UTI/Prostatitis

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capnhue
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144733
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UTI/Prostatitis
Updated:
2012-03-30 02:46:49
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Regis University
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UTI/Prostatitis
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  1. microbial etiologies CA, uncomplicated UTI
    • E. coli
    • staphylococcus saprophyticus
    • Enterobactericiae (Klebsiella, Proteus)
    • Enterococcus
  2. microbial etiologies HA or complicated UTI
    • Pseudomonas aeruginosa
    • E.coli
    • Enterobacter
    • Enterococcus
    • Staph aureus
    • Canadida albicans (catheterized pts)
  3. 5 things that support an ascending infection (lower UTI)
    • colonization of distal urethra
    • movement of oranism from urethra to bladder
    • stasis of urine
    • movement of oranism from bladder to renal perlvis
    • movement of oraganism into renal parenchyma
  4. Risk factors for UTi
    • predisposing lesion of urinary tract
    • neurologic deficit
    • medical condition impairing immune system
    • prescence of catheter
    • mechanical instrumentation
    • sex
    • previous UTI
    • pregnancy
    • use of spermicides
  5. Treatment for uncomplicated cystitis UTI
    • Nitrofurantoin (avoid CrCl <60)
    • tmp/smx (160/800 double strength)
    • fosfomycin (lower efficacy)
    • alternatives - fluoroquinolones (cipro, levo), amoxicillin or ampicillin
  6. Adjunctive treatment for UTI
    • phenazopyridine
    • avoid: hepatic and renal impairment (CrCl - <50)
  7. Prevention of UTI
    carnberries
  8. Treatment of uncomplicated Pyelonephritis NOT hospitalized
    • cipro, cipro ER, levo if resistance <10%
    • TMP-SMX
    • culture result NOT available: IV ceftriaxone or aminoglycoside followed by TMP-SMX
  9. Treatment of uncomplicated Pyelonephritis HOSPITALIZED
    • fluoroquinolone (cipro, levo)
    • aminoglycoside +/- ampicillin
    • 3rd gen cephalosporin (ceftriaxone) +/- aminoglycoside
    • carbapenem
  10. Complicated Pyelonephritis treatment
    • aminoglycoside + anti-pseudomonal fluoroquinolone (cipro, levo)
    • aminoglycoside + anti-pseudomonal penicllin, cephalosporin, carbenem
    • aminoglycoside + aztreonam
  11. Asymptomatic Bacteriuria (ASM) treatment
    • pregnancy and children: amoxicillin/clavulanate, cephalosporin
    • pregnancy (except 3rd trimester) and children: TMP-SMX, nitrofurantoin
  12. Prophylactic therapy UTI
    • TMP-SMX (half of single strength)
    • trimethoprim
    • nitrofurantoin
  13. acute bacterial prostatitis
    • Microbial etiology: E.coli (common), Klebsiella, Proteus, Enterococcus (less), Pseudomonas (less common)
    • due to reflux of urine from posterior urethra or
    • hematogenous spread from distant site or
    • surgical manipulation of urethra or prostate gland
  14. Chronic bacterial prostatitis
    due to recurrent UTI from same organism (organism same as in acute bacterial prostatitis)
  15. Chronic abacterial prostatitis
    • most common prostatitis
    • lacking history of recurrent UTI
  16. Granulomatous prostatitis
    • caused by treatment of bladder cancer w/BCG (bacillus calmette guerin) or
    • from fungal source seen in immunocomprimsed pts
  17. Gold standard for diagnosis of prostatitis
    prostatic massage causing a purulent discharge that gets sent to lab
  18. Acute prostatitis treatment
    • fluoroquinolones (cipro, levo) preferred treatment
    • TMP-SMX 2nd line
    • fluoroquinolone resistant - ceftazidine, ceftriaxone, carbapenem
    • Gonorrhoeae or chlamydia treat w/: ceftriaxone or cefixime PLUS doxycycline or azithromycin
  19. Chornic prostatitis treatment
    • fluoroquinolone (cipro, levo)
    • TMP-SMX

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