thera uti

infection in the prostate

infection in the kidney

infection in the bladder

pyelonephritis

cystitis

• healthy
• premenopausal women
• non-pregnant women
• no known functional or anatomic urological abnormalities

• structural or functional urological abnormalities
• conditions that may increase risk of complications
• men
• post-menopausal women

• diabetes
• neurogenic bladder
• nephrolithiasis
• immunocompromised

• sexual intercourse
• new sexual partner
• use of spermicides
• previous UTI
• history of UTI in 1st degree relative
• inability to void completely

• micturition
• pH of urine (acidic)
• osmolality of urine
• high urea concentration
• high organic acid concentration
• prostatic secretions

• dysuria
• frequency
• urgency
• suprapubic pain
• hematuria
• (-) symptom - absence of vaginal irritation and discharge

• fever (>38C)
• chills
• flank pain
• costovertebral-angle tenderness
• N/V
• W or W/O symptoms of cystitis

• clarity - cloudy
• leukocyte esterase - positive
• nitrite - positive
• blood - positive

• 0 - normal
• 0-5 trace amount
• 5-10 possibly infected
• > 10 infected

• < 10³ generally insignificant
• 10³-10⁴ possible contamination, may repeat
• >10⁴ in males likely a UTI
• >10⁵ in females likely a UTI

young, healthy women with classic symptoms and positive dipstick = uncomplicated, lower UTI

• complicated, lower UTI
• upper UTI
• uncharacteristic symptoms
• persistent symptoms after treatment
• recurrence of UTI <1 month after Tx
• prostatitis

• Escherichia coli
• Staphylococcus saprophyticus
• Klebsiella pneumoniae
• Proteus spp

Staphylococcus epidermidis

• Escherichia coli
• Proteus spp.
• Klebsiella pneumoniae
• Enterococcus spp.
• Pseudomonas aeruginosa

staphylococcus epidermidis

• symptoms persist after 48-72 hours of appropriate antibiotics
• recurrent  symptoms within a few weeks of TX

may mask S&S of UTI's that don't respond to therapy. little clinical role because pt's respond quickly to antimicrobial therapy

• cranberry juice
• topical estrogens
• lactobacilli

• severity
• site of infection
• uncomplicated vs complicated

• availability of agent
• ecologic adverse effects
• side effects
• convenience

• allergy history
• intolerance history
• drug-drug interactions
• adherence patterns

• nitrofurantoin - 5 days
• Bactrim - 3 days
• fosfomycin - 1 dose

• fluoroquinolones - 3days
•    levofloxacin - 250-500mg QD
•    ciprofloxacin - 250mg bid
•    ciprofloxacin ER - 500mg QD
• beta-lactams - 3-7days
•    augmentin
•    cefaclor
•    cepodoxime

• individualize Tx
• always culture and narrow therapy based on
• worry about more pathogens
• longer duration of Tx 5-14 days

• fluoroquinolones
•    levofloxacin - 750mg QD - 5 days
•    ciprofloxacin - 500mg BID - 7-14 days
•    ciprofloxacin ER - 1g QD - 7-14 days

• levofloxacin - 500-750mg - 5days
• ceftriaxone - 1000mg daily - 10-14 days
• carbapenems - 1000mg QD - 10-14 days
• aminoglycosides - 7mg/kg QD - 10-14 days
•    gentamicin

• fluoroquinolones
• bactrim
• beta-lactams

when resistance rates or <10%

• >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

• fever
• chills
• altered mental status
• malaise
• flank pain
• costovertebral angle tenderness
• pelvic discomfort

• odorous urine
• cloudy urine
• pyuria

• don't draw unless symptomatic
• obtain culture prior to Tx
• culture from fresh catheter
• organisms - polymicrobial & multidrug resistant pathogens

• severity of infection
• local resistance patterns
• culture results
• choice is usually similar to Tx of complicated 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

• 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

• pregnant women - 1 screen early in pregnancy
• prior to urologic procedures

• pre-menopausal, non-pregnant women
• diabetic women
• older adults (community and institutionalized)
• spinal cord injuries
• catheterized pts

• 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

• cephalosporins 5-7 days
• nitrofurnatoin 5-7 days
• augmentin 5-7 days
• 2nd line - Bactrim 5-7 days

ceftriaxone - kernicterus

avoid use after 37 weeks due to hemolytic anemia

• avoid in 1st trimester due to CV malformations
• avoid in last weeks of pregnancy due to kernicteus

• reinfections - > 14 days after last UTI
• relapses - within 14 days

• less sex
• avoid spermicides
• pee after sex
• fluids
• no jungle wiping
• avoid douching
• avoid tight fitting underwear

• cranberry
• topical estrogen
• D-mannose

• 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

• 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

• bactrim 1/2 SS tab QD or 3 times weekly
• levofloxacin 500 mg QD
• nitrofurantoin 50-100mg daily
• TMP 100 mg QD

• continue antibiotics for mo. then observe
• may follow urine cultures monthly
• if symptoms develop, pt should be treated for UTI

• fever
• chills
• malaise
• myalgia
• dysuris
• pelvic or perineal pain
• cloudy urin

• E.coli - 50-80 % of all cases
• klebsiella
• proteus
• enterococcus sp.
• pseudomonas sp.

• fluoroquinolones - 2-6 weeks
•   levo - 750 mg QD
•   cipro - 500 mg BID
•   cipro ER - 1G QD
• bactrim - 2-6 weeks
•   160/800mg BID

pt is afebrile for 24-48 hours and can tolerate oral medications