Editing AUA & CUA Recurrent UTI (2019) (section)

== Answers ==

# What is the definition of recurrent UTIs?
#* ≥2 UTI within 6 months or ≥3 UTI within 12 months
# What is an uncomplicated UTI?
#* A UTI in a female patient has no known factors that would make her more susceptible to develop a UTI
# List 10 factors that classify a UTI as complicated.
#* UTI with multidrug resistant bacteria
#* Anatomic abnormality: cystocele, diverticulum, fistula
#* Iatrogenic: indwelling catheter, nosocomial infection, surgery
#* Voiding dysfunction: VUR, neurologic disease, pelvic floor dysfunction, high PVR, incontinence
#* Obstruction: Bladder outlet obstruction, ureteral stricture, UPJO
#* Other: pregnant, urolithiasis, diabetes, immunosuppression, UTI in men
# What are the 3 antibiotic regimens to treat recurrent UTIs?
## Self-start
## Prophylaxis
## Post-coital
# Urine culture demonstrating growth of which bacteria would be considered contaminant?
## Lactobacilli
## Corynebacteria
## Group B Streptococci
## Non-saprophyticus coagulase-negative Staphylococci
# What is the workup of a patient with recurrent UTIs?
#* History, physical exam (no role for cystoscopy or imaging in initial workup)
# What is the differential diagnosis of a UTI?
## Interstitial cystitis/bladder pain syndrome
## OAB
## Genitourinary syndrome of menopause
## Urinary calculi
## Infectious bacterial or fungal vaginitis
## Vulvar dermatitis
## Non-infectious vulvovestibulitis
## Vulvodynia
## Hypertonic pelvic floor muscle dysfunction
## CIS of the bladder
# Take a history and describe the physical exam in a patient with recurrent UTI
#* History: characterize LUTS, baseline GU symptoms between infections, UTI history, bowel symptoms, menopausal status, contraceptive method
#* Physical exam: abdominal and pelvic exam, focused neurologic exam, +/- PVR
# What are the indications to treat asymptomatic bacteriuria?
## Pregnant women
## Patient undergoing elective urologic surgery
# When should a urine culture be repeated in patients that have started treatment for UTI?
#* If symptoms persist > 7 days
# What conservative recommendations can be made to reduce risk of recurrent UTI?
## Avoid barrier contraceptives and spermicidal products
## Drink >1.5L water/day
## Changes that DO NOT play a role in rUTI prevention: hygiene practices (e.g., front to back wiping), pre- and post-coital voiding, avoidance of hot tubs, tampon use, and douching
# Describe 3 first-line antibiotic therapies for uncomplicated symptomatic UTI
## Nitrofurantoin 100mg BID x 5 days
## TMP-SMX 1 tab DS BID x 3 days
## Fosfomycin 3g x 1 dose
#* Note that ciprofloxacin is not considered first-line
# Describe 3 options for continuous antibiotic prophylaxis in the context of recurrent UTI
## Nitrofurantoin 100mg daily
## Cephalexin 250mg daily
## Fosfomycin 3g q10days
# What are drug-specific adverse events related to fluoroquinolone use?
## Prolonged QT syndrome
## Aortic rupture
## Tendon rupture
# What is the role of cranberry or lactobacillus in the treatment of recurrent UTI?
#* Cranberry can be offered, lactobacillus is not recommended