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NME > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

UTI definition

A

the inflammatory response of the urothelium to bacterial invasion

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2
Q

UTIs are the result of

A
  • reduced host defences
  • micro-organism pathogenicity

usually a combination of these factors leads to the development of symptomatic infection

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3
Q

Less common micro-organsims can result in UTI by two types of spread:

A
  • haematonegenous spread
  • direct transmission from adjacent infected
    organs
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4
Q

Less common micro-organsims can result in UTI by two types of spread:

A
  • haematonegenous spread
  • direct transmission from adjacent infected
    organs
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5
Q

UTIs can be broadly divided into (2):

A
  • uncomplicated: occuring in a patient with a
    structurally and functionally normal urinary
    tract
  • complicated
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6
Q

Bateriuria definition

A

presence of bacteria in the urine

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7
Q

Pyuria

A

presence of white cells in the urine

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8
Q

Sterile pyuria

A

presence of white cells in the urine with bacteriuria

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9
Q

Asymptomatic bacteriuria definition

A

presence of bacteria on two consecutive urine cultures without symptoms of upper or lower UTI

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10
Q

What is required for a UTI to be classed as a complicated UTI (2):

A
  • positive urine culture with a risk factor
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11
Q

Recurrent UTI (4):

A
  • episode of UTI after documented
    successful resolution of an earlier episode
  • frequency of at least twice in the previous
    6 months
  • three times in the last 12 months
  • classed as persistent or re-infection
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12
Q

Persistent UTI:

A
  • recurrent UTI caused by the same
    organism
  • indicates focus of infection in the urinary
    tract - stones/fistula
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13
Q

Re-infection UTI:

A
  • recurrent UTI caused by different
    organisms
  • indicates susceptibility to UTI (genetic)
  • associated with (3):
    • poor hygiene
    • sexual intercourse
    • post-menopause
  • 95% of female UTIs are due to re-infection
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14
Q

Classification of UTI table

A

insert

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15
Q

What % of females have one UTI in their lifetime?

A

50%

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16
Q

What % of UTIs occur in men?

A

20%

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17
Q

What % of elderly have asymptomatic bacteriuria?

A

20%

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18
Q

Why are women more susceptible than men to UTIs?

A
  • female urethra is shorter and straighter
  • facilitates bacterial access to the bladder
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19
Q

In postmenopausal women, what may predispose patients to UTIs?

A
  • oestregne deficiency
  • from increased colonisation with E.coli
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20
Q

In men, UTI is often associated with

A

urinary obstruction eg bladder outlet obstruction due to prostate enlargement

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21
Q

Use of what type of catheters can cause UTIs

A
  • indwelling catheters (men and women)
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22
Q

Male urethra

A

insert image

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23
Q

3 risk factors of uncomplicated UTIs:

A
  • female gender
  • older
  • younger
24
Q

Risk factors of complicated UTIs?

A
  • indwelling catheters
    -immunosuppression
  • urinary tract abnormalities
  • antibiotic exposure
25
Q

Aetiology of UTI:

A
  • UPEC
  • K. pneumoniae
  • S. saprophycticus
  • Candida
  • S. aureus
26
Q

UTIs: Anatomical Sites (6):

A

insert slide

27
Q

Classification of UTIs

A

insert

28
Q

Risk factors for complicated UTIs:

A

insert

29
Q

Acute Cystitis

A
  • the infection and inflammation of
    the bladder urothelium
  • often associated with lower urinary
    tract symptoms: dysuria, frequency,
    urgency, suprapubic pain, offensive
    urine
  • if dysuria and frequency are both
    present then probability of UTI >90
    and EMPIRICAL antibiotic treatment
    indicated
30
Q

Acute Pyelonephritis

A
  • infection/inflamm of kidney
  • symptoms: flank pain, nausea,
    vomiting and pyrexia
  • must differentiate early between
    acute, uncomplicated and
    obstructive (stone from kidney to
    ureter, backpressure causes this,
    antibiotics won’t help)
  • can result in urosepsis
  • imaging of upper urinary tract key
    for evaluating obstruction or renal
    stones
31
Q

Catheter associated UTI:

A
  • catheters provide a focus for
    bacterial biofilm formation
  • long0term indwelling catheters
    often colonised with two or more
    organisms
32
Q

When is antibiotic treatment indicated in patients with catheter associated UTI?

