[08.06] Urinary Tract Infection V2.pdf

Urinary tract infection

What is the spectrum of disease conditions or clinical syndromes that can be either asymptomatic or symptomatic?

Significant morbidity

In the pre-antibiotic era, what was the clinical impact of urinary tract infections?

One year

In the pre-antibiotic era, how long could acute cystitis with dysuria last before resolving or worsening?

Nitrofurantoin

Which drug, discovered in the 1950s, was the first tolerable and effective agent to treat UTI?

Asymptomatic subclinical infection and symptomatic disease

What are the two general categories of UTI syndromes?

Asymptomatic Bacteriuria

What is the term for the presence of bacteria in the urinary tract without local or systemic symptoms?

Does not usually require treatment

What is the standard management for Asymptomatic Bacteriuria in most patients?

Pregnant women

In which specific patient population is screening and treatment for ASB always indicated?

Preterm birth and perinatal death

What are two perinatal complications associated with untreated ASB during pregnancy?

Pyelonephritis in the mother

Besides neonatal risks, what is a maternal risk of untreated ASB in pregnancy?

Antimicrobials

Symptomatic disease, such as pyelonephritis or complicated UTI, does not resolve until treated with what?

Ascension of bacteria

What is the primary mechanism by which bacteria typically enter the urinary tract?

Urethra to the bladder

UTI typically begins with the ascension of bacteria from which anatomical site to another?

Ureters

Through which structures do bacteria ascend to reach the kidneys from the bladder?

Migration of bacteria from the perianal area to the vaginal introitus

In women, what is the initial event that usually prompts a UTI?

Organism, host, and environment

The occurrence of infection, colonization, or elimination depends on the interplay of which three factors?

Type of organism, presence of virulence factors, and expression of virulence factors

What are three organism factors listed in the pathogenesis triangle?

Aggressiveness of the organism

Which organism factor determines the severity of the bacterial attack?

Immune defense mechanisms, genetic background, and behavioral factors

What are three host factors listed in the pathogenesis triangle?

Underlying disease and tissue-specific receptors

What are two additional host factors that influence UTI occurrence?

Vaginal ecology in women, anatomy, and urinary retention

What are three environmental factors listed in the pathogenesis triangle?

Medical devices and instrumentation

Which environmental factor is a common modern source of infection?

Hematogenous spread

Which route of UTI infection accounts for less than 2 percent of cases?

Bacteremia

Hematogenous spread usually results from what condition in the bloodstream?

Salmonella and S. aureus

Which two organisms are commonly associated with hematogenous spread to the urinary tract?

Search for a bloodstream source

If S. aureus is isolated from a patient without a catheter or foreign body, what clinical action is warranted?

Colonization of the vaginal introitus with intestinal flora

What is the critical initial step in the pathogenesis of UTI in women?

Enteric gram-negative rods

What general class of bacteria usually causes UTI?

Escherichia coli

Which organism accounts for 75-90 percent of acute uncomplicated cystitis cases?

Staphylococcus saprophyticus

Which organism causes 5-15 percent of AUC cases, particularly in the US?

Klebsiella, Proteus, Enterococcus, and Citrobacter

Which four bacteria collectively account for 5-15 percent of AUC cases?

Neonatal period

During which life stage is UTI more frequent in males than females?

Phimosis

Why is UTI more common in neonatal males?

Prepuce adhering to the opening of the urethra

What is the definition of phimosis in uncircumcised babies?

After the age of 50

At what age does the incidence of UTI in men become almost as high as in women?

Benign Prostatic Hyperplasia

What condition predisposes men over 50 to UTI?

50-80 percent

What percentage of women in the general population acquire at least one UTI in their lifetime?

Diaphragm with spermicide

Recent use of which contraceptive device is an independent risk factor for UTI?

Frequent sexual intercourse

Which activity is an independent risk factor for UTI in women?

History of UTI

Besides behavioral and contraceptive factors, what is a third independent risk factor for UTI?

Dose-dependent manner

How is the relationship between cystitis and sexual intercourse described?

Higher than 5 percent

What is the prevalence of Asymptomatic Bacteriuria among the elderly?

Asymptomatic Bacteriuria

Which syndrome is characterized by no local or systemic symptoms?

Cystitis

Which syndrome presents with dysuria, urinary frequency, and urgency?

Nocturia, hesitancy, and suprapubic discomfort

Besides the main triad, what are three other manifestations of cystitis?

Gross hematuria

What term describes visible blood in the urine during cystitis?

Balisawsaw

What is the Tagalog term for painful urination used by Filipinos?

Fever

What is the primary determining factor that distinguishes pyelonephritis from cystitis?

Pyelonephritis

Which syndrome is a systemic and acute manifestation presenting with fever, chills, and flank pain?

Nausea and vomiting

What are two common gastrointestinal symptoms associated with pyelonephritis?

Costovertebral angle pain

Where is the pain typically located in acute pyelonephritis besides the flank?

Rigors

What term describes the shaking chills seen in high-grade pyelonephritis?

