345.2 🩺 國考版

345.2.1 高頻考點

345.2.1.1 Pathogens

  • E. coli (75-95% uncomplicated)
  • S. saprophyticus (5-10% young women)
  • Klebsiella, Proteus, Enterococcus
  • Pseudomonas (complicated, instrumentation)
  • ESBL/CRE increasing

345.2.1.2 Uncomplicated Cystitis Treatment

  • Nitrofurantoin 100 BID × 5 d (first-line)
  • TMP-SMX × 3 d (if resistance < 20%)
  • Fosfomycin 3 g single dose
  • Cephalexin, β-lactams second-line

345.2.1.3 Pyelonephritis Treatment

  • Outpatient: ciprofloxacin × 5-7 d
  • Inpatient: ceftriaxone, pip-tazo, fluoroquinolone
  • Duration: 7-14 d uncomplicated; 14-21 d complicated

345.2.1.4 Asymptomatic Bacteriuria

  • Treat ONLY:
    • Pregnancy
    • Pre-urologic procedure
  • Otherwise: don’t treat

345.2.1.5 Recurrent UTI Prevention

  • Postcoital prophylaxis
  • Continuous prophylaxis (TMP-SMX, nitrofurantoin)
  • Vaginal estrogen (postmenopausal)
  • Methenamine hippurate (ALTAR 2022)
  • Cranberry (modest)
  • D-mannose
  • Vaccines emerging (Uromune)

345.2.1.6 Acute Bacterial Prostatitis

  • E. coli, Klebsiella common
  • Fluoroquinolone × 4-6 weeks
  • Avoid prostatic massage (bacteremia)

345.2.1.7 Chronic Bacterial Prostatitis

  • Recurrent same organism UTIs
  • Fluoroquinolone × 4-6 weeks

345.2.1.8 CP/CPPS

  • ≥ 3 mo pelvic pain
  • No infection
  • Multidisciplinary (α-blocker, NSAIDs, PT, antidepressants)

345.2.1.9 MDR UTI Treatment

  • ESBL: carbapenems (ertapenem, meropenem)
  • CRE: ceftaz-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol
  • MDR Pseudomonas: ceftolozane-tazo, ceftaz-avibactam, cefiderocol

345.2.1.10 Pregnancy + UTI

  • Asymptomatic bacteriuria → treat
  • Pyelonephritis: hospitalize, IV antibiotics
  • Avoid: fluoroquinolones (cartilage), aminoglycosides (selected), TMP-SMX (first trimester), tetracyclines
  • Use: nitrofurantoin (NOT near term), cephalexin, fosfomycin

345.2.1.11 CAUTI Prevention

  • Avoid unnecessary catheters
  • Aseptic insertion
  • Closed system
  • Remove ASAP

345.2.1.12 Sterile Pyuria

  • TB, STI, kidney stones, interstitial nephritis, urethritis

345.2.2 易混淆比范

Condition Symptoms Treatment Duration
Cystitis Dysuria, frequency, no fever Nitrofurantoin, TMP-SMX, fosfomycin 3-5 d
Pyelonephritis + Fever, flank Cipro, ceftriaxone, pip-tazo 7-14 d
Complicated UTI Variable Broad-spectrum 7-14 d
Acute prostatitis Pelvic pain + fever Fluoroquinolone 4-6 weeks
Chronic prostatitis Recurrent UTIs Fluoroquinolone 4-6 weeks
CP/CPPS Chronic pelvic pain Multimodal Chronic
Asymptomatic bacteriuria None Treat only in pregnancy / pre-procedure N/A

345.2.3 Special Topics

345.2.3.1 Postmenopausal Recurrent UTI

  • Vaginal atrophy
  • Vaginal estrogen effective
  • Cranberry, D-mannose adjunct

345.2.3.2 Catheter Management

  • Avoid unnecessary
  • Remove ASAP
  • Distinguish bacteriuria vs infection