Term
| What is the most common bacterial infection in the US? |
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Definition
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Term
| UTIs account for what % of all US prescriptions? |
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Definition
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Term
| UTIs account for what % of all nosocomial infections? |
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Definition
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Term
| What are the 2 main ways of classifying UTIs? |
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Definition
| anatomical site of infection and host characteristics |
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Term
| What are the main divisions used in classifying a UTI by anatomical site of infection? |
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Definition
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Term
| What are the lower UTI infections? |
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Definition
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Term
| What is the upper UTI infection? |
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Definition
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Term
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Definition
| infection confined to bladder |
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Term
| Briefly define urethritis. |
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Definition
| infection confined to urethra |
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Term
| Briefly define pyelonephritis. |
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Definition
| infection involving structure of kidney |
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Term
| Based of host characteristic classification of UTIs which are most common? |
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Definition
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Term
| What are the ways of classifying UTIs by host characteristic? |
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Definition
| uncomplicated and complicated |
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Term
| Briefly define uncomplicated UTI? |
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Definition
| infection involving structurally / funtionally normal GU tract |
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Term
| Briefly define complicated UTI? |
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Definition
| infection involving prolinged need for treatment or increased risk for drug failure usually due to structural / functional abnormalities of the urinary tract |
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Term
| Which populations are always considered to have complicated UTI when infected? |
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Definition
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Term
| How much more common are UTIs in women than men? |
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Definition
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Term
| What age range sees the big spike in female predominace of UTIs? |
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Definition
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Term
| What % of women will experience at least one UTI? |
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Definition
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Term
| What % of women have had a UTI necessitating antibiotics therapy by age 24? |
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Definition
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Term
| What % of women will have a UTI is a given year? |
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Definition
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Term
| What are the risk factors for UTI in women? |
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Definition
| DIane's DEalie is PREvalent with DISease due to RECENT SEX - DIAphragm / spermicide use, DElays in urination, PREvious UTI, DISplacement of vaginal flora by enteropathogenic flora from rectal source, RECENT antibiotic use - esp. beta lactams within 4 weeks - NOT Bactrim, SEXual intercourse |
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Term
| What are the principal pathogens of uncomplicated UTI? |
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Definition
| E.coli (70 -95%), Staph. saprophyticus (5 - 20%), Proteus mirabilis (<= 5%), Klebsiella pneumoniae (<= 5%) |
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Term
| What are the symptoms of uncomplicated cystitis? |
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Definition
| dysuria, pyuria, frequent urination / urge to urinate, suprapubic tenderness |
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Term
| What other infections are important to rule out during differential diagnosis of uncomplicated cystitis? |
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Definition
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Term
| What is typically the cause of urethritis? |
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Definition
| usually STD from Chlamidia or Gonorrhea |
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Term
| What usually accompanies vaginitis that helps with differential diagnosis? |
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Definition
| vaginal discharge, itching, and odor |
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Term
| What are typical pathogens involved in vaginitis? |
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Definition
| vaginal candidiasis, genital herpes, and Trichmonas vaginalis |
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Term
| What are the goals of therapy in uncoplicated cystitis treatment? |
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Definition
| alleviate symptoms, prevent complications, prevent reccurent infection, avoid adverse drug reactions, limit incorrect prescribing |
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Term
| When should Bactrim be avoided in the treatment of uncomplicated cystitis? |
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Definition
| > 10 - 20% resistance, G6PD deficiency, folate deficiency |
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Term
| Which FQs are not used in uncomplicated cystitis? |
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Definition
| moxifloxacin and gemifloxacin |
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Term
| When should FQs be avoided in uncomplicated cystitis? |
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Definition
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Term
| What is the duration of therapy for first line medications used for uncomplicated cystitis? |
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Definition
| 3 days, 7 days in pregnancy |
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Term
| What is the dosing for first line uncomplicated cystitis medications? |
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Definition
| Bactrim DS bid X3 days, cipro 250mg bid X3 days, Cipro XR 500mg qd x3 days, levofloxacin 250mg qd x3 days, same but x7 days in pregnancy |
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Term
| 2nd line medications for uncomplicated cystitis should only be used in what cases? |
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Definition
| 1st line contraindicated, 1st line allergies, pregnancy |
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Term
| When should nitrofurantoin be avoided in uncomplicated cystitis? |
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Definition
|
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Term
| When is nitrofurantoin contraindicated? |
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Definition
| when Clcr < 60 mL / min, term/L&D (38+ weeks) |
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Term
| What is often the DOC for uncomplicated cystitis in pregnancy? |
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Definition
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Term
| What are the second line agents for uncomplicated cystitis? |
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Definition
| nitrofurantoin, fosfomycin, Augmentin, Keflex, Ceftin (cefuroxime), Suprax (cefixime) |
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Term
| Why is nitrofurantoin not a first line medication for uncomplicated cystitis? |
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Definition
| poor Klebsiella coverage and horrible Proteus coverage |
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Term
| What is the duration of therapy for second line drugs used in uncomplicated cystitis? |
