345.4 📋 章末速記 Summary

345.4.1 🔑 一句話總結

UTI classification + treatment：(1) acute uncomplicated cystitis (premenopausal non-pregnant women) → nitrofurantoin 100 BID × 5 d (first-line) or TMP-SMX × 3 d (if resistance < 20%) or fosfomycin single dose；(2) acute pyelonephritis (upper UTI + fever + flank pain) → outpatient ciprofloxacin × 5-7 d, inpatient IV ceftriaxone or pip-tazo × 7-14 d；(3) complicated UTI (men, pregnancy, diabetics, immunocompromised, anatomic, instrumentation) → broader spectrum, longer duration；(4) asymptomatic bacteriuria → treat ONLY in pregnancy + pre-urologic procedure；(5) recurrent UTI → postcoital prophylaxis, continuous antibiotic prophylaxis, vaginal estrogen (postmenopausal), methenamine hippurate (ALTAR 2022), cranberry (modest), D-mannose, Uromune vaccine emerging；(6) CAUTI → remove catheter + culture-guided + avoid empiric for asymptomatic catheter bacteriuria；(7) prostatitis：acute bacterial (E. coli, Klebsiella) → fluoroquinolone × 4-6 wk (avoid prostatic massage), chronic bacterial → fluoroquinolone × 4-6 wk, CP/CPPS → multidisciplinary (α-blocker, NSAIDs, PT)；pathogens：E. coli 75-95% uncomplicated > Klebsiella > Proteus (urease — struvite) > Enterococcus > S. saprophyticus (young women); complicated 加 Pseudomonas + ESBL/CRE；MDR therapies：ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol for CRE + ESBL + MDR Pseudomonas；pregnancy UTI：treat ASB + avoid fluoroquinolones/tetracyclines/TMP-SMX first trimester; use nitrofurantoin (not near term) + cephalexin + fosfomycin。

345.4.2 💊 治療精要

uncomplicated cystitis first-line：nitrofurantoin 100 mg BID × 5 d OR TMP-SMX 160/800 BID × 3 d (if local resistance < 20%) OR fosfomycin 3 g single dose
pyelonephritis outpatient：ciprofloxacin 500 BID × 5-7 d OR levofloxacin 750 daily × 5-7 d OR TMP-SMX × 14 d (susceptible)
pyelonephritis inpatient：IV ceftriaxone 1-2 g daily OR pip-tazo OR fluoroquinolone; severe → broader; bacteremia minimum 14 days
complicated UTI：broader spectrum (pip-tazo, carbapenem) + address underlying (obstruction, stone, catheter) × 7-14 d
MDR / ESBL / CRE：ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol for select; fosfomycin oral for ESBL uncomplicated cystitis
recurrent UTI prevention：postcoital prophylaxis (TMP-SMX or nitrofurantoin) + continuous prophylaxis 3-6 mo + vaginal estrogen for postmenopausal + methenamine hippurate (ALTAR 2022) + cranberry / D-mannose modest + Uromune vaccine emerging
acute bacterial prostatitis：fluoroquinolone (ciprofloxacin 500 BID) × 4-6 weeks + IV initial if severe + avoid prostatic massage (bacteremia risk)
CP/CPPS：multidisciplinary; α-blockers (tamsulosin), NSAIDs, physical therapy, antidepressants, pregabalin
pregnancy UTI：treat ASB (avoid preterm labor); nitrofurantoin (not near term — hemolytic anemia in newborn), cephalexin, fosfomycin; avoid fluoroquinolones, tetracyclines, TMP-SMX (1st trimester)

345.4.3 🎯 盧醫師的考前提醒

E. coli is 75-95% of uncomplicated UTI；S. saprophyticus 5-10% young women；Proteus mirabilis (urease + struvite stones); complicated 加 Pseudomonas + Enterococcus + S. aureus
uncomplicated cystitis first-line nitrofurantoin × 5 days (not for pyelonephritis — poor renal tissue penetration)
fluoroquinolones reserved：increasingly resisted + collateral damage (C. diff, tendinopathy, QT, neuropathy)；use for pyelonephritis + complicated UTI + prostatitis
asymptomatic bacteriuria：treat ONLY pregnancy + pre-urologic procedure；otherwise resistance + side effects > benefit
CAUTI：remove catheter ASAP + distinguish from asymptomatic catheter bacteriuria (latter don’t treat)
acute bacterial prostatitis：fluoroquinolone × 4-6 weeks (prostate penetration limited, long duration needed); avoid prostatic massage (bacteremia risk)
CP/CPPS (chronic prostatitis / chronic pelvic pain syndrome)：no infection + ≥ 3 months pain; multidisciplinary (α-blocker + NSAID + PT + antidepressant)
methenamine hippurate (ALTAR 2022) for recurrent UTI prevention：non-inferior to antibiotics + reduces antibiotic exposure + alternative to chronic prophylaxis
vaginal estrogen for postmenopausal recurrent UTI：addresses vaginal atrophy + microbiome; effective + low-risk
MDR therapies for resistant uropathogens：ceftazidime-avibactam (ESBL + CRE + Pseudomonas), meropenem-vaborbactam (CRE-KPC), imipenem-relebactam (CRE), cefiderocol (broad including Acinetobacter), ceftolozane-tazobactam (MDR Pseudomonas)