicated UTI with or without shock

3 or 4th gen cephalosporin, carbapenem, pip/tazo, FQ > aminoglycosides

Treatment for non sepsis in complicated UTI

3 or 4th gen cephalosporin IV/PO, pip/tazo, FQ IV/PO > aminoglycosides, carbapenem

What are risk factors for resistant uropathogens

use of FQ within last 12 mo, avoid FQ

Catheter associated UTI treatment

only treat symptomatic, remove/replace catheter and treat for 7 days (can increase to 10-14)

Duration of therapy for pregnancy

5-7 days

DOC for pregnancy UTI

cephalexin or augmentin

When to treat asymptomatic bacteriuria

pregnant, received kidney transplant within 1 mo, receiving urological surgery

When to treat candiduria

antifungals if neutropenic, low birth weight, undergoing urological surgery

What is recurrent UTI

≥2 UTI within 6 mo or ≥3 within 1 year

What is a recurrent relapse UTI

UTI caused by the same pathogen

What is a recurrent re-infection

UTI caused by a different pathogen

When is antibiotic prophylaxis recommended

for recurrent UTI after trying OTC options

Treatment options for antibiotic prophylaxis

bactrim 40/200 mg qd for 6-12 mo OR 40/200 or 80/400 mg ONCE

nitrofurantoin 50 or 100 mg qd for 6-12 mo OR ONCE

cephalexin 125-250 mg once daily for 6-12 mo or 250 mg ONCE

Treatment for pain

phenazopyridine 200 mg PO TID for 2 days

Treatment of prostatitis

cipro 400 mg IV or 500 mg BID levo 500-750 mg IB or PO daily bactrim DS PO BID

Duration of treatment for acute prostatitis

2-4 weeks

Duration of treatment for chronic prostatitis

4-6 weeks

Pregnancy avoid

T3 macrobid (hemolytic anemia) T1 and T3 Bactrim, FQ