Independent risk factors for ACUTE CYSTITIS (3)

• Frequent sexual intercourse

• History of UTI
• Spermicide

Independent risk factors associated with PYELONEPHRITIS in young healthy women (6)
• frequent sexual intercourse
• New sexual partner
• UTI in the previous 12 months
• Maternal history of UTi
• Diabetes
• Incontinence

Independent risk factors for RECURRENT UTI (5)

• frequent sexual intercourse
• new sexual partner
• First UTI before 15 years of age
• Maternal history of UTI
• Use of spermicide

Risk factors for UTI in healthy postmenopausal women (3)

• sexual activity
• Diabetes mellitus
• Incontinence

Risk factors for RECURRENT UTI in postmenopausal women (2)

• history of postmenopausal UTI
• Anatomic factors affecting bladder emptying
- cystocele
- urinary incontinence
- residual urine
Agents in ACUTE UNCOMPLICATED CYSTITIS (“KEEPS C”)
• Klebsiella - frequent in young women
• E. Coli - majority
• Enterococcus
• Proteus
• S. Saprophyticus
• Citrobacter

Agents in UNCOMPLICATED PYELONEPHRITIS

• E. Coli

Agents in COMPLICATED UTI (eg, CAUTI)

• Klebsiella
• P. Aeruginosa
• Proteus
• Citrobacter
• Acinetobacter
• Morganella

Agents in UTI through Hematogenous spread d/t bacteremia

• Salmonella
• S. Aureus

IMPORTANT CONCEPTS:
• isolation of Salmonella and S. Aureus in a patient WITHOUT A CATHETER or other instrumentation
—————> search for bloodstream source
• isolation of Candida in the urine of a NON-INSTRUMENTED patient
—————> implies genital contamination or potentially widespread visceral dissemination
Mild Pyelonephritis Severe Pyelonephritis
• low-grade fever - high-fever
• With or without lower-back / CVA tenderness - Flank and/or Loin pain
• - rigors
• - nausea
• - vomiting

Cystitis
• dysuria
FEVER
• Urinary frequency • main feature distinguishing cystitis
• Urgency from pyelonephritis

UTI drugs that have MINIMAL EFFECT on fecal flora

• Pivmecillinam
• Fosfomycin
• Nitrofurantoin

Affect the fecal flora more significantly (drugs w rising resistance)

• trimethoprim
• TMP-SMX
• Quinolones
• Ampicillin
Acute Uncomplicated Cystitis
• Antibiotics
- Nitrofurantoin
- TMP-SMX
- Fosfomycin
- Fluoroqionolones
* used if no other therapeutic options
* MC used: ciprofloxacin & Levofloxacin
* Moxifloxacin - not reach adequate urinary levels
- B-lactams (Cefpodoxime & cefexime)
• Urinary Tract Analgesics
- Phenazopyridine - cause significant nausea
- Combination Analgesics
+ Urinary antiseptics (Mehanamine, methylene blue)
+ Urine-acidifying agent (Sodium phosphate)
+ Antispasmodic agent (Hyoscyamine)

Pyelonephritis
• Fluoroquinolones (Oral or IV) (depends on px tolerance for oral intake)
• Ciprofloxacin, Oral (500mg BID, with or without an initial IV 400-mg dose)
• TMP-SMX, Oral (1 DS BID x 14days) (in susceptible patients)
* susceptibility unknown - inital 1g dose Ceftriaxone IV)
• B-lactams, Oral (less effective than fluoroquinolones) (used w caution and close ff-up)
• Fluoroquinolones, IV
FIRST-LINE AGENTS

UTI in PREGNANT WOMEN Acute Uncomplicated Cystitis

• Ntrifurantoin
• Ampicillin & Cephalosphorins • TMP-SMX
* tx of asymptomatic and symptomatic px Pyelonephritis
* with ASB: 4-7 days • fluoroquinolones

• B-lactam Therapy , IV UTI in Pregnant women

• Ampicillin
- for women with overt pyelonephritis • Cephalosphorins

UTI in Men
UTI in Men • Fluoroqionolones
• TMP-SMX
• Fluoroquinolones (7-14d)
CANDIDURIA
• TMP-SMX (if susceptible) (7-14d)
• Fluconazole
*7-day is observed to reduce antibiotic exposure
ACUTE BACTERIAL PROSTATITIS
• for documented Chronic Bacterial Prostatitis • Aminoglycosides
• B-Lactams
—4-6wk course of antibiotic is necessary
• recurrence ——> 12-week treatment CHRONIC BACTERIAL PROSTATITIS
• Ciprofloxacin
• Levofloxacin
Complicated UTI
Xanthogranulomatous Pyelonephritis
• Nephrectomy
Emphysematous Pyelonephritis
• percutaneous drainage, elective nephrectomy
Papillary Necrosis with Obstruction
• Relieve obstruction, preserve renal function

CAUTI
• 7-14d course of antibiotics

CANDIDURIA
• Fluconazole 20-400mg/d x 7-14d
• Fluconazole resistant
Oral Flucytosine
Parenteral Amphotericin B