Urinary Tract Infection Microbiology Flashcards Preview

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Flashcards in Urinary Tract Infection Microbiology Deck (47):
1

What is a complication UTI?

Upper UTI with or without systemic signs and symptoms
Catheter-associated UTI

2

What are the criteria for urosepsis?

Temperature over 38
Heart rate >90/min
Respiratory rate >20/min
WBC >15 or <4

3

What are the at risk groups for developing bacteriuria?

Hospitalised
Catheterised
Diabetics
Anatomical abnormalities
Pregnant
Preschool aged children (girls > boys)

4

In which patients should you treat asymptomatic bacteriuria?

Preschool children
Pregnant women
Renal transplant patients
Immunocompromised patients

5

What are the features of ascending urinary tract infections?

Urethral colonisation
Occurs more in women
Multiplication in the bladder
Ureteric involvement

6

What are the features of descending UTIs?

Associated with blood-borne infections
Involves the renal parenchyma

7

In which situations are UTIs most likely to be caused by multiple organisms (<5%)?

Long-term catheters
Recurrent infections
Structural/neurological abnormalities

8

What are the clinical features of a UTI?

Suprapubic discomfort
Dysuria
Urgency
Frequency
Cloudy, blood stained, smelly urine
Low-grade fever
Sepsis
Failure to thrive, jaundice (neonates)
Abdominal pain and vomiting (children)
Nocturia, incontinence and confusion (elderly)

9

Name the common causative organisms of UTIs.

Gram negative bacilli
- E.Coli
- Klebsiella
- Proteus
- Pseudomonas
Gram positive bacteria
- Strep (entercoccus)
- Staph
Anaerobes
Candida

10

What are the investigations for an uncomplicated UTI?

1) Non-pregnant women
On 1st presentation, culture is not mandatory
- dipstick has high false positive rates
- antibiotic for 3-7 days
- culture if there is no response to treatment and change the antibiotic
2) Children and men
- send urine for each and every presentation
- treat

11

How are UTIs in pregnancy managed?

Send urine sample with each presentation
Treat for 7-10 days
- amoxicillin and cefalexin
Hospital admission and IV antibiotics if severe
Can develop into pyelonephritis (30%)

12

What antibiotics should you not give a pregnant woman for a UTI?

Trimethoprim
- not in first trimester
Nitrofurantoin
- not near term

13

What constitutes a recurrent UTI?

Two or more episodes in 6 months
Three or more episodes in a year

14

How should you manage a recurrent UTI?

Send a sample with each episode
Encourage hydration
Encourage urge initiated and post-coital voiding
Cranberry products
Intravaginal/oral oestrogen
Urology investigation
Self administered single dose/short course therapy
Single dose post-coital antibiotics
Prophylactic antibiotics
- if simple measures fail
- 6 months ideally (trimethoprim or nitrofurantoin)

15

How do catheter associated UTIs occur?

Disturbance of the flushing system
Colonisation of the urinary catheter
Biofilm production by bacteria

16

Name some complications of catheters.

CAUTI
Obstruction-hydronephrosis
Chronic renal inflammation
Urinary tract stones
Long term risk of bladder cancer

17

How are catheter infections prevented?

Catheterise only if necessary
Remove when no longer needed
Remove and replace if causing an infection
Catheter care
Hand hygiene

18

How are CAUTIs treated?

Check recent microbiology
Start empirical antibiotics
Remove catheter is not needed
Replace catheter under antibiotic cover
- gentamicin and ciprofloxacin
May need to be more broad spectrum

19

What is acute pyelonephritis?

Upper urinary tract infection (moderate/severe)
Ascending infection involving the pelvis of the kidney
Enlarged kidney
Raised abscesses on the surface of the kidney

20

How is acute pyelonephritis managed?

Check recent microbiology
Send urine and blood cultures
Image the kidneys
Community
- trimethoprim, ciprofloxacin or co-amoxiclav
Hospital
- broad spectrum
No response means further investigation is needed
Uncomplicated = 7-14 days
Complicated = longer than 2 weeks

21

What causes a renal abscess?

