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RB Y2 Renal > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

define UTI

A

presence of micro-organisms in the urinary tract that are causing clinical infection

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2
Q

what does lower UTI denote

A

infection confined to the bladder - cystitis

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3
Q

complicated UTI

A

UTI complicated by systemic symptoms (eg fever, loin pain, malaise) or urinary structural abnormality/stones

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4
Q

bacteriuria

A

bacteria present in the urine

doesnt always mean there is a n infection

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5
Q

in which patients is there commonly bacteriuria without infection

A

elderly and those with catheters

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6
Q

UTI in men

A

culture as this is uncommon and there is often an underlying cause

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7
Q

is urine sterile?

A
  • bladder urine normally is
  • urine passed via the urethra will be contaminated with bacteria from the perineum or lower urethra
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8
Q

why is MSU used

A

first pass is most likely to be contaminated

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9
Q

suprapubic aspiration and straight (in/out) catheter urine sample

A

achieve a clean sample, however are not practical

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10
Q

Boricon container

A
  • for MSU
  • red lid
  • contains boric acid which is a preservative to stop the bacteria multiplying so works for around 24 hours
  • Is often used in GPs
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11
Q

sterile universal container

A
  • for MSU
  • white lid
  • must reach lab within 2 hours of collection
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12
Q

what do you do with a sample you receive that has expired (over 2 hours in white, over 24 in red top)

A

discard it

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13
Q

which presumption is made when analysing a MSU sample

A

that the sample has been taken properly

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14
Q

directions for collecting a MSU

A
  • Label container
  • Give a suitable wide mouthed sterile (foil) bowl to the patient, especially important in females
  • First urine passed into toilet, and mid-stream part collected
  • Urine is transferred from bowl to appropriate laboratory container
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15
Q

should the perineum/urethral meatus be washed with sterile sample before taking MSU

A

controversiale evidence

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16
Q

who might not be able to give a MSU

A

those with mobility/cognitive issues or those who are very young

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17
Q

who is a clean catch urine sample used in

A

children, those with cognitive impairemnet or physical restriction

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18
Q

which patients is a bag specimen of urine used in

A
  • babies
  • the bag is attached to the perineum, so often contaminated with bowel flora
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19
Q

when is dipstick of good use

A
  • in the community setting
  • it is only really effective as a negative predictor (eg rule out infection)
  • often used in young women who present at the GP with cystitis
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20
Q

leukocyte esterase on dipstick

A
  • indicates the presence of WBC in the urine
  • esterase is an enzyme produced by WBC
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21
Q

nitrites on dipstick

A
  • indicate the presence of certain bacteria in the urine, these convert endogenous nitrates to nitrites
  • mainly coliforms
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22
Q

which bacteria dont produce nitrite positiive dipstick

A
  • pseudomonas
  • enterococcus
  • staphylococcus
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23
Q

in which 2 groups of patients should you definitely not dipstick urine

A
  • elderly
  • catheter specimens

contaminated !!

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24
Q

what is microscopy of urine used for

A
  • looks for the presence of polymorphs (pus cells), bacteria and red cells in urine
  • rarely used
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25
Q

what is a culture used for

A

to detect significant bacteriuria

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26
Q

Kass’s criteria for urine culture

A

counts number of colonies to determine the likelihood of a UTI

  • >105 organisms / ml: significant =probable UTI
  • <103 organisms / ml: not significant bacteriuria
  • 104 organisms / ml:? contaminated ?infection - repeat specimen
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27
Q

which patient group does Kass’s criteria apply to

A

those of child bearing age

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28
Q

what is a genuine UTI in a non-catheterised usually caused by

A
  • pure growth - single organism >105 orgs/ml
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29
Q

mixed growth

A
  • (≥2 organisms)
  • even if >105 is probably not significant
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30
Q

what is the distribution like of infection in the kidney

A

patchy

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31
Q

pathogenesis of pyelonephritis

A
  • most commonly an ascending infection from a lower UTI
    • present in conjunction with cystitis
    • bacteria from bowel, perineal skin of lower end of urethra
  • blood borne spread
    • rarely occurs in septicemia, infective endocarditis or post surgery
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32
Q

which organisms are often implicated in a pyelonephritis from blood borne spread

A

S aureus

also E coli

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33
Q

what is the most common organism in a UTI

A

E coli

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34
Q

organisms implicated in UTI

A
  • E coli
  • Other aerobic Gram negatives e.g. Enterobacteriaceae, Pseudomonas**, Proteus
  • Enterococcus (faecalis and faecium)
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35
Q

