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    Urinary Tract Infection

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    Zaki Achmad Nhr
    This document discusses urinary tract infections including their types, symptoms, diagnosis, and treatment. It covers upper and lower urinary tract infections such as pyelonephritis, cystitis, urethritis, and prostatitis. Common pathogens are E. coli, S. saprophyticus, and others depending on the type of infection. Uncomplicated cystitis in women is usually treated with a 3 day course of antibiotics like TMP/SMX or fluoroquinolones. More severe or complicated infections involving males or structural abnormalities may require longer treatment courses.

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    Urinary Tract Infection

    Uploaded by

    Zaki Achmad Nhr
    33 views24 pages
    This document discusses urinary tract infections including their types, symptoms, diagnosis, and treatment. It covers upper and lower urinary tract infections such as pyelonephritis, cystitis, urethritis, and prostatitis. Common pathogens are E. coli, S. saprophyticus, and others depending on the type of infection. Uncomplicated cystitis in women is usually treated with a 3 day course of antibiotics like TMP/SMX or fluoroquinolones. More severe or complicated infections involving males or structural abnormalities may require longer treatment courses.

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    This document discusses urinary tract infections including their types, symptoms, diagnosis, and treatment. It covers upper and lower urinary tract infections such as pyelonephritis, cystitis, urethritis, and prostatitis. Common pathogens are E. coli, S. saprophyticus, and others depending on the type of infection. Uncomplicated cystitis in women is usually treated with a 3 day course of antibiotics like TMP/SMX or fluoroquinolones. More severe or complicated infections involving males or structural abnormalities may require longer treatment courses.

    Copyright:

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    Download as pptx, pdf, or txt
    33 views24 pages

    Urinary Tract Infection

    Uploaded by

    Zaki Achmad Nhr
    This document discusses urinary tract infections including their types, symptoms, diagnosis, and treatment. It covers upper and lower urinary tract infections such as pyelonephritis, cystitis, urethritis, and prostatitis. Common pathogens are E. coli, S. saprophyticus, and others depending on the type of infection. Uncomplicated cystitis in women is usually treated with a 3 day course of antibiotics like TMP/SMX or fluoroquinolones. More severe or complicated infections involving males or structural abnormalities may require longer treatment courses.

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    Download as pptx, pdf, or txt
    of 24

    URINARY TRACT INFECTION

    Urinary Tract Infection


     Upper urinary tract Infections:
     Pyelonephritis

     Lower urinary tract infections


     Cystitis (“traditional” UTI)
     Urethritis (often sexually-transmitted)

     Prostatitis
    Symptoms of Urinary Tract Infection

     Dysuria
     Increased frequency
     Hematuria
     Fever
     Nausea/Vomiting (pyelonephritis)
     Flank pain (pyelonephritis)
    Culture in UTI
     Positive Urine Culture = >105 CFU/mL
     Most common pathogen for cystitis, prostatitis,
    pyelonephritis:
     Escherichia coli
     Staphylococcus saprophyticus
     Proteus mirabilis
     Klebsiella
     Enterococcus
     Most common pathogen for urethritis
     Chlamydia trachomatis
     Neisseria Gonorrhea
    Lower Urinary Tract Infection - Cystitis

     Uncomplicated (Simple) cystitis


     In healthy woman, with no signs of systemic disease
     Complicated cystitis
     In men, or woman with comorbid medical problems.
     Recurrent cystitis
    Uncomplicated (simple) Cystitis
     Definition
     Healthy adult woman (over age 12)
     Non-pregnant
     No fever, nausea, vomiting, flank pain
     Diagnosis
     urinalysis (no culture or lab tests needed)
     Treatment
     Trimethroprim/Sulfamethoxazole for 3 days
     May use fluoroquinolone (ciprofoxacin or levofloxacin) in patient with
    sulfa allergy, areas with high rates of bactrim-resistance
     Risk factors:
     Sexual intercourse
    Complicated Cystitis
     Definition
     Females with comorbid medical conditions
     All male patients
     Indwelling foley catheters
     Urosepsis/hospitalization
     Diagnosis
     Urinalysis, Urine culture
     Further labs, if appropriate.
     Treatment
     Fluoroquinolone (or other broad spectrum antibiotic)
     7-14 days of treatment (depending on severity)
     May treat even longer (2-4 weeks) in males with UTI
    Special cases of Complicated cystitis

