UTI

Question 1

What is a UTI ?

Answer 1

Microorganisms infecting any part of the urinary tract WITH the presence of symptoms NOT JUST COLONIZATION

Question 2

What are the different types of UTI?
1
2
3
4

Answer 2

1. LOWER UTI (most common)
2. Upper UTI
3. Urosepsis
4. Prostatitis

Question 3

A lower UTI (cystitis) presents with ______, _______, ________, ________, __________

Answer 3

burning, frequency, urgency, pain, hematuria

Question 4

Upper UTI (pyelonephritis aka kidney infection) presents with +/- lower UTI symptoms PLUS ________, ______, _____ etc

Answer 4

flank pain, fever, chills, N/V, CVA tenderness

Question 5

Prostatitis is a type of UTI common in

Answer 5

MEN

Question 6

An uncomplicated UTI is defined as a UTI in ____________ female patients __________ structural/ functional abnormalities or _____________

Answer 6

non-pregnant female patients WITHOUT // immunocompromised

Question 7

Most common pathogens for a uncomplicated UTI
1.
2.
3.
4.
5.

Answer 7

1. E.Coli (70-90%)
2. P. mirabilis
3. K. pneumoniae
   “PEK”
4. S. SAPROPHYTICUS
5. Enterococcus spp

Question 8

A complicated UTI is defined as a patient having structural or functional abnormalities that interfere with normal flow of urine and the following:

Answer 8

• Male
• Children
• Pregnant
• Diabetes
• Catheters
• Immunocompromised

Question 9

Most common pathogens for complicated UTI
1.
2.
3.
4.
5.

Answer 9

1. Ecoli (~50%)
2. P. mirabilis
3. Enterococcus faecalis
4. Staphylococcus
5. Pseudomonas
   Acinetobacter

Question 10

Asymptomatic bacteria is defined as

Answer 10

Bacteriuria in the absence of symptoms
common pathogens E. coli etc

Question 11

Recurrent UTI is defined as

Recurrent UTI causative pathogens are:

Answer 11

2 episodes of uncomplicated UTI in past 6 months
3 episodes of uncomplicated UTI in past 12 months

Same as initial pathogens

Question 12

Urinary tract infection most common route is _________ colonization of urethra by fecal flora, can ascend to bladder and kidneys

Answer 12

Ascending

Question 13

List some risk factors of UTI
1.
2.
3.
4. Diabetes
5. Catheter, renal dysfx
6. neurologic dysfunction
7. previous antibiotic use
8. sexual intercourse

Answer 13

1. Age young very old
2. Females
3. Pregnancy

Question 14

Diagnosis of UTI is based on _______ +/- urine culture and urinalysis

Answer 14

symptoms

Question 15

Indication for urine culture:
1.
2.
3.
4.

Answer 15

1. ALWAYS for pyelonephritis and or complicated UTI
2. ALWAYS for pregnancy or diagnostic uncertainty
3. bacterial prostatitis
4. uncomplicated cystitis only if failure to respond or early recurrence or relapse

Question 16

Examples of non pharm therapy for UTI
1.
2.
3.

Answer 16

1. Surgical for deformities
2. fluid hydration
3. cranberry juice extract

probiotics low evidence

Question 17

Treatment of UNCOMPLICATED UTI
1st line therapy
1.
2.
3.

Answer 17

1. Nitrofurantoin po x 5 days
2. tmp-smx (or tmp alone) po x 3 days
3. fosfomycin 3 g PO x 1 dose (only available as powder) good for ESBL / pseudomonas

2nd Line
1. FQ (Cipro/Levo/Norflox) Po x 3D
2. Beta-lactams 3-7 d (lower efficacy)

Question 18

Ampicillin or Amoxicillin alone should be avoided in UTI treatment because ?

Answer 18

HIGH E.Coli resistance

Question 19

Asymptomatic bacteriuria treatment?

Answer 19

Bacteriuria without symptoms does not need to be treated

E.Coli most common

Question 20

The only time patients with asymptomatic bacteriuria should be treated are if
1.
2.

Answer 20

1. Pregnant
2. Undergoing endourological procedures

Question 21

Treatment of COMPLICATED UTI
1st line therapy
1.
2
3.
4.

Answer 21

1.Tmp-smx
2. FQ x 7-14d
3. amox-clav
4. cefixime

Question 22

Pyelonephritis Empiric Treatment
Outpatient uncomplicated (Mild-Mod)
1.

Answer 22

FQ (cipro/levo) x 5-7d

2nd line
Amox clav
tmp-smx
tmp

Question 23

Pyelonephritis Empiric Treatment
Inpatient
1.
2.
3.
4.

Answer 23

1. AMG IV (+ ampicillin if enterococcus suspected) x 10-14 d
2. Carbapenem IV +/- ampicillin (if not using imipenem) x 7-14 d
3. FQ IV
4. 3rd gen cephalosporin (cefepime) +/- ampicillin or piptaz IV x10-14d

Question 24

The following two classes of antibiotics should be used when considering additional coverage for ESBL hospital-acquired UTI
1.
2.

Answer 24

1. Carbapenem (pref Ertapenem IV)
2. AGs

Question 25

The following antibiotics should be used when considering additional coverage for Pseudomonas spp hospital-acquired UTI 1. 2. 3. 4. 5.

Answer 25

1. pip-taz 2. meropenem 3. imipenem 4. cipro/levo 5. cefepime

Question 26

The following antibiotics should be used when considering additional coverage for resistant enterococcus hospital-acquired UTI 1 2 3

Answer 26

1. vancomycin IV 2. linezolid 3. daptomycin

Question 27

The treatment of acute or chronic prostatitis involves either of these two medications: 1. 2.

Answer 27

1. FQ 2. TMP-SMX Ceftriaxone then doxycycline if STI related

Question 28

The following are common pathogens for prostatitis: Ecoli, P. aeruginosa, Others can be STI related, and these two are: 1 2

Answer 28

1. N. Gonorrhea 2. C. trachomatis

Question 29

Recurrent UTI infections, defined as >2 infections in 6 months or >3 in 12 months can be treated via these 3 methods 1. 2. 3.

Answer 29

1. short course self therapy 2. post-intercourse 3. long term prophylaxis

Question 30

First line options for post intercourse prophylaxis include the following: 1. 2. 3.

Answer 30

1. TMP SMX 2. Macrobid 3. FQ (norflox/cipro) TMP, Cephalexin

Question 31

First line options for long-term low dose prophylaxis for recurrent UTI include the following: 1 2 3

Answer 31

1 TMP SMX (1st) 2 macrobid 3 FQ (norflox/cipro) TMP, cephalexin, FOSFOMYCIN, vaginal estrogens

Question 32

Which of the following medications is safe for use in UTI pregnant patient? a. Nitrofurantoin b. TMP-SMX c. FQ d. AG e. Amox/Clav

Answer 32

E

Question 33

Candida spp and other fungi may cause UTIs in patients with _____________

Answer 33

indwelling urinary catheters

Question 34

In patients with diabetes and candiduria, ________ is the preferred treatment

Answer 34

Fluconazole

Question 35

A patient with asymptomatic catheter UTI should be treated? T or F

Answer 35

FALSE, do not treat if patient is asymptomatic CULTURE and remove catheter Mild/Mod symptoms: FQ or ceftriaxone