thera uti

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thera uti
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2013-09-10 15:43:28
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thera uti
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  1. Prostatitis
    infection in the prostate
  2. pyeloephritis
    infection in the kidney
  3. cystitis
    infection in the bladder
  4. upper UTI
    pyelonephritis
  5. lower UTI
    cystitis
  6. 4 characteristics of uncomplicated UTI
    • healthy
    • premenopausal women
    • non-pregnant women
    • no known functional or anatomic urological abnormalities
  7. 4 characteristics of complicated UTI
    • structural or functional urological abnormalities
    • conditions that may increase risk of complications
    • men
    • post-menopausal women
  8. 4 conditions that may increase risk of complications
    • diabetes
    • neurogenic bladder
    • nephrolithiasis
    • immunocompromised
  9. 6 risk factors for UTI
    • sexual intercourse
    • new sexual partner
    • use of spermicides
    • previous UTI
    • history of UTI in 1st degree relative
    • inability to void completely
  10. 6 defense mechanisms against UTI's
    • micturition
    • pH of urine (acidic)
    • osmolality of urine
    • high urea concentration
    • high organic acid concentration
    • prostatic secretions
  11. 6 S&S of cystitis
    • dysuria
    • frequency
    • urgency
    • suprapubic pain
    • hematuria
    • (-) symptom - absence of vaginal irritation and discharge
  12. 6 S&S of pyelonephritis
    • fever (>38C)
    • chills
    • flank pain
    • costovertebral-angle tenderness
    • N/V
    • W or W/O symptoms of cystitis
  13. 4 signs on a urine dipstick to look to indicated UTI
    • clarity - cloudy
    • leukocyte esterase - positive
    • nitrite - positive
    • blood - positive
  14. 4 catergories for WBC on microscopy
    • 0 - normal
    • 0-5 trace amount
    • 5-10 possibly infected
    • > 10 infected
  15. 4 catergories for CFU's in a culture showing bacteria
    • < 103 generally insignificant
    • 103-104 possible contamination, may repeat
    • >104 in males likely a UTI
    • >105 in females likely a UTI
  16. example when you don't need to to culture for UTI
    young, healthy women with classic symptoms and positive dipstick = uncomplicated, lower UTI
  17. 6 cases when to culture for a UTI
    • complicated, lower UTI
    • upper UTI
    • uncharacteristic symptoms
    • persistent symptoms after treatment
    • recurrence of UTI <1 month after Tx
    • prostatitis
  18. 4 bacteria for uncomplicated UTI
    • Escherichia coli
    • Staphylococcus saprophyticus
    • Klebsiella pneumoniae
    • Proteus spp
  19. contaminant that shows up in uncomplicated UTI
    Staphylococcus epidermidis
  20. 5 bacteria showing up in complicated UTI
    • Escherichia coli
    • Proteus spp.
    • Klebsiella pneumoniae
    • Enterococcus spp.
    • Pseudomonas aeruginosa
  21. contaminant bacteria showing up in complicated UTI
    staphylococcus epidermidis
  22. 2 cases when you would need to do follow-up cultures for uncomplicated UTI
    • symptoms persist after 48-72 hours of appropriate antibiotics
    • recurrent  symptoms within a few weeks of TX
  23. urinary analgesics
    may mask S&S of UTI's that don't respond to therapy. little clinical role because pt's respond quickly to antimicrobial therapy
  24. alternate therapies with little efficacy results
    • cranberry juice
    • topical estrogens
    • lactobacilli
  25. infection specific factors for antibiotic selection
    • severity
    • site of infection
    • uncomplicated vs complicated
  26. drug specific factors for antibiotic selection
    • availability of agent
    • ecologic adverse effects
    • side effects
    • convenience
  27. pt specific factors for antibiotic selection
    • allergy history
    • intolerance history
    • drug-drug interactions
    • adherence patterns
  28. 3 drugs for uncomplicated cystitis Tx - first line
    • nitrofurantoin - 5 days
    • Bactrim - 3 days
    • fosfomycin - 1 dose
  29. second line options for uncomplicated cystitis Tx
    • fluoroquinolones - 3days
    •    levofloxacin - 250-500mg QD
    •    ciprofloxacin - 250mg bid
    •    ciprofloxacin ER - 500mg QD
    • beta-lactams - 3-7days
    •    augmentin
    •    cefaclor
    •    cepodoxime
  30. 4 general rules of complicated cystitis
    • individualize Tx
    • always culture and narrow therapy based on
    • worry about more pathogens
    • longer duration of Tx 5-14 days
  31. PO options for complicated cystitis - empirical therapy
    • fluoroquinolones
    •    levofloxacin - 750mg QD - 5 days
    •    ciprofloxacin - 500mg BID - 7-14 days
    •    ciprofloxacin ER - 1g QD - 7-14 days
  32. IV options for complicated cystitis - empirical therapy
    • levofloxacin - 500-750mg - 5days
