34 Urinary Tract Infections Flashcards

1
Q

Which organisms make up the perineal flora?

A

Skin: Coagulase -ve staphylococci.

Lower GI: enterbacteriaceae. Enterococcus.

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2
Q

Where is the boundary between upper and lower urinary tract infections?

A

Bladder.

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3
Q

What are the symptoms of cystitis? (7)

A
Dysuria.
Urinary frequency.
Urgency.
Suprapubic tenderness.
Polyuria.
Nocturia.
Haematuria.
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4
Q

What is pyelonephritis?

A

Infection of the kidney or renal pelvis.

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5
Q

What are the symptoms of pyelonephritis? (3)

A

Loin/abdominal pain/tenderness.
Fever.
Evidence of systemic infection.

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6
Q

What is urethral syndrome?

Who gets it?

A

Bacterial cystitis/frequency-dysuria syndrome.
30-50 y/o women.
Symptoms of UTI without demonstrable infection.

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7
Q

What is the definition of significant bacteriuria?

A

over 10^5 cfu/cml.

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8
Q

What are the limitations of significant bacteriuria? (4)

A

Some have symptoms below 10^5.
Lower counts significant in males (10^3).
Not applicable to catheter urine.
Bacterial count is normally distributed.

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9
Q

What is asymptomatic bacteriuria?

Who commonly has it?

A

Significant bacteriuria of a single organism, with no clinical symptoms.
Community dwelling females over 70.

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10
Q

What is sterile pyuria?

A

Pus cells in the urine with no organisms grown.

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11
Q

What are the predisposing factors for UTI? (6)

A
Sex: 10F : 1M.
Urinary stasis.
Instrumentation.
Sexual intercourse.
Fistulae.
Congenital abnormalities: vesico-ureteric reflux.
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12
Q

What are the three sources of a UTI infection?

A

Perineal.
Fistulae (genital/GI tract).
Haematogneous (rare)/

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13
Q

What are the most common causes of UTI in a community setting? (3)

A
E.coli 70%.
Staphylococcus saprophyticus (sexually active W).
Proteus mirabilis (kidney stone related).
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14
Q

What are the most common causes of UTI in a hospital setting? (5)

A
E. coli. 50%
Enterococcus. 20%
Klebsiella.
Coliforms.
Pseudomonas aeruginosa.
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15
Q

What are the causes of sterile pyuria? (6)

A

Inhibition of bacterial growth (antibiotics, contamination).
Fastidious organisms: M.tubercuosis, Haemophilus, Neisseria gonorrhoea.
Inflammation: urinary stones, renal disease.

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16
Q

Why does long term indwelling catheterisation result in bacteriuria?
When might this change to bacteraemia?

A

Biofilm colonisation.

On manipulation/removal of catheter.

17
Q

When should prophylaxis be used in catheterisation? (3)

A

History of symptomatic catheter associated UTI.
Purulent discharge from site.
Colonisation with staphylococcus aureus.

18
Q

Which urine tests are used in UTI? (4)

A

Midstream (MSU).
Catheter urine (CSU).
Clean catch.
Supra-pubic aspirate.

19
Q

When are blood samples taken in UTI diagnosis?

A

On suspicion of pyelonephritis.

20
Q

When is an early morning urine sample taken?

A

Suspected urinary tuberculosis.

21
Q

When does a UTI warrant further investigation? (4)

A

Recurrent UTI.
UTI in adult male.
UTI in childhood.
Suspected pyelonephritis.

22
Q

Which antibiotics are used for UTI infection? (4).

A

Nitrofurantoin.
Pivmecillinam.
Trimethoprim.
Fosfomycin.

23
Q

What is the treatment for cystitis?

A

Females: 3 day course antibiotics.

Males/recurrent cases: 7 day course antibiotics.

24
Q

What is the empiric therapy for pyelonephritis? (2,2)

A

Cefuroxime, ciprofloxacin.

Piperacillin-tazobactam if >65y/o.

25
Q

Who should be treated for asymptomatic bacteriuria? (3)

A

Pregnant (associated with upper UTI, pre-term baby + low birth weight).
Infants: prevention of pyelonephritis.
Prior to urological procedures.