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Definition
| 7 days with the exception of fosfomycin 3g po x1 dose |
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Term
| What is the brand name for fosfomycin? |
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Definition
|
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Term
| What is the uncomplicated cystitis dosing for Macrobid and Macrodantin? |
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Definition
| Macrobid 100mg po bid x7 days, Macrodantin 50 - 100mg po qid x7 days |
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Term
| What adverse side effect is seen with 6+ months of nitrofurantoin use? |
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Definition
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Term
| What are the morbidity/mortality risks of pyelonephritis? |
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Definition
| sepsis, renal abscess, renal failure |
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Term
| What are the usual suspects for pyelonephritis? |
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Definition
| E.coli, Staph. sprophyticus, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus |
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Term
| In additions to cystitis-like symptoms what other widely varying symptoms are seen in pylonephritis? |
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Definition
| fever, chills, nausea, vomiting, abdominal pain, flank pain, elevated WBCs, bacteremia |
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Term
| What patients are at increased risk for pyelonephritis? |
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Definition
| those with recent history of UTI or UTI >= 7 days |
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Term
| How is pyelonephritis divided into mild to moderate and serious? |
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Definition
mild to moderate - stable patients with no significant alteration in vital signs / labs, low fever, no nausea / vomitting, minimal WBC increase
serious - ill appearing and / or pregnant |
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Term
| What is the treatment of choice for mild to moderate uncomplicated pyelonephritis? |
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Definition
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Term
| What are the alternates to treatment of choice for mild to moderate uncomplicated pyelonephritis and when may they be used? |
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Definition
| Augmentin 10 - 14 days only if cultures confirm Gram positive, Bactrim 14 days only if cultures verify sensitivity or with FQ allergy |
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Term
| What are the alternates to treatment of choice for mild to moderate uncomplicated pyelonephritis and when may they be used? |
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Definition
| Augmentin 10 - 14 days only if cultures confirm Gram positive, Bactrim 14 days only if cultures verify sensitivity or with FQ allergy |
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Term
| Why is nitrofurantoin not used in pyelonephritis? |
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Definition
| it does not concentrate well in the kidney |
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Term
| When should a change in therapy be considered in mild to moderate pyelonephritis? |
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Definition
| if there is no improvement within 72 hours of therapy initiation |
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Term
| What are the treatments of choice for uncomplicated serious pyelonephritis? |
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Definition
| parenteral FQ, aminoglycoside +/- ampicillin, cefotaxime / ceftriaxone / cefepime +/- aminoglycoside --> all 10 - 14 days |
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Term
| When should you begin to see clinical improvement when properly treating serious pyelonephritis? |
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Definition
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Term
| When does fever generally resolve in proper treatment of serious pyelonephritis? |
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Definition
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Term
| What are the most common reasons for treatment failure in severe pyelonephritis treatment? |
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Definition
| antibiotic resistance and nephrolithiasis |
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Term
| When should serious pyelonephritis patients be switched to po medications? |
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Definition
| when they have been afebrile for 2 - 3 days |
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Term
| What should the duration of therapy be for treating immmunosuppressed patients with serious pyelonephritis? |
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Definition
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Term
| When should all serious pyelonephritis patients receive follow-up cultures and what duration of additional treatment should be given to those patients that relapse? |
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Definition
| test 1 - 2 weeks after antibiotic finish, if relapse then treat for 6 more weeks |
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Term
| What is asymtomatic bacteriuria (ASB)? |
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Definition
| significant colonization of lower GU tract without symptoms of infection |
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Term
| Who should be screened for ASB? |
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Definition
| those that you would want to treat if found positive (pregnant at 12 - 16 weeks and monthly thereafter if positive, patients scheduled for TURP or other urological procedures) |
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Term
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Definition
| 2 consecutive cultures with > 100000 CFU of the same organism |
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Term
| How is ABS treated in certain patients with increased risk of developing UTI? |
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Definition
| same as cystitis - same agents and durations |
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Term
| How is complicated cystitis treated? |
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Definition
| same as uncomplicated but 7 days treatment, nitrofurantoin not typically used in men because they tend to have more proteus infections than women |
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Term
| How is pylonephritis treated in men? |
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Definition
| Same as women but all agents used 10 - 14 days |
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Term
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Definition
| empiric FQ or Bactrim for 4 - 12 weeks |
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Term
| What are the chronic suppressive therapies for patients failing bacterial prostatitis treatments? |
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Definition
| Bactrim SS qd, nitrofurantoin 100mg qd - bid, surgery |
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Term
| When is uncomplicated cystitis considered recurrent and what are the options for women who have it? |
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Definition
| intermittent self - treatment, postcoital regimen, continuous daily prophylaxis |
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|
Term
| Why is nitrofurantoin CI at term / L&D? |
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Definition
|
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Term
| When and why is Bactrim CI for UTI in pregnancy? |
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Definition
| 1st trimester - inhibitory effects on folate metabolism --> neural tube defects |
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Term
| When and why is Bactrim precautioned for UTI in pregnancy? |
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Definition
| 3rd trimester - folate metabolism --> kernicterus risk |
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Term
| What time limit chould be used for phenazopyridine use and why? |
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Definition
| 48 hours because patient does not want to mask failed antibiotics which could lead to progression of cystitis to pyelonephritis |
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