treating students with urinary tract infections n.
Skip this Video
Loading SlideShow in 5 Seconds..
Treating Students with Urinary Tract Infections PowerPoint Presentation
Download Presentation
Treating Students with Urinary Tract Infections

Loading in 2 Seconds...

play fullscreen
1 / 26

Treating Students with Urinary Tract Infections - PowerPoint PPT Presentation

  • Uploaded on

Treating Students with Urinary Tract Infections. Sara Mackenzie, MD, MPH Regional Health Specialist October 18, 2012. After this presentation, you will be able to:. Describe the prevalence of UTI in men and women Describe how to assess for uncomplicated UTI

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Treating Students with Urinary Tract Infections' - rafael-houston

Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
treating students with urinary tract infections

Treating Students with Urinary Tract Infections

Sara Mackenzie, MD, MPH

Regional Health Specialist

October 18, 2012

after this presentation you will be able to
After this presentation, you will be able to:
  • Describe the prevalence of UTI in men and women
  • Describe how to assess for uncomplicated UTI
  • List common antibiotics and indications for treatment of uncomplicated UTI
  • Identify red flags for complicated UTI or other infections (such as STI)
can i get a sense of who is on call
Can I get a sense of who is on call?
  • Center physician?
  • Center health and wellness manager?
  • Center nurse or LPN?
  • Other?

UTI = urinary tract infection

Lower urinary tract: UTI=cystitis= bladder infection

Upper urinary tract: pyelonephritis=

kidney infection

why discuss
Why discuss?
  • Global:

> 250 million UTIs/yr

> $7 billion direct costs

  • United States, annual figures:

> 7 million uncomplicated UTIs

> 250,000 acute pyelonephritis

> 4 million UTIs in pregnancy

> 1 million catheter-associated UTIs

in women
In women:
  • Acute, uncomplicated UTI:
    • 3% of all women visit ≥ once a year
    • ≥ 50% report at least one per lifetime
  • Recurrent UTI:
    • 20-40% develop frequent (≥ 3/yr.)
in men
In men:
  • Incidence significantly lower
    • 5 to 8 UTI per year per 10,000 men
  • Longer urethral length, drier periurethral environment, less frequent colonization with bacteria around urethra, and antibacterial substances in prostatic fluid
  • A UTI is said to be “complicated” UTI if:
    • Diabetes
    • Pregnancy
    • History of pyelo in last year
    • Antibiotic resistance
    • Symptoms more than 7 days before seeking care
    • Hospital acquired infection
    • Functional or structural abnormality (such as stones, anatomical)
    • Immunosuppression
    • Male
  • Important to identify as higher risk of failing therapy
  • To say another way—a UTI is said to be “uncomplicated” if:
    • Female
    • Non-pregnant
    • Otherwise healthy
    • Normal urinary tract
case 1
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 UTI
  • Complicated UTI
  • Need more information
presentation lower uti
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%
  • Review clinical history – up to date problem list 
  • Review recent antibiotic use
  • Ask about recent new sexual partners (STI risk) and pregnancy risk
  • Physical exam: assess for fever, costovetebral angle tenderness and abdominal exam
  • Pelvic not usually indicated
evaluation continued
Evaluation (continued):
  • Do you need to do urinalysis:
    • Leukocyte esterase detects white blood cells
    • Nitrite detects enterobacteriaceae
    • Hematuria common in UTI
  • Dipstick 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!

back to the case
Back to the Case
  • 22 Y/O with dysuria, frequency, urgency,
  • No prior medical history, antibiotic use, previous UTI or risk for STI or pregnancy
  • No fever, no CVA tenderness
  • Do you need to do a urine culture?
    • Yes
    • No
    • Need more information
urine culture
Urine Culture
  • Empiric treatment usually indicated as pathogens are predictable

*Uncomplicated UTI and pyelo 75-95% e.coli

urine culture1
Urine culture

Culture indicated if:

  • Symptoms not characteristic
  • Persist or recur within 3 months of prior infection or antibiotic use
  • If not responding to empiric treatment within 24 to 48 hours
  • If suspect complicated infection
  • In all women with suspected pyelonephritis
  • All men suspected to have UTI
what antibiotic for uncomplicated cystitis
What antibiotic for uncomplicated cystitis?
  • Target for e. coli
  • Weigh cost, availability, allergy profile
  • Nitrofurantoin 100mg twice daily for 7 days


  • Trimethaprimsulfamethoxazole (Bactrim DS) 1 pill twice daily for 3 days
what antibiotic should be used
What antibiotic should be used?
  • Consider local resistance patterns
  • Local public health department or hospital should have information on resistance patterns in community

E. coli resistance (UW Hall Health N=1,284)

Empiric bactrim treatment should be avoided if local resistance patterns exceed 20%

  • Not recommended as first line by IDSA 2011 guidelines
    • Selection of more drug resistant organisms
    • Colonization with multidrug resistant organisms
    • Reserve for more serious infections
uti prevention
UTI Prevention
  • 20 to 40% of women will develop recurrent (>3/year)
  • Frequency of sexual intercourse strong risk factor
  • Review contraceptive options – avoid spermicides
  • Discuss urination after sex and increase fluids
  • Cranberry juice ??
uti prevention1
UTI Prevention
  • Consider antibiotic prophylaxis
    • Prophylaxis advocated if 2 or more in 6 months or 3 or more over 12 months
      • After sex – single post coital dose
      • Daily – proven reduction in recurrence; take for 6 to 12 months;
      • Nitrofurantoin or bactrim or cipro can be used