Urinary%20Tract%20Infections

1
Urinary Tract Infections

• Tory Davis, PA-C
• UNE PA Program

2
UTI

• Can involve any part of urinary tract
• Urethra
• Bladder
• Ureter(s)
• Kidney(s)
• Bladder and urethra most commonly involved

3
How, who and why

• MC pathogen E.coli from GI tract (70-80)
• Also Enterococcus faecalis
• In women
• Close proximity of urethra to anus
• Short distance from urethral opening to bladder
• In men
• more often due to obstruction, incl
• Structural abnormalities
• Catheterization
• Neurogenic bladder
• Enlarged prostate

4
Symptoms Can Indicate Location

• Urethritis causes dysuria
• Cystitis causes
• Urinary urgency frequency, hematuria,
  suprapubic pain, malodorous urine
• Pyelonephritis
• flank pain, fevers/chills, nausea/vomiting

5
Risk Factors

• Female
• Sexually active
• Use of contraceptive diaphragm and/or spermicidal
  agents
• Aging
• Post meno ?estrogen causes thinner tissue in vag,
  urethra, bladder base

6
More risk factors

• For both males and females
• Urinary tract obstruction
• Immunocompromise
• Urinary catheter -

7
Work up

• History past UTI, blood present, flank pain,
  recent intercourse (new bacteria),
• PE
• CVAT (costoverterbral angle tenderness bang
  on kidneys) make you think pyelo.

8
Diagnosis

• Clean-catch (midstream urine)
• Dip for nitrites (b/c bac-t produce enzyme that
  converts urine nitrates to nitrites) and
  leukoesterases (protein produced by WBCs)
• Microscopy for WBCs
• Urine culture and sensitivity

9
Antibiotics

• In an uncomplicated outpt, no catheter
• Bactrim (TMP/SMX) DS (double strength) bid for 3
  days
• Fluoroquinolone (ie Ciprofloxacin) BID x 3 d
• Amoxicillinclavanulate (Augmentin)
• Nitrofurantoin (Macrobid)

10
And have a heart..

• Urinary analgesic phenazopyridine (Pyridium) 200
  mg TID prn dysuria
• NB - Makes urine orange or blue

11
Tx other

• Fluids- lots of water
• Avoid bladder irritants- coffee, soda, alcohol
• Cranberry- decreases ability of bac-t to adhere
  to bladder wall

12
UTI Prevention

• Cranberry
• Wipe front-to-back
• Urinate after intercourse
• Avoid irritants, incl feminine hygiene products
  and smoking
• Shower rather than bath
• Prophylactic abx for recurrent UTIs
• Dosing daily low dose vs post-sex dose vs prn
  symptomatic dosing

13
Special populations require special
considerations

• Like who?
• Whats special about them?

14
Pyelonephritis

• Ascending infection from lower urinary tract
  travels up ureters to the pyelum (pelvis) of the
  kidney (nephros) and causes an itis
• Or hematogenous spread
• Not good
• Sick people

15
Pyelo

• Fevers
• Rigors
• Flank pain
• Nausea/vomiting
• CVAT
• /- lower UTI sx
• blood cultures
• But good hx and PE, plus urine may be enough

16
Pyelo Tx

• Admission if fevers and leukocytosis
• IV fluids
• IV abx (Cipro, ampicillin if preg)
• Continue abx until fever-free x 24h, but can
  switch to oral dosing when pt improves