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MET3B -Renal > UTI's > Flashcards

UTI's Flashcards

1
Q

What is a Urinary tract infection?

A

Inflammatory response of urothelium to bacterial invasion

refer to an infection of any part of the urinary system from kidney to the urethra.

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2
Q

How is a UTI diagnosis defined?

A

presence of characteristic symptoms (e.g. dysuria, frequency) and significant bacteriuria . Significant bacteriuria is defined as > 105 colony forming units (CFU)/ml.

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3
Q 
Define the following terms -
Upper UTI
Lower UTI
Uncomplicated UTI
Complicated UTI
A

Upper UTI: infection of the kidney (pyelonephritis) - Renal pelvis, Ureter

Lower UTI: infection of the bladder (cystitis) and urethra (urethritis)

Uncomplicated UTI: if occurring in healthy non-pregnant adult women

Complicated UTI: the presence of factors that increase the risk of treatment failure (e.g diabetes, structural abnormalities, catheter and other devices and all UTIs in men)

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4
Q

Which organism causes 75-90% of UTI’s?

A

Escherichia coli

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5
Q

List 4 other common microorganisms associated with uncomplicated UTIs?

List 4 assocaited with complicated UTI’s

A

Uncomplicated

Proteus mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus
Streptococcus faecalis

Complicated

Streptococcus faecalis
Staphylococcs aureus
Staphylococcus epidermidis
Pseudomonas

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6
Q

What are extended-spectrum beta-lactamase (ESBL) producing E. coli?

A

organisms which are highly resistant to most beta-lactam antibiotics,

which includes penicillins and cephalosporins.

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7
Q

What is the Urothelium lining composed of?

A
  • Transitional epithelium in the upper tract and bladder

- Pseudostratified columnar in membranous and spongy urethra

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8
Q

Describe the 3 main routes of UTI infection

A

Ascending: retrograde ascent of bacteria up urethra

  • Bacteria from large bowel colonise perineum and ascend to bladder
  • May ascend from bladder to kidney via ureter

Haematogenous: (the blood)
- Uncommon cause of infection

Lymphatic

  • inflammatory bowel disease
  • retroperitoneal abscess
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9
Q

What is the meaning of the term Pyuria and Bacteriuria

A

Bacteriuria: presence of bacteria in urine

Pyuria: presence of white bloods cells in urine

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10
Q

What does Bacteriuria with no Pyuria suggest?

A

Urine is colonized rather than active infection.

Pyuria Implies an inflammatory response of urothelium to bacterial infection

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11
Q

What are the potential causes of Pyuria with no Bacteriuria?

A

Carcinoma in situ

TB infection

Bladder stone

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12
Q

What is the meaning of the terms isolated, recurrent and unresolved UTI?

A

Isolated UTI:
◦ at least 6 months between infections

Recurrent UTI:
◦ >2 infections in 6 months or 3 within 12 months
◦ Re-infection: infection by different organism
◦ Persistence: infection by same organism from a focus in urinary tract
(calculi, chronically infected prostate)

Unresolved UTI:
◦ inadequate therapy
◦ May be due to bacterial resistance

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13
Q

Which symptoms are associated with cystitis? How is this condition diagnosed?

A

frequent small volume voids
urgency
suprapubic discomfort
dysuria

Investigation to confirm diagnosis:
◦ Dipstick mid stream urine:

Presence of leucocytes (indirect testing for pyuria)
75-95% sensitive for UTI

Presence of nitrite (indirect testing for bacteriuria)
Specificity >90%
Sensitivity 35-85%

◦ Urine microscopy

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14
Q

How is Cystitis treated?

A

Uncomplicated:
Short course antibiotics e.g. Trimethoprim
Nitrofurantoin is also first line for alot of places

◦ Complicated :
7-10 day course e.g. Augmentin and investigate further

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15
Q

Which further investigations may you need to conduct for cystitis?

A

Abdominal X-ray (Kidney / Ureters / Bladder [KUB])

◦ Renal ultrasound

◦ Possibly intravenous urogram / CT urogram if structural abnormality

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16
Q

What are the symptoms for pyelonephritis and which investigations are conducted for this condition?

A

Symptoms and signs:

◦Flank / loin pain
◦ Nausea and vomiting
◦ Fever and chills
◦ Lower urinary tract symptoms (LUTS)

Investigations
◦ MSU – dipstick and send for culture
◦ Bloods – FBC, U&E, blood cultures
◦ AXR, Renal USS, CT urogram

17
Q

How is pyelonephritis treated?

