ID exam 2 UTIs

pathophysiology

ascending or descending route

women higher risk from short bladder

infection factors

inoculum size, virulence, and natural host defense (low pH in bladder)

etiology

E coli, staph, klebsiella, etc

asymptomatic UTI

one or more species of bacteria (> 100,000) with no signs or symptoms

asymptomatic screening

only pregnant (initial, 28 wks), mucosal trauma, kidney transplant

asymptomatic UTI treatment pregnancy

cephalexin, augmentin, nitrofurantoin (not in last month), bactrim (2nd trimester)

asymptomatic UTI - no screening

organ transplant, diabetes, elderly, spinal cord injury, cathereization

uncomplicated UTI

confined to the bladder

uncomplicated symptoms

dysuria, urgency, frequency, nocturia, suprapubic heaviness, gross hematuria (blood)

elderly - mental change, eating change, GI upset

uncomplicated diagnosis

urinalysis or urine culture (if Hx of drug resistance or relapse/recurrence)

urinalysis

pyuria (WBC > 10), leukocyte esterase, positive nitrates, RBC, squamous cells

quantitative culture

> 100,000 bacteria

uncomplicated treatment

nitrofurantoin x 5

bactrim x 3

fosfomycin x 1

pivmecillinam x 3-7

cephalexin x 7

cefpodoxime x 7

nitrofurantoin do not use

CrCl < 30

bactrim do not use

if used in past 3 months

complicated UTI types

pyelonephritis, catheter, candida, prostasis

pyelonephritis (kidney)

flank/back pain, CVA tenderness, fever, nausea, vomiting, malaise

catheter UTI (CAUTI)

fever, flank pain, leukocytosis, no urinary symptoms

CAUTI treatment

ceftriaxone, cephalexin (PO), meropenem, ertapenem, fluoroquinolones

susceptibility (sepsis)

with shock - 90%

without shock - 80%

CAUTI treatment considerations

need good absorption, and high urinary excretion

CAUTI IV to PO

IV 2 days, then PO 5 days, total 7 days

candida treatment

fluconazole

prostasis (prostate inflammation)

sudden onset fever, tenderness, chills, malaise, pain (chronic)

prostasis diagnosis

presentation, bacteria, midstream (acute) or recurrent (chronic)

prostasis pathogenesis

ascending, reflux of infected urine into prostate, catheters, or sex

prostasis treatment

bactrim, cipro/levofloxacin, cephalosporins, augmentin

prostasis treatment considerations

must concentrate in prostate

4 weeks acute, 12 weeks chronic

relapse UTI

occurs within 2 weeks of first UTI

recurrent UTI

2+ UTI in 6 months, or 3+ UTI in 12 months

WITH one confirmed culture

recurrent UTI pathogenesis

reinoculation from bowel flora, disruption of intracellular bacteria

recurrent UTI risk

premenopausal (sex, spermicide contraceptive)

postmenopausal (atrophy, low estrogen, urinary incontinence)

recurrent UTI diagnosis

urine culture

recurrent UTI prevention

hydration, methenamine, cranberry, vaginal estrogen, post coital antibiotics (sex)