-
microbial etiologies CA, uncomplicated UTI
- E. coli
- staphylococcus saprophyticus
- Enterobactericiae (Klebsiella, Proteus)
- Enterococcus
-
microbial etiologies HA or complicated UTI
- Pseudomonas aeruginosa
- E.coli
- Enterobacter
- Enterococcus
- Staph aureus
- Canadida albicans (catheterized pts)
-
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
-
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
-
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
-
Adjunctive treatment for UTI
- phenazopyridine
- avoid: hepatic and renal impairment (CrCl - <50)
-
Prevention of UTI
carnberries
-
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
-
Treatment of uncomplicated Pyelonephritis HOSPITALIZED
- fluoroquinolone (cipro, levo)
- aminoglycoside +/- ampicillin
- 3rd gen cephalosporin (ceftriaxone) +/- aminoglycoside
- carbapenem
-
Complicated Pyelonephritis treatment
- aminoglycoside + anti-pseudomonal fluoroquinolone (cipro, levo)
- aminoglycoside + anti-pseudomonal penicllin, cephalosporin, carbenem
- aminoglycoside + aztreonam
-
Asymptomatic Bacteriuria (ASM) treatment
- pregnancy and children: amoxicillin/clavulanate, cephalosporin
- pregnancy (except 3rd trimester) and children: TMP-SMX, nitrofurantoin
-
Prophylactic therapy UTI
- TMP-SMX (half of single strength)
- trimethoprim
- nitrofurantoin
-
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
-
Chronic bacterial prostatitis
due to recurrent UTI from same organism (organism same as in acute bacterial prostatitis)
-
Chronic abacterial prostatitis
- most common prostatitis
- lacking history of recurrent UTI
-
Granulomatous prostatitis
- caused by treatment of bladder cancer w/BCG (bacillus calmette guerin) or
- from fungal source seen in immunocomprimsed pts
-
Gold standard for diagnosis of prostatitis
prostatic massage causing a purulent discharge that gets sent to lab
-
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
-
Chornic prostatitis treatment
- fluoroquinolone (cipro, levo)
- TMP-SMX
|
|