L6: UTI Flashcards
(105 cards)
1
Q
Def of UTI
A
Urinary tract infection (UTI) is defined by the presence of bacteria in bladder urine.
2
Q
Once the diagnosis of UTI is made, it is important to classify the location and severity of tissue invasion
A
3
Q
Def of Acute pyelonephritis
A
Infection which involves the bacterial invasion of renal parenchyma
4
Q
Def of Acute cystitis
A
Infection limited to superficial invasion of the bladder
5
Q
Def of Asymptomatic bacteriuria
A
Presence of infected urine which produces
no-clinical symptoms
6
Q
Epidemeology of UTI
A
7
Q
Classification of UTI
A
- Acc to severity
- Acc to Site
8
Q
Classification of UTI
- According to severity
A
9
Q
Classification of UTI
- According to Site
A
10
Q
Simple UTI
A
UTI with no fever, dysuria, frequency or urgency
11
Q
Complicated UTI
A
- Fever, systemic toxicity
- Persistent vomiting, dehydration
- Renal angle tenderness, increased creatinine
12
Q
Recurrent UTI
A
Second episode of UTI; usually within 6 months
13
Q
Upper UTI
A
14
Q
Lower UTI
A
15
Q
Pathogenesis of UTI
A
16
Q
Pathogenesis of UTI
- Causative Organism
A
mostly E.coli
17
Q
Pathogenesis of UTI
- Method
A
18
Q
When to suspect Acute pyelonephritis in Newborn?
A
19
Q
When to suspect Acute pyelonephritis in Infants & Young Children?
A
20
Q
When to suspect Acute pyelonephritis in Older Children?
A
21
Q
When to suspect Acute cystitis in Children > 2 years?
A
22
Q
DDx of Voiding symptoms in children > 2 years
A
- Vulvovaginitis (itching + vaginal discharge + inflamed vulva)
- Pin worm infestation
- Hypercalciuria
- Unstable bladder
23
Q
Host Factors contribuiting to UTI
A
+++ Anatomical factors
24
Q
Host Factors contribuiting to UTI
- Age
A
Higer in boys < 1 year & in girls < 4 years
25
Host Factors contribuiting to UTI
- Sex
- Females (2-4 folds higher)
- This may be the result of the shorter female urethra.
Because the incidence of UTI in male neonates is as high, if not higher, than female neonates
26
Host Factors contribuiting to UTI
- Race
White children have 2-4 folds higher than black (for not completely understood reasons )
27
Host Factors contribuiting to UTI
- Genetic
- Higher in first degree relatives
- Adherence of bacteria may be genetically determined.
28
Host Factors contribuiting to UTI
- dysfunctuinal elimination
- An abnormal elimination pattern (frequent or infrequent voids, urgency, constipation)
- Bladder and/or bowel incontinence
- Withholding maneuvers
29
Host Factors contribuiting to UTI
- Circumcision
(Uncircumcised male infants with fever have 4-8 fold higher prevalence)
30
Host Factors contribuiting to UTI
- Catheterization
(Increased Risk with Increased duration of bladder catheterization)
31
Host Factors contribuiting to UTI
- Anatomical abnormalities
- Urinary obstruction
- Vesicoureteral reflux
32
Anatomical abnormalities contributing to UTI
- Urinary Obstruction
33
Anatomical abnormalities contributing to UTI
- VUR
34
RF for Renal Scarring
35
CP of UTI in neonates (<28 days)
36
CP of UTI in in children (< 2 years)
37
CP of UTI in Older Children (> 2 years)
- Fever
- Abdominal pain
- Urinary symptoms (dysuria, urgency, frequency, incontinence, macroscopic hematuria)
38
Fever + chills + flank pain --->
Pyelonephritis
39
Abdominal Ex in **UTI**
39
General Ex in **UTI**
40
Genital (Local) Ex in **UTI**
40
Atypical **UTI**
41
Recurrent **UTI**
42
Red Flags in **UTI**
43
Investigations for **UTI**
Labs & Rads
44
Methods of Urine Collection
45
Preservation of Urine
46
Urine Dipstick Analysis
47
Use of **Leucocyte Esterase**
- Suggestive of UTI
- However, +ve result doesn't always signal UTI
48
Test Principle of **Leucocyte Esterase**
-Leukocyte esterase is present in neutrophils and can be assayed in urine by dipstick strips
49
Sensitivity & Specifity of **Leucocyte Esterase**
Sensitivity: 84%
Specifity: 78%
50
False Positive in **Leucocyte Esterase**
- Imipenem
- Clavulanic acid
51
False negative in **Leucocyte Esterase**
* Ascorbic acid
* Boric acid
* Gentamicin
* Nitrofurantoin
* Cephalexin
* Proteinuria
* Glycosuria
* Urobilinogen
52
Use of **Nitrite**
- Suggestive of UTI
- Not identify gram +ve infection (Lack nitrate reductase enzyme)
53
Test Principle in **Nitrite**
- bacterial enzyme nitrate reductase can convert urinary nitrate to nitrite.
