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Inflammation block > UTIs > Flashcards

UTIs Flashcards

1
Q

What is a UTI

A
  • Inflammatory response of the urothelium to bacterial invasion
  • Usually associated with bacteriuria & pyuria
  • Bacterial infection of the urine with>10^5 colony forming units/ml of urine. (allow lower counts in symptomatic pts)
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2
Q

Define bacteriuria

A

The presence of bacteria in the urine, which may be symptomatic or asymptomatic

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3
Q

Define pyuria

A

The presence of WBCs (>/=10per HPF x400) in the urine

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4
Q

Define pyelonephritis

A

Inflammation of the kidney due to a bacterial infection

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5
Q

What falls under simple/uncomplicated UTIs

A
  • Female
  • First presentation
  • Not pregnant
  • No signs of pyelonephritis
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6
Q

What falls under complicated UTIs

A
  • Male
  • Recurrent UTIs
  • Pregnancy
  • Elderly
  • Catheter related
  • Children
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7
Q

Why are UTIs more common in women

A

cos they have a shorter urethra so bacteria don’t have to travel much distance to reach the bladder

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8
Q

Outline the difference between ‘recurrent UTIs’ and ‘Persistent UTIs’

A
  1. ) Recurrent UTIs= >2 in 6/12 (or >3 in 1 year)

2. ) Persistent UTIs= hasn’t been managed or organism is resistant to the abx you have given

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9
Q

State and give egs of the different types of UTIs

A
  1. ) Lower UTIs:
    - urethritis
    - cystisis
    - prostatitis
  2. ) Upper UTIs:
    - Pyelonephritis
    - Intrarenal/perinephric abscess (this may be a reason for no improvement on treatment cos the abscess would need to be drained)
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10
Q

What are the risk factors for a UTI

A
  • previous UTI
  • surgery
  • catheterisation
  • upper tract obstruction (stones)
  • Neurogenic bladder

adults:

  • sex,spermicides;diaphragm
  • pregnancy
  • diabetes mellitus
  • BPE

older age:

  • prolapse
  • oestrogen deficiency
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11
Q

Outline the different uropathogens

A
  • streptococci
  • proteus
  • Klebsiella
  • E coli
  • Staphylococci
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12
Q

How can we classify bacteria?

A
  1. )COCCI(round)
    - Gram positive: staphylococcus;streptococcus;enterococcus
    - Gram negative: Aerobes=neisseria
  2. ) BACILLI(RODS)
    - Gram positive: a.) Aerobes=corynebacteria(c.urealyticum)
    b. )anaerobes= lactobacillus
  • Gram negative
    a. ) Aerobes= enterobacteria(escherichia, Klebsiella, proteus), peudomonas
    b. ) Anaerobes: bacteroides
  1. )Others:
    - Filamentous bacteria(M.tuberculosis), chlamydiae, fungi, mycoplasma
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13
Q

Outline the characteristics of STD: what it may be; symptoms; investigations & examinations

A
  • Chlamydia trachomatis or Neisseria gonorrhea
  • Chlamydia= frequently asymptomatic in females, but can present with dysuria, discharge or pelvic inflammatory disease
  • Send urinalysis, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
  • Pelvic exam-send discharge from cervix or urethra for chlamydia PCR
  • Low estrogen in post menopausal women
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14
Q

Define post void residual

A

The amount of urine left in your bladder after using the toilet

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15
Q

How can a MSU be used as a useful assessment for STD

A
  • urine dipstick +/- microscopy
  • Ensure accurate collection of mid stream sample
  • Process specimen promptly, or refrigerate to prevent overgrowth of contaminants
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16
Q

What further investigations may be carried out following complications to an STD?

A
  • Imaging: USS&PVR(post void residual bladder), KUB(kidney,ureter&bladder) X-ray
  • Cytoscopy
17
Q

In which cases should asymptomatic bacteriuria be treated?

A
  • Pregnancy
  • Patients prior to undergoing a surgical procedure
  • Post renal transplant-early postop (cos you would’ve immunosuppressed them so something which is aysmptomatic could turn into a full blown UTI)
18
Q

Outline the mechanism of penicillin/cephaloporin

A
  • bactericidal

- Inhibits bacterial wall synthesis

19
Q

Outline the mechanism of aminoglycosides

A
  • bactericidal

- Inhibits ribosomal protein synthesis

20
Q

outline the mechanism of tetracyclines

A

bacteriostatic

-translocation interference

21
Q

Outline the mechanism of trimethoprim

A

bacteriostatic

  • nucleic acid interference
  • dihydrofolate reductase inhibition
22
Q

Outline the mechanism of Fluroquinolones

A

bacteriostatic

-inhibit DNA gyrase

23
Q

Why is routine use of prophylactic abx in catheterized pts not recommended

A
  • Because the actual bugs are sitting on the catheter
  • There’s no way you can penetrate the catheter with the abx so there’s no point in treating them
  • If the urine looks ‘mucky’ or they have a UTI you’ll have to change the catether and give abx if really needed
24
Q

What strategies are available to reduce risk of UTI

A
  1. ) ABX
  2. ) Behaviour
  3. )Cranberry
  4. ) Developing vaccines D-mannose
  5. )Estrogens
25
Q

How can lifestyle measures reduce the risk of a UTI

A
  • increased fluid intake
  • post-coital voiding
  • perineal hygiene
26
Q

Which fruit may present risk of UTI

A

cranberry

-better concentration when taken as tablets

27
Q

Which vaccines may reduce risk of UTI

A
  • Urovac:vaginal mucosal vaccine
  • Intranasal vaccine for proteus mirabilis
  • PapDG vaccine for E coli
  • Fim CH vaccine for E coli
  • Vaccine for chlamydia Trachomatis
28
Q

How can administration of estrogens reduce risk of UTI

A
  • giving women topic estrogens to rebalance pH levels; meaning the Ecoli are less able to attach, reduces risk of UTI
  • Post menopausal they sometimes get atrophic vaginitis i.e the area in/around the vagina becomes beneficial/correct for the e coli to attach due to the change in environment
  • Ensure no contraindications: eg DVTs/ Ca breast
29
Q

What are the symptoms of UTI

A
  • burning, frequency, urgency of peeing
  • Pyuria= pus m(WBC) in the urine
  • Urine culture- growth of bacteria in the urine

Inflammation block (27 decks)

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