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Flashcards in UTI Deck (14):
1

Who gets UTIs?

Women (20-30% have recurrent UTIs)
Men >50 y.o

2

Host factors that predispose to UTIs

Kidney stones (bacterial accumulation)
Vesicourethral reflux (in children)
Neurologic problems (incomplete bladder emptying)
Prostate hypertrophy
Loss of sphincter control
Short urethra (in women)
Urinary catheters

3

Host factors that prevent UTIs

Flushing of urinary tract
pH
Chemical content of urine

4

Examples of virulence factors in uropathogenic E. coli

Fimbriae to adhere
Capsular polysaccharides inhibit phagocytosis
Haemolysins damage membranes

5

What is the most common nosocomial infection

Catheter associated UTIs- risk of UTI increases by 3% each day the catheter stays in place

6

S/S of UTI
- AND what is not a sign?

Change in the frequency of urination
Dysuria
Urgency
Hesitancy
New-onset incontinence (elderly)
Fever
Costovertebral angle tenderness (pyelonephritis)

**malodorous, cloudy urine alone is not a sign of UTI**

7

General steps for diagnosing a UTI

-History
-Signs and Symptoms
-Urinanalysis
-Urine C&S

8

Different ways to collect a urine sample

-Midstream catch (must clean periurethral area first)
-Foley catheter sample (collect from <24hr old catheter)
-Suprapubic aspiration
-Ileal conduits (in pts with cystectomy, will always be contaminated)
-Nephrostomy tubes (kidney punctured percutaneously)
-Direct cystoscopy

9

Urinalysis
-signs you could have a UTI

- leukocyte esterase: WBCs are present, but not specific to UTI (e.g. cancer, inflammation due to catheter)

-Nitrite: + if bacteria that can reduce nitrate are present

10

Quantitaive urine cultures
-use
-when to consider contamination
- sample delivery, storage

-Used to characterize presence +/- severity of infection
-Probably contaminated if 3 or more species grow
- Need to deliver within 2 hrs to lab, or store in fridge so bacteria doesn't overgrow

11

Antibiotic choices for empiric UTI therapy:
-Acute cystitis
-Recurrent cystitis
-Pyelonephritis
-Asymptomatic bacteriuria

Acute cystitis: Nitrofurantoin or fosfomycin

**do not use TMP-SMX or ciprofloxacin empirically due to high levels of resistance in E.coli**

Recurrent cystitis: longer course of Ab

Pyelonephritis: Cefixime or Amoxil-Clav in community. Ceftriaxone or Gentamicin in hospital (IV)

Asymptomatic bacteriuria: do not treat unless pregnant or undergoing instrumentation

12

Management of:
-catheter-associated UTI
-recurrent febril UTI in paediatric patients

CAUTI: change or remove catheter and Ab

Paeds: US +/- voiding cystourethrogram to check fro vesciouretral reflux

13

How do bacteria get into the urinary tract?

-ascend through the urethra
-seeding of the kidneys with bacteria in the blood (less common)

14

Etiology of UTI

Bacterial
-Enterobacteriaceae (E. coli (80%), Klebsiella, Proteus)
-Enterococcus
-CNS
-GBS

**differs in hospital-acquired UTI. Can also have candida**