A

Not systemically unwell consider outpatient management – 10 days oral
antibiotics - oral fluoroquinolone such as ciprofloxacin

◦ systemically unwell – admit for IV co-amoxiclav antibiotics, and consider IV antibiotics at
home -

ceftriaxone may be used for patients with urosepsis or acute severe pyelonephritis.

18
Q

List 4 organism which mainly cause pyelonephritis

A

E. Coli

◦ Less commonly Enterococci/Klebsiella/Proteus/Pseudomoas

19
Q

State the main complication for Pyelonephritis and describe how it is treated

A

Perinephric abscess (abscess in Gerota’s fascia (perinephric space) ):

infection extends outside parenchyma

Treatment:
drainage of collection (radiologically or formal open incision)

antibiotics until resolution of infection (clinically and radiological evidence)

20
Q

What are the risk factors for Pyelonephritis complications and which organisms can be responsible for these complication?

A 
Diabetes
 Obstructing calculus (stone)

Microbiology:
S. aureus
E. coli
Proteus

21
Q

UTI’s can cause urosepsis - describe the sepsis 6 principal

A

3 IN
- high flow oxygen (94-98%)
Those at risk of carbon dioxide retention (COPD) should have a target of 88-92%

  • IV fluids should be started (crystalloid )
  • Antibiotics - piperacillin/tazobactam (tazocin)

3 OUT
- two sets of blood cultures should be taken (before giving antibiotics)

  • serum lactate should be obtained from blood gas
  • Urine output should be measured ideally with a catheter
22
Q

Which factor increase your risk of an UTI via the Ascending route?

A

Increased risk: vesicoureteric reflux/impaired ureteric peristalsis e.g. in patients with stones

23
Q

List 3 modifiable risk factors for UTI’s?

A

Contraceptive diaphragm
Recurrent sexual intetocurse
indwelling catheter

24
Q

What effect does Trimethoprim have in renal function tests?

A

Causes a rise in creatinine

25
Q

Which type of urine sample is required for UTI investigations?

A

Mid stream urine sample

26
Q

How should a pregnant woman with a UTI be treated?

A

Immediate 7-10 days on antibiotics. Options include

amoxicillin, ampicillin, nitrofurantoin, and cephalosporins (cephalexin).

27
Q

Which recreational drug has been associated with cystitis? Which bladder findings is associated with this type of cystitis?

A

Ketamine

Bladder wall thickening and contracted bladder

28
Q

Which antibiotic is best suited for a UTI caused by klebsiella?

A

Meropenem

29
Q

What are the 3 first-line drugs to treat uncomplicated UTI? Describe the dose for each drug and the length of use in men and women.

A

Trimethoprime - 200 mg BD for 3 days in women or 7-14 days in men

Nitrofurantoin - 50 mg QDS or 100 mg MR BD for 3 days in women or 7-14 days in men.

Fosfomycin 300mg - single dose sachet

30
Q

Which drug class is used to treat Acute uncomplicated pyelonephritis that does not require admission to hospital?

A

An oral fluoroquinolone such as 500 mg of ciprofloxacin 12-hourly for 14 days.

31
Q

Which drug is used to treat complicated cystitis. Which drug is used to treat cystitis with a more severe disease such as urosepsis?

A

Oral course of a fluoroquinolone. In the presence of more severe disease (e.g. urosepsis) or patients unable to tolerate oral therapy, broad-spectrum IV antibiotics can be used

32
Q

How is urosepsis or acute severe (complicated) pyelonephritis treated?

A

Intravenous co-amoxiclav (e.g. 1.2 g 8-hourly, adjusted based on renal function) or ceftriaxone

33
Q

What are the risk factors for a UTI?

A

Factors reducing antegrade flow of urine-

  • Voiding dysfunction
  • Obstructed urinary tract, including BPH
  • Spinal cord injury, resulting in a neuropathic bladder

Factors promoting retrograde ascent of bacteria

  • Female gender (due to a short urethra)
  • Indwelling catheter or ureteric stents / nephrostomy tubes in-situ
  • Structural renal abnormalities, such as vesico-ureteric reflux (VUR)

Factors predisposing to infection or immunocompromise

  • Diabetes mellitus
  • corticosteroid use
  • HIV infection (untreated)

Factors promoting bacterial colonisation

  • Renal calculi
  • Sexual intercourse
  • Oestrogen depletion (menopause, pregnancy)

MET3B -Renal (5 decks)

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