Kidney and Urinary Tract Disease - Urinary Tract Infections (33) Flashcards Preview

Clinical Pathology > Kidney and Urinary Tract Disease - Urinary Tract Infections (33) > Flashcards

Flashcards in Kidney and Urinary Tract Disease - Urinary Tract Infections (33) Deck (33):
1

Where is sterile flora in urinary tract?

Kidneys, ureters, bladder (except in UTI)

2

What flora is in urethra?

Perineal flora - skin/lower GI tract

3

Skin flora

Coagulase-negative staphylococci

4

Lower GI tract flora

(Anaerobic bacteria), Aerobic bacteria (Enterobacteriaceae - gram -ve bacilli/coliforms), gram positive cocci (eneterococcus)

5

Clinical classification of UTI

1. Cystitis
2. Pyelonephritis
3. Urethral syndrome

6

Microbiological classification of UTI

1. Significant bacteriuria
2. Asymptomatic bacteruria
3. Sterile pyuria

7

Where does cystitis effect?

Lower urinary tract - bladder

8

Cystitis symptoms

Dysuria, urinary frequency, urgency, supra-pubic pain/tenderness, polyuria, nocturia, haematuria

9

Where does pyelonephritis effect?

Upper urinary tract - kidneys/renal pelvis

10

Pyelonephritis symptoms

Lower UTI, loin/abdominal pain/tenderness, fever, systemic infection (rigors, nausea, vomiting, diarrheoa, elevated CRP, WBC)

11

What is urethral syndrome?

Symptoms of lower UTI without infection

12

Who does urethral syndrome common effect?

Women 30-50 years

13

Urethral syndrome can also be called

Abacterial cystitis or frequency-dysuria syndrome

14

Significant bacteriuria

Kass criteria, 10^5 cfu/mL

15

Limitations of significant bateriuria criteria

- Count is on a normal curve
- Symptomatic females bacterial counts

16

Asymptomatic bacteriuria

Significant bacteriuria (single organism), no symptoms

17

Sterile pyuria

Pus cells in urine, no organisms grown (antibiotics inhibit bacterial growth)

18

Causes of sterile pyuria

Inflammation (kidney stones, trauma, polycystic kidney disease, 'fastidious' organisms

19

Causative organisms of sterile pyuria

M. TB, haemophilus, N.gonorrhoea, anaerobes

20

Predisposing factors

- Female 10:1
- Pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
- Instrumentation
- Sex
- Fisutale (recto-vesical/vesico-vaginal)
- Congenital abnormalities (Vesico-ureteric reflux)

21

Sources of infection

- Perineum
- Fistulae
- Haematogenous

22

Organisms that cause UTI

- E. coli (80%)
- Staph saprophyticus (honeymoon cystitis)
- Proteus mirabilis
- Enterococcus
- Klebsiella
- Coliforms
- Pseudomonas aeruginosa

23

Investigations

1. Dipstick testing
2. Blood tests
3. Microbiology
4. Imaging

24

Dipstick

Test for blood, protein, nitrite, WBC (leucocyte esterase)

25

Microbiology - urine

Mid-stream, catheter, 'clean catch', supra-pubic aspirate (M, C&S)

26

Bloods

Suspected pyelonephritis

27

Imaging

Renal tract USS, isotope scan (DMSA, DTPA, MAG3), micturating cystourethrogram

28

Early morning urine

(EMU) X 3, whole contents of bladder, if suspected TB

29

Examples of UTI antibiotics

Nitrofurantoin, Pivmecillinam, Trimethoprim, Fosfomycin

30

Cystitis treatment

Females - 3 days, Males - 7 days

31

Pyelonephritis treatment

IV antibiotics - Cefuroxime, ciprofloxacin, Piperacillin-tazobactam (>65 years)

7-14 days

32

When should you treat asymptomatic bacteriuria?

Pregnant - associated with upper UTI, pre-term delivery, low birth weight

Infant - prevent pyelonephritis and renal damage

Prior to urological procedures - prevent UTI

33

When should you not treat asymptomatic bacteriuria?

Elderly or catherterised

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