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GERR > UTI's > Flashcards

UTI's Flashcards

1
Q

What is asymptomatic bacteriuria?

A

asymptomatic - no symptoms

bacteriuria - presence of bacteria in urine

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2
Q

Why is there bacteria in the urine even without UTI?

A

urine passes through non-sterile skin e.g. urethra

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3
Q

How much bacteria is normal to have in the urine?

A
  • less than 10 (to power 5) bacteria/ml of urine

- based on mid stream sample only

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4
Q

What is the ideal urine sample?

A

Mid stream sample

i. e. don’t catch urine at start and end of urination
- not always possible

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5
Q

Is urine in the body sterile?

A

Yes - filtrate of the blood

and blood is sterile

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6
Q

What does sterile mean?

A

complete absence of micro-organisms including viruses and bacteria

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7
Q

Why does bacteria needed to be sent to the lab fast?

A

Bacteria which may be normal can replicate in sample

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8
Q

What are the classic triad of symptoms for UTI?

A
  • frequent urination
  • urgent urination
  • dysuria (pain when urinating)
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9
Q

Who is more likely to have asymptomatic bacteriuria?

A 
Older people 
- don't necessarily have infection 
- just have more bacteria in urine 
Pregnant women 
- can have asymptomatic infection
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10
Q

How is a UTI tested for?

A

need to find the organism

  • sample from inflamed organs i.e. urine in UTI
  • blood sample if sepsis suspected
  • take sample before antibiotics (stop bacteria from being killed off before so can diagnose)
  • can also use dipstick if simple UTI with definitive result don’t need lab
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11
Q

What does uncomplicated infection mean?

A

infection where:

  • treatment is likely to be successful
  • Symptoms are obvious e.g. classic triad
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12
Q

Which UTIs are uncomplicated?

A

Lower UTI

  • Urethritis
  • Cystitis
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13
Q

What bacteria are likely to cause the uncomplicated UTIs?

A

E.coli

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14
Q

What antibiotics are used in lower urinary tract infections?

A

Nitrofurantoin

Trimethoprim

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15
Q

Why do UTI treatments fail?

A

Impeded flow:

  • old age (prostates can impede flow)
  • pregnant (uterus can impede flow)
  • kidney stones
  • plastic in urinary tract
  • resistance bacteria (often from previous antibiotic)
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16
Q

What are symptoms of UTI’s outside of classic triad?

A
  • loin pain
  • fever
    both need to be treated
17
Q

What needs to be treated with UTI outside infection?

A
  • Symptoms e.g. loin pain + fever

- underlying conditions e.g. stones

18
Q

What treatments are used in complicated UTI’s?

A

Antibiotics:

  • Co-amoxiclav
  • Gentaminin (can be nephrotoxic so contraindicated in renal failure patients)
19
Q

How is treatment in pregnant women with UTI different?

A
  • Don’t need to show symptoms to get antibiotic treatment
  • As good evidence that treatment will reduce upper urinary tract infection (and so chance of pyelonephritis) which decreases chance of early labour and underweight babies
20
Q

What antibiotic shouldn’t be given to pregnant women?

A

Trimethoprim as folate antagonist, lack of folate can cause spina bifida in child

21
Q

What antibiotics can be given to pregnant women?

A

Nitrofurantoin
Amoxicillin
Cefalexin

22
Q

What are the challenges of UTI in older age?

A
  • more likely to have co-existing conditions e.g. diabetes
  • greater chance of asymptomatic bacteriuria
  • higher chance of PVR
  • Catheters used often and higher chance of infection
  • more vulnerable to C difficile when exposed to antibiotics
  • Less able to get MSU sample so more likely to be pos for bacteriuria
23
Q

What is pyelonephritis?

A
  • infection of the kidney
  • which leads to scarring of tissue which can lead to renal failure and hypertension
  • can develop as a result of UTIs
24
Q

How are pregnant women and young children checked for UTI’s?

A
  • Dipstick test

- if leukocytes, proteins or nitrates present then sample sent to lab

25
Q

What are the challenges of UTI’s in children?

A
  • Less likely to spot symptoms
  • Risk of renal scarring
  • recurrent infection increases risk of renal failure later in life
  • harder to get MSU sample so more likely to test pos for bacteriuria
26
Q

What symptoms can be looked for in older adults and children with UTI’s?

A
  • distress
  • fever
  • confusion
  • agitation
27
Q

What can a dipstick test for specific to UTI’s?

A
  • Leukocyte esterase
  • Nitrates
  • proteins
28
Q

Are dipsticks sensitive or specific?

A

High sensitivity so high negative predictive value i.e. if test result is negative the diagnosis of UTI very unlikely

29
Q

What antibiotics can be given to children while waiting for bacterial culture?

A
  • cephalosporin cefalexin

- co-amoxiclav

30
Q

What is PVR?

A

post voiding residual volume i.e. urine left in bladder after urination (higher in older people) which increases risk of infection

31
Q

What is a common reason for recurrent UTI’s in older men?

A
  • Bacterial prostatitis (infection of prostate tissue) which is:
  • usually caused by recurrent UTI’s
  • can also be caused by STIs: Neisseria, gonorrhoea and chlamydia
  • and cystoscopy of urethra
32
Q

What symptoms may point towards bacterial prostatitis?

A
  • Rectal pain
  • ejaculatory pain
  • urinary retention
  • prostate swelling
33
Q

How is bacterial prostatitis tested for and treated?

A
  • Urine and blood sample sent to lab
  • fluoroquinolone drugs usually ciprofloxacin, only used in bacterial prostatitis as serious side effects but needed as good activity against gram negative species and reach therapeutic target in prostate tissue
34
Q

What is the protocol with infection when using catheter?

A
  • remove catheter first and if need to replace with new one may have to go on antibiotics
  • often bacteria have colonised by not yet an infection so bacteriuria but don’t need antibiotics
  • however colonisation can then lead to infection
35
Q

What organisms usually cause Catheter infection?

A

gram positive or candida ( fungi)

36
Q

What is biofilm?

A
  • organised community of bacteria existing in a resilient multicellular system to maintain themselves
  • can exist on organic or non-organic surfaces
37
Q

How are biofilms dealt with?

A

Remove surface biofilm existing on as resilient to antibiotics

38
Q

What makes biofilms so good at surviving?

A
  • secrete polysaccharide matrix to suspend them
  • bacteria near foreign surface secrete adherence molecules
  • other bacteria express antibiotic resistant mechanisms

GERR (49 decks)

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