UTI

Question 1

What are the 2 populations of patients that should be screened if they have asymptomatic bacteriuria?

Answer 1

Pregnant women
Prior urologic procedure where there is a risk of mucosal bleeding

Question 2

How long would you treat a pregnant patient with asymptomatic bacteriuria?

Answer 2

3-7 days - shortest effective course

Question 3

How long should you treat a patient that had a prior urologic procedure where there is a risk of mucosal bleeding and has asymptomatic bacteriuria?

Answer 3

1-2 dose short course

Question 4

What are the 1st line options for uncomplicated UTI management?

Answer 4

Nitrofurantoin 100 mg BID x5 day treatment
Bactrim BID x3 days
Fosfomycin 3g x single dose

Question 5

What are the 2nd line options for uncomplicated UTI management?

Answer 5

Oral beta-lactams x5-7 days
FQ’s x 3 days (cipro or levo)

Question 6

What are the 1st line PO options for complicated UTI management?

Answer 6

Bactrim x7 days
Levo/cipro x5-7 days

Question 7

What are the 2nd line PO options for complicated UTI management?

Answer 7

PO beta-lactams x7 days

Question 8

What are the PO beta-lactam options?

Answer 8

Cephalexin, Cefuroxime, cefdinir, cefpodoxime, amoxi-clav

Question 9

What is the DOT caveat regarding the PO options for complicated UTI treatment?

Answer 9

Need to include the days/doses of IV antibiotic therapy that targeted the specific bug in the treatment days

Question 10

For inpatient management of complicated UTI, what is the 1st line option?

Answer 10

Ceftriaxone

Question 11

For inpatient management of complicated UTI, when should you avoid using levofloxacin or ciprofloxacin (FQs)?

Answer 11

If the patient has had exposure to the class within 12 months

Question 12

What line option are FQs in the treatment of complicated UTIs?

Answer 12

2nd line

Question 13

How do you treat a patient in the hospital who has a complicated UTI and has a history of colonization of an ESBL-producing organism?

Answer 13

Ertapenem

Question 14

How do you treat a patient in the hospital who has a complicated UTI and a history of Pseudomonas infection?

Answer 14

Piperacillin-tazobactam

Good kidney perfusion & covers PSA

Question 15

What are good step-down/PO options for patients that clinically improve and can be discharged before being fully treated for pyelonephritis?

Answer 15

Levo/Cipro x 5-7 days TOTAL

TMP/SMX (bactrim) x 7 days TOTAL

PO beta-lactams x 7 days TOTAL

Question 16

What does the “TOTAL” refer to in the previous question?

Answer 16

The IV medications/days that the patient received while inpatient need to be considered in the total days of treatment the patient is receiving

Question 17

A patient was admitted to the hospital with pyelonephritis 2 days ago, and upon admission, they began Cefriaxone therapy to treat. They are now being discharged, how long should they be on the PO cephalexin the doctor ordered for them?

Answer 17

5 days
The patient received 2 days of therapy in the hospital. PO cephalosporins require 7 days of treatment, so there are 5 days more of treatment that the patient requires for the disease state

Question 18

In a patient that is experiencing asymptomatic bacteriuria (and falls into one of the categories that requires treatment), what is the best option?

Answer 18

Cephalexin or cefdinir
They are less likely to have resistance to E. coli & typically that is what causes asymptomatic bacteriuria

Question 19

What antibiotics WOULD NOT be appropriate options for complicated UTI management

Answer 19

Nitrofurantoin and fosfomycin

Question 20

If a pregnant patient is being treated for asymptomatic UTI - what are 2 options that would only be possible in the 1st trimester?

Answer 20

Nitrofuranoin and TMP/SMX

Question 21

What are the most common bacteria that cause UTI?

Answer 21

Enterobacterales
E. coli, klebsiella, proteus
Occasionally pseudomonas

Question 22

If a patient has a healthcare exposure UTI, what organisms need to be empirically covered?

Answer 22

Pseudomonas, enterococci and staph

Question 23

What symptoms in addition to local bladder signs would make you concerned that your patient is presenting with a complicated UTI?

Answer 23

Fever
Flank pain
Chills, rigors, hemodynamic instability
Costovertebral angle tenderness