A
  • only if symptomatic
33
Q

Epididymo-orchitis

A
  • inflammation of the epididymis and
    or testicle
  • causes pain, swelling and often
    unilateral
  • antimicrobials selected empirically
    that in young, sexually active men
    c. trachomatis is usually causative
  • in older men with BPH or other
    micturition disturbances, generally
    gram neg e-coli
34
Q

Pathogenesis of UTIs:

A
  • faecal flora (gram neg) colonise
    perineum, UTI usually results from
    retrograde ascent of these
    microorganisms
  • bacteria adhere to the urothelium
    and release toxins
35
Q

UTI: UPEC: Pathogenesis:

A

insert slidess

36
Q

Clinical Presentation of UTI: Mneumonic:

A

FUND

37
Q

Clinical Presentation of UTI: FUND:

A
  • frequency
  • urgency
  • nocturia
  • dysuria
  • foul odour
  • suprapubic pain/tenderness
    indicative of cystitis
  • costovertebral angle
    pain/tenderness indicative of
    pyelonephritis
  • Fever
  • hypotension and altered mental
    state may indicate sepsis
38
Q

Clinical Presentation of Pyelonephritis:

A
  • fevers, rigors, loin pain
  • renal angle tenderness
  • costovertebral angle pain
  • if pain radiates to groin = stone
  • risk of bacteraemia
39
Q

UTI Investigations:

A
  • urine dipstick
  • microscopy
  • urine culture
  • renal imaging
40
Q

UTI Investigations: Urine Dipstick:

A
  • urinary pH: alkaline may indicate a
    urea-splitting organism
  • leukocyte esterase: inflammatory
    cells
  • nitrite: enterobacteria family
  • blood: cystitis may cause but
    malignancy should be ruled
    out
  • protein: glomerulopathy, large WBC
    count may lead to a false
    positive
41
Q

If a urine dipstick shows presence of nitrites but not leukocytes then

A

does not necessarily suggest a UTI

42
Q

UTI Investigations: Microscopy:

A
  • midstream sample
  • centriguged
  • more 5 leukocytes per high power
    field denotes pyruria
  • sterile pyuria may occur with:
    - bacterial infections (renal
    abscesses)
    - partially treated UTI
43
Q

UTI Investigations: Urine Culture:

A
  • gold standard investigations
  • 0.1 ml urine delivered onto each half
    of split agar plate
  • number of colonies estimated after
    overnight incubation
  • more than 10to the power 5 colony
    count for diagnosing UTI
  • 50% symptomatic women have a
    lower colony count
  • 100 colonies may signal infection in
    symptomatic patients
44
Q

Urinary bacteria generally gram positive or negative?

A

Gram negative

45
Q

Gram staining:
Pink signifies
Purple signifies

A

pink = gram neg
purple = gram pos

46
Q

Is E.coli gram positive or negative?

A

Negative

47
Q

Gram positive organisms include:

A
  • enterococcus faecalis
  • staphylococcus
48
Q

UTI Investigations: Renal Imaging:

A
  • ultrasound
  • CT
  • in pts who are systemically ill, with a
    history of kidney stones
  • to rule out an infection behind an
    obstruction that mimics an abscess
49
Q

Uncomplicated cystitis: Management: Women:

A
  • empiric treatment in healthy, non-
    pregnant women with classic
    symptoms of acute UTI without
    evidence of pyelonephritis
  • urinary dipstick is only test required
  • if abnormal then pelvic exam and
    urine culture could be indicated
50
Q

Uncomplicated Cystitis: Management: Men:

A
  • urine dipstick and culture generally
    performed before therapy
51
Q

Uncomplicated Pyelonephritis: Management:

A
  • urinary dipstick is usually positive
  • urine culture sent for definitive
    diagnosis, to find causative
    organism
52
Q

Complicated UTI: Management:

A
  • suspected in pts who relapse and
    don’t improve with therapy
  • results when anatomic or functional
    abnormality of urinary tract or a
    resistant infection
  • cather associated UTI always
    complicated
  • urine culture recommended
53
Q

Asymptomatic Bacteriuria: Management:

A
  • screening for asymptomatic
    bacteruria unnecessary
  • pregnant women screened and
    treated if bacteria count 10,000 or
    more to decrease risk of
    pyelonephritis
  • patients undergoing renal or
    urologic procedures also benefit
    from screening
54
Q

UTI: Antibiotic Treatment:

A
  • empiric: consider target organisms,
    route of administration, side effects,
    resistance
  • uncomplicated UTI usually need 5
    days antibiotics (broad-spectrum)
    whilst waiting for culture
55
Q

UTI Treatment: Antibiotics: Empiric Drugs:

A
  • nitrofurantoin (4x day)
  • trimethoprim (x2 day)
  • 5-7 days for trimethoprim
56
Q

Prevention of recurrent UTIs:

A
  • correct underlying host cause
    (diabetes mellitus)
  • antibiotic prophylaxis (temporary)
  • behavioural changes:
    - high fluid intake
    - void after intercourse
    - double voiding (before and
    after)
    - OTC: cranberry juice
  • oestregen replacement for post
    menopausal women
57
Q

Prevention of Catheter Acquired UTIs:

A
  • only use for a good reason
  • asceptic insertion
  • closed drainage system
  • remove promptly when no longer
    indicated

NME (52 decks)

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