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Flashcards in Urinary Tract Infections Deck (13)
0

Urethral syndrome

Urethral infection only
Severe dysuria and urgency

1

Cystitis

Urethral syndrome and bladder infection
Heavy feeling suprapubically that is relieved by peeing

2

Pyelonephritis

Infection involving kidney parenchyma
Loin pain, fever
Rigours, bacteriaemia

3

Host defences against UTI

Urinary tract normally sterile above distal urethra
Washout dilutes and removes bacteria
IgA and IgG excreted in urine
IgA in urethra

4

Predisposing factors for UTI

Interruption of washout-> catherisation, infrequent emptying, reduced fluid intake, obstruction
Resicouretic reflux-> bladder contracts-> urine goes back up ureter
Neurological problems-> multiple sclerosis-> don't excrete all their urine
Congenital abnormalities-> horse shoe kidney, congenital uretopelvic obstruction, partial, complete ectopic insertion duplicated urethra
Diabetes
Pregnancy-> retention due to weight of uterus! progesterone induced smooth muscle relaxation

5

Common organisms causing UTI

Ability to bind urothelium
Resistant to serum bactericidal activity
Resistant to urea
Break down mucin-> helps them ascend
E.coli-> hospital and community
P.mirabalis-> community
Klebsiella sp-> hospital
S. Saprophytcus-> community, young women
S.epidmis, enterococci, p. aeruginosa, other-> hospital

6

Symptoms of UTI

Symptoms related to site
Pyelonephritis-> loin pain, fever, dysuria, confusion, not eating
Bladder-> frequency, dysuria
Urethra-> urgency
Young children-> sepsis, irritability, vomiting, failure to thrive

7

Lab diagnosis UTI

Contaminated by commensal bacteria-> isolate pathogens-> clean area, mid steam

8

Microscopy UTI

Pyuria-> white blood cells in urine
Red cells
Bacteria
Casts-> abnormal structures such as pus
Epithelial cells-> bad sample
Could be other reasons:
Post surgery
Catheter-> normal
Fever in children
Contamination from vagina

9

Culture UTI

Lactose fermenter
Non lactose fermenter
Staph-> DNase, novobiocin resistant
Streptococcus-> aesculin positive, group

10

UTI treatment

Only treat symptomatic people and those most at risk of pyelonephritis and renal damage-> young, pregnant, renal tract abnormalities
Cystitis in young and healthy may resolve with water alone
Increase fluids
Antibiotics:
Simple-> trimethoprim, nitofurantoin 3 days
Complicated -> 10-14
-> recurrent, renal involvement, male, pregnant, abnormalites, urogenital surgery, diabetes, catheter
-> cephalosporins, co-amoxiclav, gentamicin, ciproflaxacin
Prophylaxis in chronic

11

Sepsis

Bodies response to infection
Fever and shaking cells
Reduced mental altertness
N+v+d
HR>90
Resps >30
High or low white cell count
Altered kidney or liver function
High morality

12

Catheter

1 in 300 morality
Consider alternative methods
Review regularly
Smallest gauge catheter
Aseptic procedure
Closed drainage system
Obtain samples from sampling pot
Don't change regularly
Bladder washouts don't prevent infection

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