Podcast
Questions and Answers
What is the minimum CFU/mL count combined with symptoms that indicates a UTI?
What is the minimum CFU/mL count combined with symptoms that indicates a UTI?
Which of the following characteristics is associated with pyuria?
Which of the following characteristics is associated with pyuria?
Which medication is considered a first-line treatment for uncomplicated cystitis?
Which medication is considered a first-line treatment for uncomplicated cystitis?
What is the key contraindication for using Nitrofurantoin?
What is the key contraindication for using Nitrofurantoin?
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What makes ciprofloxacin and levofloxacin inappropriate as first-line agents for uncomplicated cystitis?
What makes ciprofloxacin and levofloxacin inappropriate as first-line agents for uncomplicated cystitis?
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When treating uncomplicated pyelonephritis, what is a common practice?
When treating uncomplicated pyelonephritis, what is a common practice?
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What should be avoided if local susceptibility for trimethoprim/sulfamethoxazole is less than 80%?
What should be avoided if local susceptibility for trimethoprim/sulfamethoxazole is less than 80%?
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Which clinical aspect is treated as a complicated UTI for exam consistency?
Which clinical aspect is treated as a complicated UTI for exam consistency?
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Which symptom is specifically associated with pyelonephritis but not cystitis?
Which symptom is specifically associated with pyelonephritis but not cystitis?
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What is a common microorganism responsible for uncomplicated urinary tract infections?
What is a common microorganism responsible for uncomplicated urinary tract infections?
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Which of the following is NOT considered a risk factor for urinary tract infections?
Which of the following is NOT considered a risk factor for urinary tract infections?
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What is the minimum count of CFU/mL in a urine culture that is indicative of bacteriuria?
What is the minimum count of CFU/mL in a urine culture that is indicative of bacteriuria?
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Which of these is a characteristic symptom of cystitis?
Which of these is a characteristic symptom of cystitis?
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What is the standard of care regarding the use of nitrofurantoin during pregnancy?
What is the standard of care regarding the use of nitrofurantoin during pregnancy?
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Which population is typically considered at an increased risk for complicated urinary tract infections?
Which population is typically considered at an increased risk for complicated urinary tract infections?
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Which of the following factors is NOT associated with complicated urinary tract infections?
Which of the following factors is NOT associated with complicated urinary tract infections?
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Which antibiotic is recommended for treating mild to moderate pyelonephritis in pregnant women?
Which antibiotic is recommended for treating mild to moderate pyelonephritis in pregnant women?
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Which of the following medications poses a risk of fetal ototoxicity?
Which of the following medications poses a risk of fetal ototoxicity?
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What distinguishes complicated UTIs from uncomplicated UTIs?
What distinguishes complicated UTIs from uncomplicated UTIs?
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What is a potential concern with the use of sulfonamides during pregnancy?
What is a potential concern with the use of sulfonamides during pregnancy?
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What is the appropriate treatment duration for uncomplicated urinary tract infections in pregnant women?
What is the appropriate treatment duration for uncomplicated urinary tract infections in pregnant women?
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Which of the following is the first-line treatment for uncomplicated pyelonephritis?
Which of the following is the first-line treatment for uncomplicated pyelonephritis?
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When should inpatient hospitalization be considered for pyelonephritis?
When should inpatient hospitalization be considered for pyelonephritis?
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What is the recommended duration of treatment with Levofloxacin for uncomplicated pyelonephritis?
What is the recommended duration of treatment with Levofloxacin for uncomplicated pyelonephritis?
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Which antibiotic should generally not be used for treating uncomplicated pyelonephritis?
Which antibiotic should generally not be used for treating uncomplicated pyelonephritis?
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What is a characteristic of complicated UTIs?
What is a characteristic of complicated UTIs?
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Phenazopyridine should be used with caution in which condition?
Phenazopyridine should be used with caution in which condition?
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What should be done prior to initiating antibiotics for complicated UTIs?
What should be done prior to initiating antibiotics for complicated UTIs?
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Which statement accurately describes the use of IV β-Lactams in treating pyelonephritis?
Which statement accurately describes the use of IV β-Lactams in treating pyelonephritis?
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What is the first-line drug for uncomplicated cystitis caused by Enterobacterales that produce an ESBL enzyme?
What is the first-line drug for uncomplicated cystitis caused by Enterobacterales that produce an ESBL enzyme?
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In cases of bacteriuria during pregnancy, what is the critical cutoff for CFU/mL that indicates asymptomatic bacteriuria?
