Presentation on theme: "Treating Students with Urinary Tract Infections"— Presentation transcript:
1 Treating Students with Urinary Tract Infections Sara Mackenzie, MD, MPHRegional Health SpecialistOctober 18, 2012
2 After this presentation, you will be able to: Describe the prevalence of UTI in men and womenDescribe how to assess for uncomplicated UTIList common antibiotics and indications for treatment of uncomplicated UTIIdentify red flags for complicated UTI or other infections (such as STI)
3 Can I get a sense of who is on call? Center physician?Center health and wellness manager?Center nurse or LPN?TEAP/CMHC?Other?
5 Why discuss? Global: United States, annual figures: > 250 million UTIs/yr> $7 billion direct costsUnited States, annual figures:> 7 million uncomplicated UTIs> 250,000 acute pyelonephritis> 4 million UTIs in pregnancy> 1 million catheter-associated UTIs
6 In women: Acute, uncomplicated UTI: Recurrent UTI: 3% of all women visit ≥ once a year≥ 50% report at least one per lifetimeRecurrent UTI:20-40% develop frequent (≥ 3/yr.)
7 In men: Incidence significantly lower 5 to 8 UTI per year per 10,000 menLonger urethral length, drier periurethral environment, less frequent colonization with bacteria around urethra, and antibacterial substances in prostatic fluid
10 Complicated A UTI is said to be “complicated” UTI if: Diabetes PregnancyHistory of pyelo in last yearAntibiotic resistanceSymptoms more than 7 days before seeking careHospital acquired infectionFunctional or structural abnormality (such as stones, anatomical)ImmunosuppressionMaleImportant to identify as higher risk of failing therapy
11 UncomplicatedTo say another way—a UTI is said to be “uncomplicated” if:FemaleNon-pregnantOtherwise healthyNormal urinary tract
12 Case 1:22-year-old female who is otherwise healthy comes in to Health and Wellness complaining that “it hurts when I pee, I feel like I have to go right away, and I have to pee all the time”.Uncomplicated UTIComplicated UTINeed more information
13 Presentation lower UTI Dysuria, urgency and frequency [Suprapubic pain +/- hematuria (blood in urine)]The probability of cystitis in a woman with one of the first three symptoms is 50%The probability of cystitis in a woman with dysuria, frequency and NO vaginal discharge or irritation is 90%
14 Evaluation: Review clinical history – up to date problem list Review recent antibiotic useAsk about recent new sexual partners (STI risk) and pregnancy riskPhysical exam: assess for fever, costovetebral angle tenderness and abdominal examPelvic not usually indicated
15 Evaluation (continued): Do you need to do urinalysis:Leukocyte esterase detects white blood cellsNitrite detects enterobacteriaceaeHematuria common in UTIDipstick most accurate for predicting UTI if positive for either leukocyte esterase or nitrite***Results of dipstick provide little additional useful information if history strongly suggestive of UTI!
16 Back to the Case 22 Y/O with dysuria, frequency, urgency, No prior medical history, antibiotic use, previous UTI or risk for STI or pregnancyNo fever, no CVA tendernessDo you need to do a urine culture?YesNoNeed more information
17 Urine CultureEmpiric treatment usually indicated as pathogens are predictable
18 Microbiology*Uncomplicated UTI and pyelo 75-95% e.coli
19 Urine culture Culture indicated if: Symptoms not characteristic Persist or recur within 3 months of prior infection or antibiotic useIf not responding to empiric treatment within 24 to 48 hoursIf suspect complicated infectionIn all women with suspected pyelonephritisAll men suspected to have UTI
20 What antibiotic for uncomplicated cystitis? Target for e. coliWeigh cost, availability, allergy profileNitrofurantoin 100mg twice daily for 7 daysORTrimethaprim sulfamethoxazole (Bactrim DS) 1 pill twice daily for 3 days
21 What antibiotic should be used? Consider local resistance patternsLocal public health department or hospital should have information on resistance patterns in community
22 E. coli resistance (UW Hall Health N=1,284) Empiric bactrim treatment should be avoided if local resistance patterns exceed 20%
23 Fluoroquinolones:Not recommended as first line by IDSA 2011 guidelinesSelection of more drug resistant organismsColonization with multidrug resistant organismsReserve for more serious infections
25 UTI Prevention 20 to 40% of women will develop recurrent (>3/year) Frequency of sexual intercourse strong risk factorReview contraceptive options – avoid spermicidesDiscuss urination after sex and increase fluidsCranberry juice ??
26 UTI Prevention Consider antibiotic prophylaxis Prophylaxis advocated if 2 or more in 6 months or 3 or more over 12 monthsAfter sex – single post coital doseDaily – proven reduction in recurrence; take for 6 to 12 months;Nitrofurantoin or bactrim or cipro can be used