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UTI Slides

Urinary tract infections (UTIs) are common, especially in women. UTIs can be uncomplicated or complicated depending on factors like anatomy. Common symptoms include dysuria, frequency, and urgency. Diagnosis involves urinalysis showing signs of infection like bacteria and white blood cells and urine culture. Treatment depends on factors like pregnancy and involves antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones. Recurrent UTIs may require long-term antibiotic prophylaxis.

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Roger Rab
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45 views

UTI Slides

Urinary tract infections (UTIs) are common, especially in women. UTIs can be uncomplicated or complicated depending on factors like anatomy. Common symptoms include dysuria, frequency, and urgency. Diagnosis involves urinalysis showing signs of infection like bacteria and white blood cells and urine culture. Treatment depends on factors like pregnancy and involves antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones. Recurrent UTIs may require long-term antibiotic prophylaxis.

Uploaded by

Roger Rab
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Urinary Tract Infections

Bacteriuria
• Bacteruria – presence of bacteria in the urine
• Does not necessarily represent infection
Definitions
• Uncomplicated vs complicated
• Uncomplicated frequently seen in younger females
• Complicated involves some abnormality in the urinary tract
• Requires longer treatment duration
• Men almost always considered complicated
• Reccurent UTI
• 2 or more UTIs within 6 months, or 3 or more within one year
Epidemiology
• Neonates
• More common in boys than girls
• Young children through majority of adulthood, women at
significantly higher risk
• Rates of symptomatic infection in elderly patients similar
among women and men
Etiology
• Uncomplicated:
• E. coli
• Klebsiella sp.
• Proteus sp.
• S. saprophyticus
• Enterococcus sp.
Pathophysiology
• Ascending pathway
• Explains why women at increased risk
• Hematogenous pathway
• Expect this mechanism if S. aureus isolated
• Lymphatic pathway

• Host defense mechanisms prevent bacterial overgrowth in


normal circumstances
Risk Factors
• Women • Both
• Sexual intercourse • Urologic
• Use of spermicidal instrumentation
jellies • Urethral
• Use of cervical catheterization
diaphragm • Renal transplantation
• Diabetes • Neurogenic bladder
• Pregnancy • Urinary tract
• Men obstruction
• Uncircumcised penis
• Prostatic hyperplasia
Clinical Presentation
• Lower UTI:
• Dysuria
• Gross hematuria
• Suprapubic heaviness
• Nocturia
• Increased urinary urgency and frequency
• Upper UTI:
• Fever
• Nausea/vomiting
• Malaise
• Severe flank pain

• Elderly patients may not present with classic signs and symptoms,
but instead altered mental status
Laboratory Tests/Diagnosis
• Important to obtain both a urinalysis and urine culture in most
patients
• Urinalysis should show:
• Pyuria
• Bacteruria
• Nitrites
• Leukocyte esterase
• Urine culture should have significant (>100,000 CFU) bacteria
Nonpharmacologic
• Cranberry juice
• Probiotics
• Topical estrogen
• Phenazopyridine
Asymptomatic Bacteruria
• Only treat if:
• Pregnant
• Undergoing urologic manipulation
Special Populations
• Pregnant patients
• Sulfonamide, amox-clauv, cephalexin or nitrofurantoin
appropriate
• Catheterized patients
• Remove and/or change catheter
• Only treat if symptomatic
• Men
• Typically considered complicated
Recurrent UTI
• May consider prophylaxis, though concerned about potential
resistance
• Methenamine an option for prophylaxis, not treatment

Continuous Antimicrobial Prophylaxis Post-coital Prophylaxis

Nitrofurantoin 100mg daily Nitrofurantoin 100mg

SMX-TMP SS (also three times weekly strategy) SMX-TMP SS or DS tab

Trimethoprim 100mg daily Trimethoprim 100mg

Cephalexin 250mg Cephalexin 250mg

Fosfomycin 3g every 10 days


Follow-Up
• Symptoms resolution within 48-72 hours
• Check culture results and deescalate therapy, if possible
• Repeat culture not required to test for cure
• Consider if patient not responding
WA is a 54 year old female who presents to the
emergency department complaining of dysuria, increased
urinary frequency and urgency. WA reports no recent
antibiotic use. Urinalysis (bottom right). IBW: 57; SCr: 0.9.
What is the most appropriate therapy for WA?

A. Levofloxacin x 7 days
Parameter (normal Results
B. Nitrofurantoin x 5 days values)
Color Yellow
C. Ceftriaxone x 1 Appearance
Urine nitrites (negative)
Hazy
Positive
Leuko Esterase Large
D. Piperacillin-tazobactam x 3 days (negative)
Bacteria Large
Urine WBC > 182
Urine RBC Scant
PY is a 32 year old female who presents to her
obstetricians office for her 20 week follow-up
visit. A routine urinalysis shows significant
bacteruria, but upon questioning PY does not
report any signs or symptoms of a urinary tract
infection. What do you recommend for PY?

A. No treatment; PY does not have symptoms


B. Doxycycline
C. Ciprofloxacin
D. Cephalexin
LO is a 34 yo female presenting to your clinic complaining
of flank pain, fever, nausea and vomiting x 1 day. She
reports that several days ago she felts as though she
needed to void frequently, and voiding was painful. She
took an over the counter medication to treat the pain, and
while it initially worked well, she now feels much worse.
Urinalysis (below right). What would you recommend for
LO?
Parameter (normal Results
A. Ciprofloxacin x 7 days values)
Color Yellow
Appearance Cloudy
B. Nitrofurantoin x 7 days Urine nitrites (negative)
Leuko Esterase (negative)
Positive
Large
Bacteria Large
C. Amoxicillin x 7 days Urine WBC
Urine RBC
> 182
Moderate

D. Sulfamethoxazole-trimethoprim x 7 days
References
• Gupta K, Hooton TM, Naber KG, et al. International clinical
practice guidelines for the treatment of acute uncomplicated
cystitis and pyelonephritis in women: a 2010 update by the
Infectious Diseases Society of America and the European
Society for Microbiology and Infectious Diseases. Clinical
Practice Guidelines. 2011;52(5):e103-e120.
• Hooten TM. Uncomplicated Urinary Tract Infection. New Engl J
Med 2012; 366; 11: 1028-37.
• Rose, WE. Urinary Tract Infections. In: Pharmacotherapy
Principles and Practice 5e. Eds. Chisholm-Burns MA, Wells BG,
Schwinghammer TL, et al. McGraw-Hill 2016.

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