In cases of bacteriuria during pregnancy, what is the critical cutoff for CFU/mL that indicates asymptomatic bacteriuria?
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Which of the following is recommended to avoid in pregnant women?
Which of the following is recommended to avoid in pregnant women?
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Which treatment is appropriate for pyelonephritis and complicated UTIs caused by ESBL-producing Enterobacterales?
Which treatment is appropriate for pyelonephritis and complicated UTIs caused by ESBL-producing Enterobacterales?
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What does the IDSA recommend for high-risk neutropenia patients regarding asymptomatic bacteriuria (ASB)?
What does the IDSA recommend for high-risk neutropenia patients regarding asymptomatic bacteriuria (ASB)?
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What should be considered before using imipenem-cilastatin during pregnancy?
What should be considered before using imipenem-cilastatin during pregnancy?
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If a pregnant woman has a positive urinalysis for bacteriuria~12–16 weeks gestation, what is the next step?
If a pregnant woman has a positive urinalysis for bacteriuria~12–16 weeks gestation, what is the next step?
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In the management of patients critically ill with infections caused by Enterobacterales, which class of drugs is preferred?
In the management of patients critically ill with infections caused by Enterobacterales, which class of drugs is preferred?
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Study Notes
UTI Diagnosis and Urinalysis
- A UTI is indicated by ≥102 CFU/mL plus symptoms.
- Urinalysis reveals nitrites (from enteric bacteria), leukocyte esterase (from activated WBCs), pyuria (>10 WBCs/mm³), and bacteria (not quantified).
Pathogenesis and Microbiology
- Pathogenesis includes risk factors like structural abnormalities, catheterization, pregnancy, and T2DM.
- Uncomplicated UTIs primarily caused by Escherichia coli, followed by Proteus and Klebsiella.
- Complicated UTIs can involve Candida species, Pseudomonas aeruginosa, and Enterococcus.
Presentation
- Symptoms of cystitis: urinary frequency, urgency, dysuria, with possible pyuria or hematuria.
- Symptoms of pyelonephritis: cystitis symptoms plus flank pain, fever, chills, and leukocytosis.
Treatment: Uncomplicated UTIs
-
1st Line:
- Nitrofurantoin 100 mg PO bid for 5 days (CI if CrCl < 30 ml/min).
- Trim/Sulfa 160/800 mg (DS) PO bid for 3 days (avoid if local susceptibility <80%).
-
2nd Line:
- Fosfomycin 3 g PO as a single dose (inferior bacterial efficacy).
-
3rd Line:
- Ciprofloxacin or Levofloxacin PO for 3 days (avoid if >10% resistance).
- PO β-Lactams (like Augmentin) for 3-7 days (amoxicillin/ampicillin are not recommended due to resistance).
Complicated UTIs
- Increased risk of therapy failure; requires urine culture before starting antibiotics.
- Diagnosis includes pyuria that does not confirm a UTI, while the absence may help rule out.
- Patients who fail to improve or have severe symptoms may require hospitalization.
Uncomplicated Pyelonephritis Treatment
- 1st Line: Ciprofloxacin or Levofloxacin for 7 days (monitor local resistance).
- 2nd Line: Trim/Sulfa for 14 days with possible IV antibiotics before discharge if necessary.
- 3rd Line: IV β-Lactams, discouraged for PO β-Lactams unless susceptible.
Pain Management
- Phenazopyridine (Pyridium, Azo) for symptomatic relief; causes urine discoloration.
Asymptomatic Bacteriuria (ASB)
- Screening recommended for pregnant women, not for high-risk neutropenic patients or patients with indwelling catheters.
Pregnancy Considerations
- Urinalysis in early pregnancy to screen for bacteriuria is essential.
- Treatment should avoid quinolones and tetracyclines; nitrofurantoin is avoided in the 1st trimester and near term.
- Pyelonephritis treated with IV antibiotics until the patient is stable, followed by PO options.
Key Takeaways
- Understand differences between uncomplicated and complicated UTIs.
- Ensure that symptomatic treatment considers underlying conditions and resistance patterns.
- Always assess for pyelonephritis in complicated cases and treat accordingly.
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Description
Test your knowledge on urinary tract infections (UTIs), including their pathogenesis, microbiology, and treatment options. This quiz covers both uncomplicated and complicated UTIs, focusing on key symptoms and urinalysis findings. Are you ready to challenge what you know about UTIs?
