Cases
A 54 y/o F patient is receiving IV ceftriaxone 2g daily for treatment of a complicated UTI with sepsis. Her CrCl is 33 ml/min. What should her dose be reduced to?
No dose adjustment needed
What is the brand name of nitrofurantoin?
Macrobid
What is a clinical sign that may suggest a cUTI versus uncomplicated cystitis
fever, flank pain, costovertebral angle tenderness, other signs of systemic illness (chills, rigors, or hemodynamic instability)
What are the main differences between the 2010 and 2025 UTI guidelines?
2010 guidelines did not include cUTI and UTI in males
What is the most common causative organism of UTIs?
A 25-year-old non-pregnant, premenopausal woman presents with dysuria and frequency but no fever or flank pain. According to the guidelines, she should be treated for acute uncomplicated cystitis, with this 5-day oral regimen preferred as first-line therapy.
nitrofurantoin
Name one oral cephalosporin that can be used for the treatment of cUTIs
cefpodoxime, cefuroxime, cefixime, cephalexin, etc.
This condition is defined as a subset of sepsis in which, despite volume resuscitation, vasopressors are required to maintain blood pressure and the serum lactate level is greater than 2 mmol/L
septic shock
Per the 2010 UTI guidelines, what is the treatment duration for nitrofurantoin?
5d
T/F: E. coli has a thick peptidoglycan cell wall
F
An 80-year-old nursing home resident with a permanent indwelling catheter has a routine urine culture that returns positive for E. coli, but the patient has no symptoms of infection. The 2025 guidelines recommend this management strategy
Do not treat
For the treatment of uncomplicated cystitis, this drug offers the convenience of being administered as a single 3-gram dose.
fosfomycin
For a patient presenting with a new UTI, the 2025 guidelines suggest that this specific record can increase the likelihood of effective therapy by 7-fold if the empiric choice is concordant with its results
prior urine culture
What two beta-lactam antibiotics are NOT recommended as empirical treatment for uncomplicated cystitis per the 2010 guidelines?
amoxicillin, ampicillin
T/F: most causative organisms of UTIs are atypical organisms
F
A 72-year-old patient with a history of heart failure requires intravenous treatment for a multidrug-resistant UTI. The 2025 guidelines advise caution when using intravenous fosfomycin for this patient because it delivers a significant amount (330 mg per gram) of this specific electrolyte
sodium
This specific combination drug should not be used for empirical treatment of acute cystitis if the local resistance prevalence exceeds 20% or if used for a UTI in the past 3 months
Bactrim
According to the 2025 IDA cUTI guidelines, fluoroquinolones should be avoided if patients have been exposed to this class of antibiotics in the past __ months
12
What is the treatment duration for cUTIs when NOT using fluoroquinolones?
*DAILY DOUBLE*: What is the treatment duration for cUTIs when using fluoroquinolones?
7 days
What is one similarity between E. coli and H. influenzae (common CAP organism)
Gram-negative organisms
A patient is infected with a highly resistant gram-negative pathogen. The clinician selects cefiderocol, a novel siderophore cephalosporin that bypasses traditional resistance by using this specific delivery strategy to enter the cell via iron transporters.
'Trojan Horse' strategy
Why is nitrofurantoin / fosfomycin not recommended as oral treatments for cUTIs?
Does not achieve adequate levels in the blood / renal parenchyma
Define the four-step approach detailed in the 2025 IDSA cUTI guidelines for antibiotic selection.
(1) severity of illness, (2) risk factors for resistance, (3) patient-specific considerations, and (4) if septic, consider the antibiogram.
List two first-line drugs (dosing included) for oral cUTI treatments without sepsis
-Bactrim DS (800-1600 mg) q12h
-Augmentin 875-125 mg q8-12h
-Levofloxacin 500 to 750 mg daily
List one other causative organism for UTIs other than E. coli.
Klebsiella pneumoniae, Proteus mirabilis, Staphylococcus saprophyticus