It's a complication of pyelonephritis (similar symptoms)
Gram negative bacilli (usually)

22

What are the complications of a renal abscess?

Can become life-threatening
- emphysematous pyelonephritis (severe infection causes gas accumulation in the tissues)
Poor response to antibiotics

23

What are the risk factors for a perinephric abscess?

Untreated LUTI
Anatomical abnormalities
Renal calculi
Bacteraemia
Haematogenous spread

24

What are the common causative organisms of a perinephric abscess?

E.Coli
Proteus
S.aureus
Strep
Candida

25

How can you detect a perinephric abscess?

Symptoms
- similar to pyelonephritis
- localised signs and symptoms
Positive blood cultures
Pyuria with/without bacterial growth

26

How are perinephric abscesses treated?

Empirically as a complicated UTI
(poor response normally)
Surgical removal/drainage

27

How are complicated UTIs managed in all patients?

Bloods - FBC, U&es, CRP
Urine sample
Blood culture - if pyrexic or hypothermic
Renal US
CT KUB
Antibiotic therapy for 2 weeks or more

28

Describe the interpretation of urine microscopy?

Epithelial cells - contamination
Bacteria with no WBC - contamination
Bacteria with WBC and no catheter - infection
Bacterial with WBC and a cather needs to be assessed clinically
Pyuria with no bacteria
- previous/recent antibiotic
- tumour
- calculi
- urethritis (chlamydia check)
- TB

29

What are the antibiotic guidelines for a complicated UTI?

IV therapy
- amoxicillin/vancomycin
- gentamicin/aztreonam/temocillin
Drug monitoring in gentamicin

30

What is acute bacterial prostatitis?

A spontaneous, localised infection of the prostate gland

31

What are the symptoms of acute bacterial prostatits?

Fever
Perineal/back pain
UTI
Urinary retention
Diffuse oedema
Micro abscesses

32

What are the likely causative organisms of acute bacterial prostatitis?

Gram negative bacilli
- E.Coli
- Proteus
S.aureus
N.gonorrhoea

33

What are the investigations for acute bacterial prostatitis?

Urine culture
Blood culture
Trans-rectal US
CT/MRI

34

What are the complications of acute bacterial prostatits?

Prostatic abscess
Spontaneous rupture
- urethra or rectum
Epidiymitis
Pyelonephritis
Systemic sepsis

35

What is the antibiotic management for acute bacterial prostatitis?

Check recent microbiology
Ciprofloxacin or Ofloxacin

36

What are the common symptoms of chronic prostatitis?

Perineal discomfort/back pain
Low-grade fever possible
UTI symptoms

37

What is epididymitis?

Inflammatory reaction of the epididymis
- from ascending infection of the urethra

38

What are the symptoms of epididymitis

Pain
Fever
Swelling
Penile discharge
Symptoms of UTI

39

What are the common causative organisms for epididymitis?

GNB
Enterococci
Staph
TB - in high risk groups
Need to rule out urethritis
- Chlamydia
- N.gonorrhoea

40

What is orchitis?

Inflammation of one or both testicles

41

What are the symptoms of orchitis?

Testicular pain and swelling
Dysuria
Discharge
Penile discharge

42

What is the most common cause of orchitis?

Viral (mumps)

43

What are the complications of bacterial orchitis?

Testicular infarction
Abscess formation

44

What is Fournier's gangrene?

A form of necrotising fasciitis
- rapid onset and spreading infection
Causes systemic sepsis

45

What are the risk factors for Fournier's gangrene?

UTI
Complications of IBD
Trauma
Recent surgery

46

What are the investigations used in Fournier's gangrene?

Blood cultures
Urine
Tissue/pus

47

How is Fournier's gangrene treated?

Surgical debridement
Broad spectrum/combination antibiotics
- Tazocin and gentamicin and metronidazole and clindamycin