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Flashcards in UTIs Deck (34):
1

What are the peaks of UTIs for women?

Young child
Age of sexual activity
Child bearing
Elderly

2

When do men have peaks of UTIs?

Infancy
Elderly

3

UTIs are most commonly caused by what in the elderly?

Urinary tract obstruction
(Eg. Enlarged uterus or prostate)

4

What patient factors increase the risk of UTIs?

Shorter urethra
Obstruction - BPH, pregnancy, stones, tumours
Lack of flushing
Neurological problems - residual urine, likely to fester
Ureteric reflux - ascending infection from bladder

5

What bacterial factors increase likelihood of causing UTI?

Fimbriae
K antigen - polysaccharide capsule to resist host defences
Urease
Haemolysins

6

What are the most likely pathogens to cause UTIs?

Coliforms eg. E-coli

7

Apart from E-coli, what pathogens can cause UTIs?

Proteus
Enterococcus
Coagulase negative staph
Pseudomonas
Staph aureus

8

What is the most common UTI?

Cystitis

9

Describe the presentation of cystitis

Urgency and frequency of urination
Pain (burning)
Sometimes a low grade fever

10

Asymptomatic bacteriuria is generally not a problem unless in ...

Pregnant women

11

Describe the presentation of pyelonephritis

Fever
Loin pain
Dysuria
Frequency of urination

12

Describe an uncomplicated UTI

Infection by a usual organism in a patient with a normal urinary tract and normal urinary function

13

Describe a the most common uncomplicated UTI

Females
Child bearing age
Common cystitis presentation

14

Describe a complicated UTI

When one or more factors are present that predispose the person to persistent infection, recurrent infection or treatment failure

15

What factors make the UTI complicated?

Abnormal urinary tract
Virulent organisms
Impaired host defences
Impaired renal function
(Most cases in children, men and pregnant women)

16

What investigations do we do for uncomplicated UTI?

Urine dipstick

17

What investigations do we do for complicated UTIs?

Culture urine
Turbidity
Dipstick testing

18

What are the ways of collecting urine for culture?

Mid stream urine
Collection bag
Catheter sample
Suprapubic aspiration

19

How isn't nitrite a reliable test?

Not all bacteria produce the enzyme to make nitrite

20

What are urine dipsticks useful for in UTIs?

Good at telling us how likely they are NOT to have an infection

21

What are urine dipsticks not useful for?

Uncomplicated UTIs in women
Men with typical/severe symptoms
Catheterised patients (usually positive)
Older patients without features of infection

22

What is the role of culture in UTIs?

Guidance for treatment
Collect data - epidemiology
See if urine collection is good quality
Test sensitivity to Abx

23

What do we call the area of clearance when testing Abx sensitivity?

Zone of inhibition

24

How do we treat most cases of cystitis?

Self-limiting
No Abx necessary for most

25

When would we image the tract in UTIs?

All children
Septic patients

26

What is sterile pyuria?

Presence of increased WBCs in urine without a positive culture

27

What are some causes of sterile pyuria?

Already on Abx
Urethritis
Vaginal infection/inflammation
Chemical inflammation
TB
Appendicitis

28

Describe the treatment for UTI

Increase fluid intake
Address underlying disorder
3 day course Abx - uncomplicated
5-7 day course - complicated

29

Describe Abx for simple cystitis

Trimethoprim or nitrofurantoin
3 day course

30

Describe Abx for complicated UTI

Trimethoprim, nitrofurantoin or cephalexin
5 - 7 days

31

Why is amoxicillin not an appropriate treatment for UTIs?

Many organisms causing UTIs are resistant to amoxicillin

32

Who do we do follow up UTI cultures for?

Children
Pregnant women

33

How do we treat pyelonephritis?

14 day course
Agent with systemic activity
Possibly IV
Co-amoxiclav
Ciprofloxacin
Gentamicin

34

How and why do we give prophylaxis for UTIs?

3 or more episodes per year
No treatable underlying condition
Trimethoprim or nitrofurantoin
Single nightly dose