Elderly pts w/ UTIs present with which 3 sxs?
- AMS
- Change in eating habits
- GI sxs
Patients w/ indwelling catheters or neurologic disorders may present w/ which 2 sxs?
- Flank pain
- Fever
3 biochemical tests for UTI
- Common dipstick test
- Leukocyte esterase dipstick test (detects pyuria)
- Urine culture (most reliable)
4 goals of UTI tx
- Eradicate invading organism(s)
- Prevent or treat systematic consequences of infection
- Prevent recurrence of infection
- Decrease potential for collateral damage with too broad of antimicrobial therapy
Uncomplicated UTIs are mostly caused by what organism?
75-95% caused by Escherichia coli
Remainder:
- Staph saprophyticus
- Klebsiella pneumoniae
- Proteus
Complicated infections may be associated w/ other gram negative organisms and ______.
Enterococcus faecalis
Management for uncomplicated UTIs
- Short course (3 days) w/ trimethoprim-sulfamethoxazole (bactrim)
- 1 dose of fosfomycin
- 5 days of nitrofurantoin
What 2 fluoroquinolones should be reserved for suspected pyelonephritis or complicated infections?
- Ciprofloxacin
- Levofloxacin
(Short course for 3 days)
Tx for pregnant women w/ UTI from either E. coli or Staph sapro
- Amoxicillin - clavulanate x7 days (augmentin)
- Cephalosporin x7 days
- Trimethoprim-sulfamethoxazole x 7 days (avoid during 3rd trimester)
Tx for gram + bacteria
- Amoxicillin
- Amoxicillin-calvulanic acid
(for 14 days)
Tx for uncomplicated (E. coi) Acute Pyelonephritis
- Quinolone x7 days
- Trimethoprim - sulfa (if susceptible) x 14 days
Tx for complicated Acute Pyelonephritis
- Quinolone x14 days
- Extended spectrum penicillin plus aminoglycoside
Tx for Prostatitis
- Trimethoprim-sulfamethoxazole x4-6 weeks
- Quinolone x4-6 weeks
What is a complication of treating UTI w/ Bactrim?
- Begins w/ flu-like sxs
- Facial swelling
- Tongue swelling
- Hives
- Skin pain
- Red or purple skin rash that spreads within hours to days
- Blisters on your skin and mucous membranes of your mouth, nose, eyes, and genitals
- Shedding of skin
Steven-Johnson Syndrome
What can you add to your diet to prevent UTIs?
- Regulating genitourinary bacteria therefore aiding in prevention of UTIs
- Possible clinical benefit in sexually active adult women w/ recurrent UTI by decreasing adherence of bacteria to the bladder epithelial cells
- Adhesion research and clinical trials show no significant effectiveness w/ this beverage
Cranberry Juice
What is used as a urinary anesthetic / analgesic?
Phenazopyridine HCL
- Azo dye
- Has no antimicrobial properties
- brand names: Pyridium, Azo-Standard, Uristat
- Fallback: analgesics may mask signs/sxs of UTIs not responding to antimicrobial therapy
6 Adverse effects of Phenazopyridine HCl
- Red-orange discoloration of body fluids (& soft contacts)
- Rash
- Anaphylaxis
- Rare hemolytic anemia
- Methemoglobinemia
- Acute renal failure
UTI in pregnancy
- If significant bacteriuria: when is tx recommended?
- What is the tx?
- Tx is recommended if pt is symptomatic OR asymptomatic
- Tx for 7 days with either: Cephalexin, Amoxicillin, or Amox/Clav