54
Sensitivity & Specificity in **Nitrite**
- 50%
- 98% (Highly specific & low false +ve rate)
55
Microscopic Examination in **UTI**
56
Def of **Pyuria**
57
Sensitivity of **Pyuria**
Sensitivity is 89 % which means it suggests infection, but infection can occur in absence of pyuria
58
Specifity of **Pyuria**
Presence of WBCs in urine is not specific for UTI as pyuria can be present without UTI
59
Causes of Sterile **Pyuria** (False Positive)
- Renal TB
- Urethritis
- Inflammation near the bladder (appendicitis, Chrons disease)
- Intestinal nephritis
60
True UTI without +ve leukocyte esterase on dipstick analysis and > 5 WBC/HPF with standardized microscopy is .......
unusual
61
Absence of pyuria in presence of significant bacteriuria may occur in .....
- Early in the course of UTI (before the local inflammatory response develops
- Bacterial contamination of the urine sample (e.g. from the urethra or periurethral)
- Colonization of the urinary tract (e.g. asymptomatic bacteriuria)
62
Pyuria & Bacteruria association
63
..... is the gold standard for the diagnosis of UTI.
Urine culture
64
Urine culture should be performed in the following groups, even if the dipstick and microscopic analysis are negative:
65
Urine culture interpretation in UTI
66
CBC in UTI
67
Read Dx of UTI from Notes
68
Imaging in Dx of UTI
To identify abnormalities of the genitourinary tract, including VUR and obstructive uropathies. It Includes:
- Renal bladder sonography.
- Voiding cystourethrogram (VCUG)
- Tc-99m DMSA scintigraphy
69
Indications of Imaging in Dx of UTI
70
Imaging in Dx of UTI
- Time of US
Immediately
71
Imaging in Dx of UTI
- value of US
72
VCUG in UTI
- Time
3-6 weeks after infection but can be done after completing of antibiotic therapy
73
VCUG in UTI
- Prophylactic Antibiotics
- Prophylactic oral antibiotics should be given for 3 days with VCUG taking place on the 2nd day
74
VCUG in UTI
- Uses
74
Technique of **Tc-99m DMSA scintigraphy** in UTI
75
What is the gold standard test for diagnosing acute pyelonephritis and renal scars?
Tc-99m DMSA scintigraphy
76
DMSA in UTI
- Disadvantages
However, it doesn't distinguish lesions that will spontaneously resolve from those which cause renal scarring
77
DMSA in UTI
- How to overcome the drawbacks?
Thus, a delay of 4 - 6 months is needed following acute pyelonephritis to allow acute reversible lesions to resolve in order to diagnose renal scarring
78
Indications of Imaging in UTI
- Child < 6 months
79
Indications of Imaging in UTI
- Child 6m - 3 years
80
Indications of Imaging in UTI
- Children > 3 years
81
TTT of UTI
- Goals
82
TTT of UTI
- General Measures
83
TTT of UTI
- Hygeinic Measures
84
TTT of UTI
- TTT Protocol
- Empirical Therapy
- Early and aggressive antibiotic therapy is necessary to prevent renal damage.
- It is initiated while awaiting culture results in infants and young children who are at risk for UTI complications and children with underlying urologic abnormalities.
85
TTT of UTI
- Oral Antibiotics
86
TTT of UTI
- Parentral Therapy
87
TTT of UTI
- Other Meds
Sulpha combinations (TMP-SMX), amoxicillin, penicillin, or nitrofurantoin.
88
TTT of UTI
- Duration of Antibiotics
89
TTT of UTI
- For pyelonephritis
90
TTT of UTI
- For Cystitis
91
Suppressive Therapy in UTI
- Indications
VUR → Till reflux resolves especially in children < 5 years of age.
92
Suppressive Therapy in UTI
- Duration
Antibiotic prophylaxis is continued for up to 6 months after surgical correction of VUR.
93
Suppressive Therapy in UTI
- Drugs
94
Suppressive Therapy in UTI
- SE of Cotrimocxazole
Avoid in children < 3 months age or G6PD def.
95
Suppressive Therapy in UTI
- SE of Nitrofurantoin
1. GIT upset
2. Avoid in children < 3 months age or G6PD def. or renal insufficiency.
96
Suppressive Therapy in UTI
- Advantages of Cephalixin
Drug of choice in 1st 3 months of life
97
Suppressive Therapy in UTI
- Precautions of Cifixime
selected circumstances only
98
DOC for suppressive therapy in UTI in first 3 months of life
Cephalexin
99
Prognosis of UTI
- Recurrent UTI
- HTN
- Renal scarring
100
Prognosis of UTI
- Recurrent UTI
Approximately 14% of children younger than 6 years with UTI have a subsequent UT.
101
Prognosis of UTI
- HTN
Hypertension can result from renal scar formation in patients who have had acute pyelonephritis, often in association with VUR or another urinary tract anomaly.
102
Prognosis of UTI
- Renal Scarring
Acute pyelonephritis has the potential to cause tubulointerstitial damage and renal scar formation.