where does E coli reside in cells

A

in the LPS layer of gram negatives and activates the immune response from here

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36
Q

give 2 reasons as to why E coli is the most common cause of UTI

A
  • most common aerobe in the bowel
  • has fimbriae which allow it to ascend up the urinary tract
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37
Q

what precautions must be taken for a E coli infection

A

no extra needed - standard gloves and apron

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38
Q

infection with which organism causes the development of renal stones

A
  • proteus
  • produces urease which breaks down urea to form ammonia, which increases urinary pH
  • this causes precipitation of salts
    • renal stones
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39
Q

which type of stones does proteus cause

A
  • struvite stones- triple phosphate stones
  • cause staghorn calculi
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40
Q

describe the culture of proteus

A

swarming

41
Q

what is the odour of proteus culture described as

A

burnt chocolate

42
Q

what is pseudomonas assoicated with

A

catheters and instrumentation

43
Q

which ABx cover pseudomonas

A

resistant to most oral ABx, except ciprofloxacin

44
Q

what gram positives cause UTI

A
  • enterococcus
    • enterococcus faecalis is the main concern
    • and also Enterococcus faecium
  • staph saphrophyticus
45
Q

in which context are UTI infected with Enterococcus usually seen

A

hospital acquried infections

46
Q

what type of coagulase is Staphylococcus saphrophyticus

A

negative

47
Q

who is infections with Staphylococcus saphrophyticus usually seen in

A

women of child bearing age

48
Q

name 2 anatomical reasons as to why females are more likely to get UTI

A
  • shorter, wider urethra
  • proximity of urethra to anus
49
Q

how does pregnancy increase risk of UTI

A
  • ureteric dilatation due to hormones causes a slower flow of urine - inc risk of infection
  • weight of uterus on bladder
50
Q

vesico-ureteric reflux

A

normally the ureters prevent reflux:

  • enter the bladder in an infero-medial direction
  • the last part is detrusor muscle, which contracts with the bladder

1y or 2y problems with this

  • 2y - bladder outlet obstruction can increase pressure in the bladder and distort the valve
51
Q

congenital causes of vesico ureteral reflux

A
  • In congenital cases, the ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle, therefore the intramural course of the ureter is shortened.
52
Q

how does diabetes increase risk of UTI

A
  • poor circulation dampens down inflammatory response
  • high glucose levels in urine
  • bladder doesnt empty as well as it should
53
Q

other factors that increase risk of UTI

A
  • urinary tract obstruction
  • sex
  • indwelling catheter
  • incomplete bladder emptying
  • thrush
54
Q

name 4 specific risk factors for pyelonephritis

A
  • HIV/AIDS
  • diabetes
  • IS
  • congenital/acquired urodynamic abnormalities
55
Q

clinical signs of cystitis

A
  • Urinary frequency
  • Dysuria
  • Nocturia
  • Suprapubic pain
  • Haematuria is not a usual symptom
56
Q

clinical signs of pyelonephritis

A
  • Fever, loin pain and rigors suggest involvement of the upper urinary tract. The patient will be significantly more unwell
    • Vomiting, tachycardia
  • Leukocytosis – increased WBC in blood
57
Q

ideal ABx for treatment of lower UTI

A
  • excreted in urine in high concentration
  • oral
  • inexpensive
  • few side effects
58
Q

how long are ABx required for to treat uncomplicated lower UTI in women

A

3 days

59
Q

how long are ABx required to treat a lower UTI in males

A

7 days

60
Q

what is an alternative to ABx that can be used in those with cystitis that may be just as good

A

anti inflammatories

61
Q

what is abacterial cystitis also known as

A

urethral syndrome

62
Q

abacterial cystitis

A
  • the patient has symptoms of a UTI, there are pus cells present in the urine but there is not signifcant growth on culture
63
Q

reason for abacterial cystitis

A
  • early phase of UTI
  • urethral trauma - honey moon cystitis
  • urethritis caused by STI
64
Q

what can be done to the urine to provide symptomatic relief of UTI symptoms

A

alkalinze it

65
Q

asymptomatic bacteriuria

A
  • Significant bacteriuria (>105 orgs/ml) but the patient is asymptomatic
  • there are no pus cells in the urine
66
Q

are ABx required for Asymptomatic Bacteriuria

A
  • usually no!
  • it may recur even if ABx treatment is given
  • give in pregnancy
67
Q

when are pregnant women screened for bacteriuria

A

1st antenatal visit

68
Q

Asymptomatic Bacteriuria in pregnancy

A

treated with ABx, as if left untreated there is a risk of pyelonephritis

69
Q

risk of pyelonephritis in pregnancy

A
  • intra uterine growth retardation
  • premature labour
70
Q

which ABx are given for Asymptomatic Bacteriuria in pregnancy (GP setting)

