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UTI

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mzmaisel's version from 2016-09-04 22:29

Section 1 Definitions

Question Answer
Definition: Asymptomatic bacteriuriaMicrobes and WB in urine without UTI symptoms
Definition: Urine colonizationmicrobes in urine without WBC & UTI symptoms
Definition: Urethritisinfection of the urethra
Definition: Cystitisinfection limited to the bladder
Definition: Prostatitisinflammation of the prostate gland
Definition: Pyelonephitisinflammation & infection of the kidney
Uncomplicated UTI classificationnormal urinary tract; adult women (15-45 yo), cystitis or urethritis
Complicated UTI classificationUpper UTI (pylonephritis); altered urinary tract; young/old/immunocompromised; hospital acquired, catheter associated; symptoms longer than 7d; more than 3 in 6 mo
Risk Factors for UTIfemale, elderly>ped, preg (disruption in hormones), sexual intercourse, hospitalization
Definition: Ureteritisinfection ureter
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Section 2 Microbiology and presenting symptoms

Question Answer
Microbiology of uncomplicated, CA UTImainly PEK; staph saprophyticus, enteroccoci
Microbiology of hospital-acquired, complicated UTIPEK, CAPES, enterococcus, candida,
Presenting S/Sx Subjective: cystitissuprapubic pain, dysuria, frequency and urgency to urinate, cloudy, foul smelling urine
Presenting S/Sx Subjective: urethritispain, burning, discharge from urethra (consider STD in differential)
Presenting S/Sx Subjective: prostatisAcute: sytemic sx, urinary sx, local pain Chronic: more subtle sx
Presenting S/Sx Subjective: pyelonephritsCVA tenderness/flank pain, fecer, leukocytosis, sytemic symptoms
Presenting S/Sx Objective: Urinalysisleukocyte esterase, blood, nitrite (sign of enteric GNR), increased pH, and urine casts
Presenting S/Sx Objective: Urine microscopybacteria and WBC > 10
cutoff for significant bacteriuria>10^5 CFU/ml in female and >10^3 in male
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Section 3

Question Answer
TMP/SMX rolegood for acute uncomplicated cystits with a short course of 3d, longer course in outpatient pyelonephritis (14d)
TMP/SMX proscheap and good for short course, good choice for CA and uncomplicated (narrow spectrum than FQ)
FQ rolein acute short course (3d) and in complicate long (7-14d)
FQ prosdaily dosing with levo or renal dose cipro, good for short course, great renal concentration and broad specturm GN coverage (pseudo)
FQ consover-utilized with resistance developing, broad spectrum
Nitrofurantoin Roleacute uncomplicated cystitis (7d), prophy for recurrent UTI
Nitrofurantoin dose100mg PO q12 for macrobid and Q6h for Macrodantin
Nitrofurantoin prosnarrow specturm, lower e.coli resistance and covers enterococus
Nitrofurantoin consmultiple daily dosing, ineffective in short course, incrased tox with CrCl <50ml/min, not for pyelonephritis and dosen't get systemic concentration
Pyelonephritis Treatment inpatient3rd gen cephs (ceftriaxone) IV only, or FQ or gent; in nosocomial cover for pseudomonas
Nonpharm and adjunctiveaggressive hydration, cranberry juice, vitamin c (acidification of urine) methanamine, phenazopyridine
Acute pylonephritis in outpatient (mild to moderate)TMP/SMX for 7-14 OR FQ 7-14 OR ceph/doxy/amox/clav
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Section 4 Special Notes

Question Answer
Nitrofurantoin Special issuesnot for use in CrCl <50, not for short course cystitis (requires 7 days), not for pyelonephritis (only gets into bladder)
What to use for cystitis in pregnancyceph or amp
Pros/Cons of FosfomycinSingle dose but very had to get
Nosocomial urosepsisAntipseudomonal coverage
Role of aminoglycosidessevere pylenephritis, urosepsis in setting of B-lactam allergy
Cystitis in PregnancyNO FQ/TCN (preg D), NO TMP/SMX (C/D); USE ceph, amox or nitrofurantoin; treat even if asymptomatic to avoid complications
Complicated CystitisTMP/SMX or FQ for 7-14 d (long course)
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