    • ceftriaxone - 1000mg daily - 10-14 days
    • carbapenems - 1000mg QD - 10-14 days
    • aminoglycosides - 7mg/kg QD - 10-14 days
    •    gentamicin
  33. PO Tx for pyelonephritis
    • fluoroquinolones
    • bactrim
    • beta-lactams
  34. PO for pyelonephritis, when to use fluoroquinolones
    when resistance rates or <10%
  35. 3 signs of catheter-associated UTI
    • >103 cfu/ml of >1 bacterial species in a catheter urine specimen
    • or
    • midstream voided urine when the catheter has been removed within 48 hours
    • plus
    • symptoms of UTI
  36. 7 S&S of CA-UTI
    • fever
    • chills
    • altered mental status
    • malaise
    • flank pain
    • costovertebral angle tenderness
    • pelvic discomfort
  37. 3 signs that aren't indicative of CA-UTI
    • odorous urine
    • cloudy urine
    • pyuria
  38. 2 points on CA-UTI cultures
    • don't draw unless symptomatic
    • obtain culture prior to Tx
    • culture from fresh catheter
    • organisms - polymicrobial & multidrug resistant pathogens
  39. 4 guides when choosing an antibiotic for CA-UTI
    • severity of infection
    • local resistance patterns
    • culture results
    • choice is usually similar to Tx of complicated UTI
  40. Tx durations for CA-UTI
    • typically 7-14 days
    •   7days if respond to initial Tx
    •   10-14 days if delayed response to initial Tx
    •    Levofloxacin - 5 days may be adequate
  41. Diagnosis of asymptomatic bacteruria in men and women
    • men - 1 voided urine specimen with 1 bacterial species > 105 cfu/mL
    • women - 2 consecutive voided urine specimen with the same bacterial species > 105 cfu/mL
    • M & F - 1 catheterized urine specimen with 1 bacterial species >102 cfu/mL
  42. who do we screen for asymptomatic bacteruria
    • pregnant women - 1 screen early in pregnancy
    • prior to urologic procedures
  43. who don't we screen for asymptomatic bacteruria
    • pre-menopausal, non-pregnant women
    • diabetic women
    • older adults (community and institutionalized)
    • spinal cord injuries
    • catheterized pts
  44. when would pyuria be an indication for Tx of asymptomatic bacteriuria
    • children
    • pregnancy
    •    treat 3-7 days
    •    followed by periodic screening for reoccurence
    • certain urologic procedures (TURP)
    •   initiate shortly prior to procedure
    •   only continue if catheter remains
    • catheter-acquired bacteriuria persisting 48 hours after removal of catheter
  45. Tx for UTI's in pregnancy
    • cephalosporins 5-7 days
    • nitrofurnatoin 5-7 days
    • augmentin 5-7 days
    • 2nd line - Bactrim 5-7 days
  46. is there a cephalosporin to avoid in pregnancy and why
    ceftriaxone - kernicterus
  47. nitrofurantoin in pregnancy
    avoid use after 37 weeks due to hemolytic anemia
  48. Bactrim in UTI in pregnancy
    • avoid in 1st trimester due to CV malformations
    • avoid in last weeks of pregnancy due to kernicteus
  49. differentiate between reinfection and relapse in terms of when occurs
    • reinfections - > 14 days after last UTI
    • relapses - within 14 days
  50. 7 behavioral tips for preventing reinfections
    • less sex
    • avoid spermicides
    • pee after sex
    • fluids
    • no jungle wiping
    • avoid douching
    • avoid tight fitting underwear
  51. 3 biologic mediators for the prevention of reinfections
    • cranberry
    • topical estrogen
    • D-mannose
  52. prophylactic antimicrobials for reinfections in women
    • if they have had
    •   3 or more UTI's in the past 12 months
    •   2 or more UTI's in the past 6 months
    • must be confirmed by urine culture
  53. single dose prophylaxis regimens for UTI's
    • Bactrim 1/2 SS tablet x 1 dose
    • TMP 100 mg x 1 dose
    • nitrofurantoin 50-100mg x 1 dose
    • cephalexin 250 mg x 1 dose
  54. continuous prophylaxis for UTI's
    • bactrim 1/2 SS tab QD or 3 times weekly
    • levofloxacin 500 mg QD
    • nitrofurantoin 50-100mg daily
    • TMP 100 mg QD
  55. duration and follow up of continuous prophylaxis fo UTI's
    • continue antibiotics for mo. then observe
    • may follow urine cultures monthly
    • if symptoms develop, pt should be treated for UTI
  56. 7 S&S of prostitis
    • fever
    • chills
    • malaise
    • myalgia
    • dysuris
    • pelvic or perineal pain
    • cloudy urin
  57. microorganisms of prostitis
    • E.coli - 50-80 % of all cases
    • klebsiella
    • proteus
    • enterococcus sp.
    • pseudomonas sp.
  58. acute prostatitis outpatient treatment
    • fluoroquinolones - 2-6 weeks
    •   levo - 750 mg QD
    •   cipro - 500 mg BID
    •   cipro ER - 1G QD
    • bactrim - 2-6 weeks
    •   160/800mg BID
  59. general rule of switching from IV to PO meds for most conditions
    pt is afebrile for 24-48 hours and can tolerate oral medications

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