Prostatitis

Which infection among men presents with dysuria, frequency, and perineal pain?

Complicated UTI

Which category describes symptomatic infection in a patient with an anatomic predisposition?

Foley catheters

What is a common foreign body that leads to a complicated UTI?

Delayed response to therapy

Complicated UTIs are considered in patients who are elderly or immunocompromised because they have a risk for what?

Anatomic abnormalities

A UTI is considered complicated if the patient has instrumentation or what other structural issue?

Uncomplicated UTI

What term refers to acute cystitis or pyelonephritis in nonpregnant outpatient women without anatomic abnormalities?

Recurrent UTI

Which type of UTI is explicitly stated as not necessarily complicated?

Acute Cystitis

A 35-year-old female with painful urination and suprapubic pain for 2 days most likely has what condition?

Vaginal discharge

What symptom is notably absent in cystitis and suggests a different diagnosis if present?

Clinically suspected

In pre-menopausal, non-pregnant women with typical symptoms, AUC is diagnosed how?

Urinalysis

Which test is not necessary to confirm the diagnosis of AUC in symptomatic women without vaginal discharge?

Nitrofurantoin

What is the primary first-line treatment for acute uncomplicated cystitis?

100 mg BID for 5 days

What is the recommended dose and duration for Nitrofurantoin monohydrate macrocrystals?

100 mg QID for 5 days

What is the recommended dose and duration for local Nitrofurantoin macrocrystals in the Philippines?

3 grams single dose PO

What is the recommended dose and duration for Fosfomycin trometamol in AUC?

Ciprofloxacin

What is the drug of choice for pyelonephritis that can also be used for complicated cystitis?

Levofloxacin

What antibiotic is used for pyelonephritis in doses of 500-750 mg?

7 days

Nitrofurantoin therapy for AUC can be extended up to how many days?

Low resistance

What is the status of bacterial resistance to nitrofurantoin after 60 years of use?

E. coli, Proteus, Pseudomonas, Serratia, Enterobacter, and yeasts

Nitrofurantoin remains highly effective against which six organisms?

It does not reach significant levels in tissue

Why is nitrofurantoin not used for the treatment of pyelonephritis?

Fluoroquinolones

Which class of drugs is highly effective but may propagate resistance and C. difficile outbreaks?

C. difficile outbreaks

Overuse of fluoroquinolones for minor UTIs can manifest as diarrhea due to what?

Nitrofurantoin

According to the Philippine guidelines 2015, what is the first-line treatment for AUC?

Fosfomycin

According to the Philippine guidelines 2015, what is the second-line treatment for AUC?

Trimethoprim-Sulfamethoxazole

Which drug is excluded from the first-line Philippine AUC guidelines due to high allergic reaction rates?

Stevens-Johnson Syndrome

What is a severe allergic reaction associated with Co-trimoxazole (TMP-SMX)?

160/800 mg BID for 3 days

What is the dosage for TMP-SMX in AUC if susceptibility is proven?

Nausea and headache

What are the common side effects of Nitrofurantoin?

Rash, urticaria, nausea, vomiting, and hematologic abnormalities

What are five common side effects of TMP-SMX?

Diarrhea, nausea, and headache

What are three common side effects of Fosfomycin?

Nausea, vomiting, and diarrhea

What are three common side effects of Pivmecillinam?

Drowsiness and insomnia

Besides GI issues, what are two neurological side effects of Fluoroquinolones?

Ofloxacin

What fluoroquinolone is dosed at 200 mg BID for 3 days for AUC?

Ciprofloxacin extended release

Which form of ciprofloxacin is dosed at 500 mg OD for 3 days for AUC?

Amoxicillin-clavulanate

Which beta-lactam is dosed at 625 mg BID for 7 days for AUC?

Cefuroxime axetil

Which cephalosporin is dosed at 250 mg BID for 7 days for AUC?

Cefaclor

Which cephalosporin is dosed at 500 mg TID for 7 days for AUC?

Cefixime

Which cephalosporin is dosed at 200 mg BID for 7 days for AUC?

Cefpodoxime proxetil

Which cephalosporin is dosed at 100 mg BID for 7 days for AUC?

Ceftibuten

Which cephalosporin is dosed at 200 mg BID for 7 days for AUC?

Healthy women with no functional urologic abnormalities

In whom is acute uncomplicated pyelonephritis suspected?

Systemic signs and symptoms

What differentiates pyelonephritis from lower urinary tract infections?

Greater than 5 WBC/HPF

What level of pyuria in centrifuged urine is characteristic of pyelonephritis?

Greater than 10,000 CFU/ml

What is the urine culture threshold for bacteriuria in acute pyelonephritis?

Fluoroquinolones

What is the first-line oral antibiotic regimen class for uncomplicated acute pyelonephritis?

Levofloxacin 750 mg OD for 5 days

What is the primary oral regimen for pyelonephritis involving Levofloxacin?

Ciprofloxacin 500 mg BID for 7-10 days

What is the primary oral regimen for pyelonephritis involving standard Ciprofloxacin?