UTI

Question 1

Symptoms of cystitis:

Answer 1

• Frequent urination
• Dysuria
• hematuria
• suprapubic pain
  (remember, not associated with systemic signs)

Question 2

Symptoms of pyelonephritis:

Answer 2

• costovertebral angle tenderness
• urgency
• systemic symptoms: fever, chills, nausea, vomiting

Question 3

Uncomplicated UTI: def

Answer 3

• Lower urinary symptoms in otherwise healthy young non-pregnant women

Question 4

Complicated UTI: def

Answer 4

• pregnant women
• men
• obstruction
• immunosuppression
• renal failure
• renal transplant
• nosocomial UTI
• cathéter-associated UTI
• renal stones
• pyelonephritis

Question 5

Catheter associated UTI:

Answer 5

source of UTI from catheter

Question 6

Main pathogens for non-complicated UTI

Answer 6

• E.coli
• S. saprophyticus
• enterococcus

Question 7

Main pathogens for complicated UTI

Answer 7

Same as non-complicated +

• Ab resistant E.coli
• pseudomonas

Question 8

Main pathogens for catheter associated UTI

Answer 8

• corynebacterium urealyticum

- candida

Question 9

Diagnosis for UTI:

Answer 9

• urine sample, preferably in mid-stream
• urine dipstick: only gives an initial idea of the disease, whether is hematuria, nitrites, proteinuria etc…
• urinalysis: test for presence of bacteria, hematuria, presence of WBCs, nitrites
• urine culture: to determine the pathogen

Question 10

Goal of UTI treatment:

Answer 10

• 1st thing to do is symptomatic relief

- if no response -> perform an imaging

Question 11

Treatment of UTI: antibiotics used

Answer 11

Clinical response should occur within 24 hours, except for pyelonephritis, should occur within 48-72 hours

• Nitrofurantoin: highly active for E.coli
• TMP + SMX (sulfamethoxazole + trimethorprim)
• fosfomycin
• beta-lactams: amoxicillin
• fluoroquinolones: ciprofloxacin, levofloxacin. For uncomplicated pyelonephritis and complicated UTI

Question 12

Treatment of UTI: prophylaxis of recurrent UTI

Answer 12

• nitrofurantoin
• TMP + SMX orally daily
• antibiotics for 4-6 weeks

Question 13

Treatment of UTI: uncomplicated cystitis

Answer 13

• Nitrofurantoin: highly active for E.coli
• TMP + SMX (sulfamethoxazole + trimethorprim)
• fosfomycin
• beta-lactams: amoxicillin
• fluoroquinolones: ciprofloxacin, levofloxacin.

Question 14

Treatment of UTI: uncomplicated pyelonephritis

Answer 14

• fluoroquinolones

In case of fluoroquinolone resistance -> use ceftriaxone or gentamicin

Question 15

Treatment of UTI: complicated UTIs

Answer 15

• any of the normal used antibiotics is recommended
• when diagnosis of cystitis vs pyelonephritis is unclear -> give TMP + SMX
• UTI in men: TMP + SMX
• if resistant E.coli: nitrofurantoin or fosfomycin (but not for pyelonephritis)

Question 16

Treatment of UTI: Catheter associated UTI

Answer 16

• usually antibiotics for 7 days
• fluoroquinolone for patients who are not severely ill and can take oral antibiotics
• fluconazole for candida