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UTIs Flashcards

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1
Q

what is a UTI?

A

the presence and multiplication of microorganisms in the urinary tract

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2
Q

give examples of clinical syndromes caused by UTIs

A 
cystitis
prostatitis 
Epididymitis/orchitis
Urethritis
Pyelonephritis
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3
Q

what a re the classifications of UTIs?

A

Asymptomatic bacteriuria
Uncomplicated
Complicated

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4
Q

what is the difference between bacteriuria and pyuria?

A

bacteriuria is the presence of bacteria in the urine and pyuria is the presence of leucocytes in the urine

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5
Q

what is sterile pyuria?

A

presence of white cells in the urine but a pathogen cannot be cultured

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6
Q

what is the most common age group to get asymptomatic bacteriuria?

A

over 65s

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7
Q

what percentage of people with a catheter will have asymptomatic bacteriuria?

A

100%

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8
Q

describe the prevalence of asymptomatic bacteriuria

A

increases with age in both genders
higher in women at all ages
rapid and marked increase with pregnancy

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9
Q

what is the popln that comes under uncomplicated bacteriuria

A

non pregnant women

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10
Q

what is the popln that comes under complicated bacteriuria

A 
Pregnant
Men
Catheterised
Children
Recurrent/persistent infection
Immuncompromised
Noscomial infection
Structural abnormality
Urosepsis
Associated urinary tract disease
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11
Q

in children who are girls or boys more likely to get UTIs?

A

girls

if it happens in boys, it is a sign of structural abnormality which needs to be reviewed

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12
Q

what percentage of women experience a UTI in their life?

A

10-20%

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13
Q

what is the complication of asymptomatic bacteriuria in renal transplant pts?

A

pyelonephritis

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14
Q

what are some of the causative organisms for UTI?

A 
E. coli - most common causative organism
Proteus 
Klebsiella
Enterococci
Staph. saprophyticus 
S. aureus 
Pseudomonas aeruginosa
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15
Q

which of the bacterial causes is associated with renal stones?

A

proteus - as it produces ureas which causes an increase in the pH of the urine and this is the pH that stones form at

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16
Q

where does Klebsiella come from?

A

the gut - it is an Enterobacteriaceae

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17
Q

who does Staph saprophyticus most commonly affect?

A

young women

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18
Q

what needs to be checked for when we have a pt with Staph aureus bacteriuria?

A

endocarditis, abscesses, prosthetic joint infections, likes to seed places, can be in the kidneys - so the pt needs to be investigated for a deep infections

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19
Q

What are the G+ cocci that cause UTIs?

A

Enterococcus
Staph. saprophyticus
Staph aureus

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20
Q

What are the G- bacteria that can cause UTIs?

A

Neisseria
Enterobacteriaciae ie E.coli and Kelbsiella, Proteus
Bacteroides

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21
Q

what are the culture negative causes of UTI?

A 
mycobacteria 
Chlamydia 
Fungi eg Candida albicans 
Mycoplasma 
Ureaplasma urealyticum
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22
Q

explain the pathogenesis of UTIs

A

colonic flora colonises the vagina, then the urethral meatus and then the bacteria ascend further till they cause a UTI

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23
Q

What factors predispose to UTI?

A 
obstruction from prostatic hypertrophy
bladder stones or tumour 
low urinary volume 
ureteric stones 
stasis during pregnancy 
ureteric reflux
female short urethra 
catheterisation 
low urinary volume eg due to dehydration
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24
Q

what factors make uropathogenic E.coli virulent?

