Term
UTI CLASSIFICATION
NAME THE lower tract infections. |
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Definition
1. urethritis
2. cystitis
3. prostatis |
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Term
UTI CLASSIFICATION
Name an upper tract infection. |
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Definition
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Term
what are uncomplicated UTIs?
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Definition
females
age 15-45
healthy |
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Term
what are complicated UTIs?
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Definition
everything else...
both genders
lesion
obstruction
neurologic dysfunction
upper and lower tract
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Term
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Definition
| >/= 3 UTIs within 1 year in healthy nonpregnant woman |
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Term
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Definition
differnt organism
> 2 weeks apart |
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Term
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Definition
same organism
< 2 weeks apar
persistent source of infection
did we get the right agent? |
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Term
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Definition
1. female
2. age
men - bph, enlarged prostate
women: estrogen helps maintain natural flora
3. sexual activity
4. diabetes mellitis
5. history of UTI
6. preggers
7. catheters |
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Term
clinical presentation
lower UTI |
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Definition
More localized symptoms
1. dysuria
2. urgency/frequency
3. nocturia
4. suprapubic heaviness
5. hematuria
6. foul-smelling
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Term
Clinical Presentation
Upper UTI |
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Definition
flank pain
fever
n/v
malaise
muscle weakness |
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Term
common pathogens
uncomplicated |
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Definition
Escherichia coli (75-95%)
Proteus mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus
Other G+ or G- bacteria
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Term
common pathogens
complicated |
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Definition
Escherichia coli (<50%)
Proteus spp.
Klebsiella pneumoniae
Enterobacter spp.
Pseudomonas aeruginosa - hospital
Staphylococci and enterococci
MRSA
VRE
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Term
| What's the problem with using fq's for e coli? |
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Definition
resistance!
nitrofuratonin has very little resistance |
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Term
| Treatment for Uncomplicated UTI |
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Definition
Nitrofurantoin monohydrate/macrocrystals
100mg BID X 5 days
Why?
resistance levels are extremely low
no collateral damage
concentrations in theurine
dosen't affect the natural flora
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Term
| Other treatments for uncommplicated UTI |
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Definition
trimethoprim/sulfamethoxazole 160/800
BID x 3 days
- only appropriate empirically with local resistance less than 20%
compliance could be better
Fosfomycin
3 gm x1
inferior efficacy - but an option
BL/BLI and oral cephs
FQs work but collateral damage! |
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Term
| treatment for pyelnephritis |
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Definition
always get urine culture before starting ab
inpatient vs. outpatient
- account for severity of illness
high risk conditions
pregnant
diabetic
immunocompromised
structure abnormalities
oral regimens may start with IV agens for 24 h or until hemodynamically stable
IV/PO cipro or levo (7-10)
IV extended specturm beta lactam +/- AG (10-14 days)
PO beta lactams are less effective
Bactrim 14 days if bacteria is susceptible |
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Term
| Who do you treat if there is bacteria in the urine culture but patient is asyptomatic? |
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Definition
pregnant women (beta lactams, sulfonamids, and nitrofurantoin (uncomplicated))
children <5
patients undergoing TURP or urologica procedure
foley catheter? change the catheter |
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Term
What patient population is most likely to get candiduria?
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Definition
catheterized patients
only treat if symptomatic or high risk:
neutropenic
neonates
urologic procedure |
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Term
Treatement for Candiduria
(recall who you should and should not treat) |
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Definition
fluconazole
amph B IV
ampho B bladder irrigation
duration: 7 - 10 days
change the foley |
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Term
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Definition
acute: nonspecific, systemic symptoms, may have urinary sx
chronic: slow progression, difficulty urinating, low back pain, perineal fullness |
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Term
causes of infection
(prostatis) |
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Definition
reflux of urine into prostate
sexual intercourse
functional abnormalities of the prostate
catheters
UT procedures |
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