Urinary infection Flashcards

(43 cards)

1
Q

What is the definition of a urinary tract infection (UTI)?

A

Presence of microorganisms with invasion of adjacent tissues that are part of the genitourinary system.

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2
Q

What are the main anatomical classifications of UTIs?

A

UTIs can be classified based on the anatomical location:

  • Kidney (pyelonephritis)
  • Bladder (cystitis)
  • Urethra (urethritis)
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3
Q

What are the clinical classifications of UTIs?

A

UTIs are classified clinically as:

  • Primary infection
  • Recurrent infection
  • Reinforcement infection
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4
Q

What is a primary infection in the context of UTIs?

A

The initial episode of a UTI caused by a microorganism infecting the urinary tract.

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5
Q

What is a recurrent infection in UTIs?

A

A UTI that occurs after a previous infection, typically defined as >2 episodes in 6 months or >3 episodes per year.

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6
Q

What is a reinforcement infection in UTIs?

A

After successful resolution of a UTI, an infection with the same microorganism occurs up to 3 weeks later.

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7
Q

What defines a new UTI infection after eradication?

A

Appearance of a new infection by a different microorganism after 7-10 days of having eradicated a previous UTI.

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8
Q

What are the common bacterial causes of UTIs?

A

Common bacterial causes include:

  • Escherichia coli
  • Klebsiella
  • Proteus mirabilis
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Enterococcus faecalis
  • Streptococcus agalactiae
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9
Q

What are non-bacterial causes of UTIs?

A

Non-bacterial causes include:

  • Fungi: Candida spp.
  • Viruses: Cytomegalovirus (CMV)
  • Parasites: Trichomonas vaginalis, Schistosoma spp.
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10
Q

What are the mechanisms of UTI pathogenesis?

A

Mechanisms include:

  • Systemic spread
  • Colonization of kidneys
  • Ascension to kidneys
  • Biofilm formation
  • Colonization and invasion of bladder
  • Ascension via urethra
  • Contamination of periurethral area
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11
Q

What are the clinical signs and symptoms of pyelonephritis?

A

Pyelonephritis symptoms include:

  • Renal fossa pain
  • Fever
  • Chills
  • Nausea
  • Vomiting
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12
Q

What are the clinical signs and symptoms of cystitis?

A

Cystitis symptoms include:

  • Pelvic pain
  • Polakiuria (frequent urination)
  • Hematuria (macro or micro)
  • Straining
  • Tenesmus
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13
Q

What are the clinical signs and symptoms of urethritis?

A

Urethritis symptoms include:

  • Dysuria (painful urination)
  • Polakiuria
  • Purulent discharge (e.g., in Neisseria gonorrhoeae infections)
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14
Q

How is cystitis classified based on frequency?

A

Cystitis is classified as:

  • Isolated or simple: Single episode
  • Recurrent: >2 episodes in 6 months or >3 episodes per year
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15
Q

What are the specific symptoms associated with cystitis?

A

Cystitis-specific symptoms include:

  • Tenesmus
  • Polakiuria
  • Urgency
  • Terminal drip
  • Hematuria
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16
Q

What defines pyelonephritis pathologically?

A

Pyelonephritis is the inflammation of the kidney parenchyma due to bacterial infection.

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17
Q

What are the risk factors for UTIs in women?

A

Risk factors in women include:

  • Short urethra
  • Proximity of urethra to anus
  • Sexual activity
  • Pregnancy
  • Menopause (decreased estrogen)
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18
Q

What are the general risk factors for UTIs?

A

General risk factors include:

  • Obstruction (e.g., kidney stones, prostatic hypertrophy, tumors)
  • Vesicoureteral reflux
  • Narrow urethra
  • Pregnancy
19
Q

What are the clinical features of a moderate UTI?

A

Moderate UTI features:

  • Fever
  • With or without flank pain
  • Dysuria
  • Polakiuria
  • Bladder urgency
20
Q

What are the clinical features of a severe UTI?

A

Severe UTI features:

  • High fever (peaks at 72 hours)
  • Nausea
  • Vomiting
  • Flank pain
21
Q

What laboratory tests are used for UTI diagnosis?