A

adherence molecules ie fimbriae

toxins that cause extensive tissue damage

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25
What happens post-menopause for the risk of UTI to increase?
after menopause, the pH rises and there is increased colonisation by colonic flora reduction in vaginal mucus secretion means there is increased vaginal mucosal receptivity to uropathogenic E. coli
26
How is the normal acidic vaginal pH maintianed?
the normal vagina is heavily colonised with lactobacilli, which metabolise glycogen to lactate which is acidic
27
What are the symptoms of a UTI?
frequency dysuria fever haematuria
28
What are the investigations that are done to diagnose a UTI?
collect a urine sample urinalysis microscopy culture and sensitivity
29
What may be found on urinalysis in a UTI?
``` blood protein pH change glucose and ketones as diabetics are more prone to UTIs leukocytes nitrates ```
30
What are the different types of urine sample?
``` MSU CSU - catheter specimen of urine early morning urine - for TB SPA - suprapubic aspirate clean catch - clean down below before giving the sample ```
31
What may be seen on microscopy with a UTI?
``` WBCs RBCs casts bacteria epithelial cells ```
32
What doe epithelial cells in the sample indicate?
poorly taken specimen ie not MSU
33
how is asymptomatic bacteriuria treated in over 65s?
do not treat, as not likely to get pyelonephritis and more likely to get problems with bacterial resistance
34
how are uncomplicated UTIs treated
``` give 3 days antibiotics give advice: - increase fluid intake - void pre and post intercourse - hygiene ```
35
what is a complicated UTI?
Any UTI in the presence of a structurally or functionally abnormal urinary tract, with or without host compromise
36
how are complicated UTIs treated?
always send sample for culture | give antibiotics for 7 DAYS
37
How are recurrent/complicated UTIs investigated?
``` MSU DRE or PV (vaginal exam) post void bladder scan (incomplete bladder emptying) USS of renal tract/pelvis X-ray KUB, NCCT KUB to rule out stones flexible cystoscopy to look at bladder ```
38
what are the first line antibiotics used for UTI?
Nitrofurantoin | Trimethoprim
39
when should nitrofurantoin not be given and why?
final trimester of pregnancy as it causes neonatal haemolysis Renal function eGFR <45 end of the RANT = final trimester
40
when should trimethoprim not be given
first trimester of pregnancy
41
what are the new antibiotics that can be given for UTI?
fosfomycin | pivmecillinam
42
should you dipstick a catheter sample?
No
43
what structure do bacteria form on catheters?
biofilms - difficult for antibiotics to penetrate this
44
what are the complications of a long term catheter?
UTI/Pyelonephritis Stones Obstruction Chronic inflammation
45
how do we prevent community a community acquired uti?
do not catheterise or if you must use intermittnet catheterisation or suprapubic keep catheter closed and reove as soon as possible replace the catheter and do not treat if asymptomatic as can produce resistance
46
what should women be screened for in pregnancy in terms of UTIs?
asymptomatic bacteriuria
47
what are the risk factors for UTIs in pregnancy?
``` increasing age parity sexual activity diabetes previous UTI ```
48
how are UTIs in pregnancy investigated?
* culture rather than use a dipstick * Positive cultures should be confirmed with a second sample before recommending treatment * Asymptomatic bacteriuria should be treated(unlike elderly) to prevent pyelonephritis * Test of cure should be sent 1 week after treatment
49
what is prostatitis?
Inflammation/swelling of the prostate gland
50
what are the symptoms of chronic bacterial prostatitis?
pain in the urogenital regions eg perineum, suprapubic, testicles, penis, lower back, abdomen, rectum, groin etc urinary symptoms - LUTS and urethral burning sexual dysfunction - ejaculatory dysfunction and loss of libido psychosocial symptoms - depression, anxiety
51
how does acute bacterial prostatitis present?
Systemically unwell, fever, rigors, significant voiding LUTS, pelvic pain, comes on v. quickly
52
how does chronic bacterial prostatitis present?
Symptoms >3 months, recurrent UTI’s Pelvic pain, voiding LUTS Uropathogens in urine +/- blood
53
how does chronic pelvic pain syndrome present?
Chronic pelvic pain +/- LUTS +/- UTI’s
54
what are the causative organisms for prostatitis?
E. coli Proteus Klebsiella
55
what is the pathogenesis of prostatitis?
Ascending infection from the urinary tract | or Haematogenous spread
56
how is prostatitis diagnosed?
``` Urinalysis and MSU Bloods (FBC< U+E, CRP) including cultures STI screen Urodynamic tests TRUSS +/- CT abdo and pelvis ```
57
when do you need to admit a pt with acute prostatitis?
Unable to take oral antibiotics. - vomiting Severely ill. In acute urinary retention
58
how is acute prostatitis treated?
- start antibiotics immediately: quinolone ie ciprofloxacin or ofloxacin for 28 DAYS (give triomethoprin if unable to take quinolones) - treat the pain
59
how do you treat chronic prostatitis?
``` Pain relief Paracetamol/ibuprofen Stool softener Antibiotics 4-6 weeks, quinolone +/- α blocker ```
60
what is the symptom of urethritis?
dysuria = Painful/difficult urination
61
what are the causative organisms of urethritis?
``` It is sexually transmitted: Gonococcal vs non gonococcal Chlamydia trachomatis Ureaplamsa urealyticum Trichomonas vaginalis Mycoplasma genitalium HSV ```
62
How do you manage urethritis?
``` Requires sexual health referral =GUM antibiotics depending on the cause Ceftriaxone Azithromycin Oflaxacin Doxycycline ```
63
How does epidiymo-orchitis present?
Presents with acute onset of pain and swelling
64
What is the pathophysiology of Epididymo-orchitis?
Sexually transmitted pathogens ascending from the urethra or non-sexually transmitted uropathogens spreading from the urinary tract this depends on age, if <35 then more likely to be an STI than a UTI and vice versa if over 35 so take a sexual history
65
what are the sexually transmitted causes of Epididymo-orchitis?
Chlamydia trachomatis Neisseria gonorrhoeae Gram negative enteric organisms – anal intercourse
66
what are the non- | sexually transmitted causes of Epididymo-orchitis
Gram negative enteric organisms (urinary tract surgery/instrumentation) