Wk 11 UTI

What does the urinary tract do?

Filters and excretes waste and extra fluid from bloodstream

What do kidneys do?

Filters blood to produce urine

What do ureters do?

Carry urine from kidneys to bladder

What does the bladder do?

Stores urine and empty through the urethra

What is UTI?

Microorganisms in the urinary tract than cannot be accounted for by contamination (don’t base just on culture). Classified as uncomplicated or complicated

What is uncomplicated UTI?

Infection confined to bladder in afebrile women or men

What is complicated UTI?

Infection beyond the bladder in women or men (pyelonephritis, febrile, bacteremic, catheter associated, prostatitis)

What is the epidemiology of UTI?

Occur in women more than men until age 65 then both similar

What is ascending UTI pathway? (most common)

Bacteria enter into urethra, travel up to bladder. Bacteria colonize in bladder, go into kidneys through ureter. Caused through sex, or bad bathroom hygiene.

What is descending UTI pathway?

Hematogenous (bloodstream spread). S. aureus, candida spp, salmonella spp, mycobacterium tuberculosis

Why does UTI occur in female more than male?

Urethra closer to rectum, urethra is shorter

What are host defense mechanisms for UTI?

Low pH, high urea concentration, osmolality extremes, urinary mucus coats bladder, vaginal flora lactobacillus (females only), prostate secretes zinc inhibits bacteria (males only)

What are risk factors for UTI?

Post menopause (lactobacillus needs estrogen), BPH, diabetes, pregnancy, neurological dysfunction, urinary obstruction, catheter, sex, spermicides

What bacteria is most responsible for UTI?

E.Coli

What is upper UTI (pyelonephritis)

Involves kidney infection

What is lower UTI (cystitis)?

Involves bladder infection

What are symptoms of pyelonephritis (kidney)?

Flank pain, costovertebral angle (CVA) tenderness, fever, N/V + cystitis symptoms

What are symptoms of cystitis (bladder)?

Dysuria, increased urinary frequency/ urgency, suprapubic pain

What are appropriate urine collection techniques?

Mid-stream clean catch, catheterization (change out catheter before sampling)

What are objective signs of urinary analysis?

Macroscopic dipstick (leukocytes, nitrite, elevated pH). Microscopic (bacteria count, WBC > 5-10 pyuria, squamous cell + represents skin contamination retake urine sample)

What is urosepsis?

Sepsis syndrome caused by UTI

What is nitrofurantoin (Macrobid)?

1st line for cystitis, avoid in pyelonephritis, prostates (no therapeutic blood concentration). multi salt BID formation in Macrobid. Macrodantin is QID. Beer’s criteria don’t use if Crcl < 30, avoid in 3rd trimester pregnancy. 5 days.

What is trimethoprim-sulfamethoxazole (Bactrim)?

1st line in cystitis, pyelonephritis, and prostates. Avoid if local E.coli resistance > 20% or if used in UTI past 3 months. Avoid in pregnancy. 3 days

What is fosfomycin (Monurol)?

1st line in cystitis. Avoid in pyelonephritis. Safe in pregnancy. 1 day

What are B-lactams?

2nd line in cystitis, Cephalosporins or augmentin

What are fluoroquinolones?

Last line in cystitis. Avoid if local E.coli resistance > 10%. BBW tendonitis, peripheral neuropathy, CNS effects. Avoid in pregnancy

What are risk factors for resistant uropathogens?

Avoid antibiotics which patient has had a resistant pathogen isolated from urine previously, if pt has been exposed to FQs in past 12 months avoid them

What are the antibiogram susceptibility thresholds in sepsis for complicated UTI?

≥ 90% in sepsis with shock, ≥ 80% in sepsis without shock

What is the therapy for complicated UTI with or without shock?

Cefotaxime, ceftriaxone (enterobacterales). Cefepime, ceftazidime, pip-tazo (enterobacterales + PSA). Meropenem, Imipenem (ESBL, PSA)

How is catheter associated complicated UTI treated?

Do not treat asymptotic patients. Remove/change catheter in symptomatic patients.

How is pregnancy complicated UTI treated?

Treat asymptomatic and symptomatic patients, Drugs of choice cephalexin, amoxicillin-clavulanate. Treat for 5-7 days

When should asymptomatic bacteriuria be treated?

Patient is pregnant, undergoing urological surgery, kidney transplant within 1 month

When should treatment with anti fungal agents occur?

Neutropenic patients, very low birth with infants, patients who will undergo urologic manipulation

What is recurrent UTI?

≥ 2 UTI within 6 months or ≥ 3 UTIs within one year. Reinfections are caused by different organisms, relapse caaused by same organism

What are ways to prevent recurrent UTI?

Change contraceptive method if using spermicides, postcoital voiding, do not delay voiding, wipe front to back, maintain hydration. Cranberry juice, lactobacillus probiotics. If all these fails use antimicrobial prophylaxis.

What are used in antibiotic prophylaxis?

Take 6-12 months daily or one dose postcoital (TMP-SMX, nitrofurantoin, cephalexin)

What is phenazopyridine?

Urinary tract analgesic. Adr orange urine

What is bacterial prostatitis?

Inflammation of prostate gland. Acute (fever, chills, N/V, body aches) treat 2-4 weeks. Chronic (painful ejaculation) treat 4-6 weeks.