     Indwelling foley catheter


     Try to get rid of foley if possible!
     Only treat patient when symptomatic (fever, dysuria)
     Leukocytes on urinalysis
     Patient’s with indwelling catheters are frequently colonized with great deal of
    bacteria.
     Should change foley before obtaining culture, if possible
     Candiduria
     Frequently occurs in patients with indwelling foley.
     If grows in urine, try to get rid of foley!
     Treat only if symptomatic.
     If need to treat, give fluconazole (amphotericin if resistance)
    Recurrent Cystitis
     Want to make sure urine culture and sensitivity
    obtained.
     May consider urologic work-up to evaluate for
    anatomical abnormality.
    Pyelonephritis
     Infection of the kidney
     Associated with constitutional symptoms –
    fever, nausea, vomiting, headache
     Treatment:
    2-weeks of
    Trimethroprim/sulfamethoxazole or
    fluoroquinolone
    Hospitalization and IV antibiotics if patient
    unable to take po.
    Prostatitis
     Symptoms:
     Pain in the perineum, lower abdomen,, bladder irritation,
    bladder outlet obstruction, and sometimes blood in the
    semen
     Treatment:
     Trimethoprim/sulfamethoxazole, fluroquinolone or other
    broad spectrum antibiotic
     4-6 weeks of treatment
     Risk Factors:
     Trauma
     Dehydration
    Urethritis
     Chlamydia trachomatis
     Frequently asymptomatic in females, but can present with dysuria, discharge
    or pelvic inflammatory disease.
     Chlamydia screening is now recommended for all females ≤ 25 years
     Treatment:
     Azithromycin – 1 g po x 1
     Doxycycline – 100 mg po BID x 7 days
     Neisseria gonorrhoeae
     May present with dysuria,
     Treatment:
     Ceftriaxone – 125 mg IM x 1
     Cipro – 500 mg po x 1
     Levofloxacin – 250 mg po x 1
     Ofloxacin – 400 mg po x 1
     Spectinomycin – 2 g IM x 1
    Question #1
     An 18-year old woman presents with urinary
    frequency, dysuria, and low-grade fever. Urinalysis
    shows pyuria and bacilli. She has never had similar
    symptoms or treatment for urinary tract infection.
    Question # 1
     What category of UTI does this patient have?
     Does this patient require further testing?
     Would you treat this patient, and if so, with what
    and how long?
    Goal
    To eradicate the offending organisms from the
    urinary bladder tissue.
    The main treatment of UTI is by antibiotics.
    Choice of antibiotic depends on:
    Whether infection is complicated or uncomplicated.
    Whether infection is primary or recurrent.
    Type of patient : pregnant women ,children ,
    hospitalized patients , diabetic patients
    Bacterial count.
    Presence of symptoms.
    Choice of antibiotic depend on
    susceptibility pattern ,include:
    Amoxicillin ( with or without clavulanate)
    Cephlosporins ( first or second generation)
    Nitrofurantoin ( long term use)
    Fluoroquinolone ( ciprofloxacin or norfloxacin)
    (not for pregnant women or children) ,first
    choice if other antibiotics are resistant.
    Complicated Cystitis
    Ciprofloxacin for 5-14 days is better choice then
    others.
    Relapsing infection
    Caused by treatment failure or structural
    abnormalities or abscesses.
    Antibiotics used as initial infection
    Treatment for 7-14 days.
    Oral treatment regimens for acute uncomplicated cystitis

    Agent Normal dosage Side effects, cautions


    Ciprofloxacin 250 mg bid for 3 d Drowsiness; increases theophylline levels; avoid in
    pregnancy; avoid divalent and trivalent cations;
    Fosfomycin 3-g single dose Increased incidence of diarrhea and nausea and
    increased relapse rate
    Gatifloxacin 200 mg/d for 3 d Avoid in pregnancy; avoid divalent and trivalent
    cations
    Levofloxacin 250 mg/d for 3 d Avoid in pregnancy; avoid divalent and trivalent
    cations
    Nitrofurantoin 100 mg bid for 7 d Idiosyncratic pulmonary fibrosis; avoid in patients
    with estimated monohydrate/ creatinine clearance <
    Nitrofurantoin 100 mg qid for 7 d 60 mL/min

    Norfloxacin 400 mg bid for 3 d Avoid in pregnancy; avoid divalent and trivalent
    cations
    Ofloxacin 200 mg bid for 3 d Avoid in pregnancy; avoid divalent and trivalent
    cations
    Trimethoprim 100 mg bid for 3 d Nausea
    Trimethoprim- 1 double-strength Nausea; rash;
    sulfamethoxazole tablet bid for 3 d
    Drug safety During pregnancy

    Avoid Ceftriaxone one day before delivery


    Avoid nitrofurantoin and trimethoprim in the first
    trimester can lead to birth defects
    Nitrofurantoin Avoid near term and hemolytic
    anemia in G6PD deficiency(0.0004%)
    Sulfonamides should be avoided in the last days
    before delivery because they can increase the level
    of unbound bilirubin in the neonate

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