A
  • trimethoprim is contraindicated in 1 st trimester
  • nitrofurantoin is contraindicated in 3rd trimester
  • cefalexin may be used!
71
Q

why is Trimethoprim contraindicated in 1st trimester

A

inhibits folic acid synthesis

72
Q

why is Nitrofurantoin contraindicated in 3rd trimester

A

can cause neonatal haemolysis

73
Q

does a catheter increase the risk of UTI

A

yes, it is the most common cause hospital acquired infection

74
Q

when should you give ABx to someone with a catheter

A
  • >105 orgs/ml AND supporting evidence of UTI
  • as the longer the catheter is in situ, the more likely it is to be colonised with bacteria
75
Q

what will giving unnecessary ABx in someone with a catheter cause

A

catheteter to become colonised with resistant organisms

76
Q

empirical treatment of female lower UTI in GP setting

A

trimethoprim or nitrofurantoin orally for 3 days

77
Q

empirical treatment of uncatheterised male with UTI

A
  • get cultures
  • trimethoprim or nitrofunratoin orally for 7 days
78
Q

empirical treatment of complicated UTI/pyelonephritis in the GP setting

A

co-amoxiclav or co-trimethoprim for 14 days

79
Q

empirical treatment of complicated UTI/pyelonephritis in the hospital setting

A
  • amoxcillin and gentamicin for 7 days
  • co-trixomazole if penicillin allergic
80
Q

which 2 important organisms is the ABx coverage of amoxicillin and gentamicin covering

A
  • Coverage of Gram positives (E facealis is the most important) and coliforms (E.coli) respectively
81
Q

chronic pyelonephritis

A

recurrent episodes of acute causes scarring of the kidney

82
Q

presentation of chronic chronic pyelonephritis

A
  • often there is no previous history of UTI and present with vague symptoms
  • can present wth hypertension and uraemia
83
Q

what is seen on renal imaging with chronic pyelonephritis

A

coarse cortical scarring, distortion of calyces

84
Q

management of chronic pyelonephritis

A
  • tight control of blood pressure
  • intermittent ABx
85
Q

ureteritis/cystitis cystica

A
  • chronic reactive inflammatory reaction that occurs in the setting of chronic irritation of the bladder mucosa
  • multiple small fluid cysts project out into the lumen, canr esmeble tumours
86
Q

causes of cystitis cystica

A

chronic irritation to urothelium

  • chronic bladder outlet obstruction
  • chronic infection
  • bladder calculi
87
Q

pathology of cystitis cystica

A
  • Chronic irritation results in metaplasia of the urothelium, which proliferates into buds
  • These develop into cystic deposits
88
Q

clinical features of cystitis cystica

A

frequency, dysuria, urgency, haematuria, suprapubic pain

89
Q

how is TB Pyelonephritis usually acquired

A

can spread haematogenously, usually from the lung

90
Q

clinical features of TB Pyelonephritis

A
  • None are specific, so have a high index of suspicion in those with sterile pyuria and risk factors (e.g. HIV/AIDS)
  • Weight loss, fever, loin pain, dysuria
91
Q

what must be asked in the history of someone with suspected genitourinary TB

A

Ask about past lung TB, although often there is no history

92
Q

pathology of TB pyelonephritis

A
  • formation of caseous foci (casating granulomatous inflammation), these grow slowly with progressive renal destruction
  • classically a cold abscess
93
Q

what is a cold abscess

A

lacks intense inflammation associated with infection, commonly seen in TB

94
Q

investigation of TB pyelonephritis

A

acid fast bacilli may be seen on ZN staining - absence doesnt exclude TB however

95
Q

what is schistosomiasis caused by

A

Schistosoma haematobium

96
Q

what is Schistosoma haematobium

A

a trematode (fluke) caught from fresh water exposure in tropical countries eg sub saharan africa

97
Q

acute and chronic signs of schistosomiasis

A
  • acute - swimmers itch
  • chronic - hepatomegaly, liver fibrosis, portal hypertension
98
Q

Schistosomiasis in renal disease

A
  • in established disease, there are adult worms which lay eggs
  • these migrate to the veins around the bladder and ureters
  • initially cause haematuria
  • later cause fibrosis - obstruction, hydronephrosis and kidney failure
99
Q

what does Schistosomiasis predispose one to

A

urothelial malignancy (Squamous carcinoma)

RB Y2 Renal (26 decks)

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