Flashcards in UTIs Deck (20)
What are some of the factors that predispose a person to UTIs?
A shorter urethra causing more infections in females, obstruction, and enlarged prostate and stones and tumours, neurological problems such as incomplete emptying on urine and utreic reflux in children
What are the common sites of uteric tract obstruction?
PUJ: calculi, ureter, bladder, VUJ bladdder neck and porstate
What are some of the bacterial factors that encourage UTIs?
Fimbrae allow attachment to the host epithelium, K antigen permits the production of a polysaccharide capulse, hameolysis damage host membranes and cause damage, and urease breaks down ureea creating a favourable environment for growth
What are the most common causes?
Coliforms such as Ecoli, generally gram negative rods
What are the clinical syndromes that are assoicated with UTIs?
Cystitis, causing frequency and dysuria, and acute pyelonephritis or chronic oyleonephritis asymptomatic bacteriuria and septicaemia +\- shock
What are the clincial symptoms and signs of UTis?
Lower uti, with dysuria, frequency, urgency, sometimes low grade fever, and upper UTI is fever, loin pain and may have dysuria and frequency
What is a uncomplicated UTI?
Defined as an infection by a usual organism in a paitient with a normal urainarry tract and a normal urianary function- may occurs in male and females of any age
What is a complicated Uti?
When one of more factors are present that presdipose to a persistent infection, a chronic infection, recurrent infection or renal failure, including UtI with an abnormal urainarry tract, a virulent organism such as staph aureus impaired host defences or impaired renal function
How in practice do you differentiate between complicated and uncomplicated UTI?
Infections in children, men and pyelonephritis and pregant women are determined to be complicated
How do you investigate UTI?
In healthy non pregant women of child bearing age ther is no need to culutre urine, however you would culutre urine in a complciated UTi, such as pregancy and treatment failure
What are some of the near patietnt forms of testing urine?
Turbidity, and dipstick testing such as lecuocyte esterase, nitrite, heamtouria and proteinuria
What are the useful factors of dipstick testing?
It is useful to exclude UTI is children over 3 years, men with mild or non specific treatment or elderly and instuitinonaslsied women
When is dipstick testipng nor useful?
Acute uncomplicated UTI im women, men with typical or severe symptoms, catheterised patients, older patients without features of infection
What is the role of culuture?
Investigation of children and males and other complicated infections, increased sensitivity, epidemiology of isolates, susceptibility data and the control of specimen quality
When would you undertake imaging of the urinary tract?
Considered in all children wiht UTI, and is valvubale in septic patients to identify, and males for posterior urethral valves, and females vesic- uteric reflux
What are some of the features of asymptomatic bacteriuria?
High prevalence in older people especially females, and generally have assoicatie pyuria, not associated with increased morbidity or mortality and can lead to inapproitate antibiotic treatment.
How do you treat a simple cystitis?
Uncomplicated infections can be treated with TRIMETHOPRIM or NITROFUROTONIN on a 3 day course p
How woudl you treat a complicated UTi?
Use TRIMETHOPRIM, NITROFURANTONIN OR CEPHALEXIN on a 5-7 day course, amoxixillcin not approate because 50% of isolates are resistant
How would you treat pyelonephritis or septiceaemia?
You woudl used a 14 day course an use an agent with systemic activation, not Nirtofuratonin, you would use CO-AMOXICALV CIPROFLOXACIN amd GENTAMICIN (iv only, nephrotoxic)