A

Laboratory tests include:

  • Blood tests
  • General urine test
  • Urine culture with antibiogram
22
Q

What are the sensitivity and specificity of leukocyte esterase in UTI diagnosis?

A

Sensitivity: 83%
Specificity: 78%

23
Q

What are the sensitivity and specificity of nitrites in UTI diagnosis?

A

Sensitivity: 53%
Specificity: 98%

24
Q

What are the sensitivity and specificity of leukocytes in UTI diagnosis?

A

Sensitivity: 73%
Specificity: 81%

25
What are the sensitivity and specificity of bacteria in UTI diagnosis?
Sensitivity: 81% Specificity: 83%
26
When are urine cultures indicated for UTIs?
Urine cultures are indicated for: - Pregnant women - Complicated UTIs - Recurrent UTIs - Therapeutic failure - Pyelonephritis
27
What are the treatment options for lower UTIs?
Treatment for lower UTIs includes: - Nitrofurantoin (monitor urine pH) - Phenazopyridine (for symptom relief) - Fosfomycin
28
What are the treatment options for UTIs in pregnancy?
Treatment for UTIs in pregnancy includes: - Cephalexin - Ceftriaxone
29
What is the treatment approach for upper UTIs (e.g., pyelonephritis)?
For upper UTIs: - Take urine culture - Start empiric treatment with Ciprofloxacin
30
What is the most common cause of UTIs and its prevalence?
Escherichia coli is the most common cause of UTIs, accounting for approximately 70-95% of uncomplicated UTIs.
31
What are key considerations for nitrofurantoin use in UTIs?
Nitrofurantoin is highly effective for uncomplicated cystitis but requires a urine pH <5.5 for optimal activity and is contraindicated in pyelonephritis or renal impairment.
32
What is a key feature of fosfomycin in UTI treatment?
Fosfomycin is a single-dose treatment option for uncomplicated UTIs, with excellent activity against multidrug-resistant E. coli.
33
What are the risks of untreated UTIs in pregnancy?
Untreated UTIs in pregnancy can lead to pyelonephritis, preterm labor, and low birth weight, making early screening and treatment critical.
34
How are recurrent UTIs managed?
Recurrent UTIs may require prophylactic antibiotics (e.g., low-dose nitrofurantoin or trimethoprim-sulfamethoxazole) or non-antibiotic measures like cranberry products.
35
What are potential complications of pyelonephritis?
Pyelonephritis can lead to complications like renal abscess, sepsis, or chronic kidney disease if not treated promptly.
36
How is a urine culture interpreted for UTI diagnosis?
A urine culture with ≥10⁵ colony-forming units (CFU)/mL of a single organism is diagnostic for UTI in symptomatic patients.
37
How does vesicoureteral reflux contribute to UTIs?
Vesicoureteral reflux increases the risk of pyelonephritis by allowing urine to flow backward from the bladder to the kidneys, promoting bacterial ascension.
38
What is a common cause of UTIs in young, sexually active women?
Staphylococcus saprophyticus is a common cause of UTIs in young, sexually active women, often presenting as acute cystitis.
39
What is the impact of antibiotic resistance on UTI treatment?
Increasing resistance to trimethoprim-sulfamethoxazole and fluoroquinolones has made nitrofurantoin and fosfomycin preferred first-line agents for uncomplicated UTIs.
40
What are preventive measures for UTIs?
Preventive measures for UTIs include adequate hydration, voiding after intercourse, and avoiding irritants like spermicides.
41
What is a key fact about catheter-associated UTIs (CAUTIs)?
Catheter-associated UTIs are the most common healthcare-associated infections, and prompt catheter removal is critical to prevention and treatment.
42
What defines a complicated UTI?
Complicated UTIs occur in patients with structural or functional urinary tract abnormalities, immunosuppression, or multidrug-resistant organisms, requiring longer treatment durations.
43
How do UTIs present in children?
UTIs in children may present with nonspecific symptoms (e.g., fever, irritability) and require imaging to rule out anatomical abnormalities like vesicoureteral reflux.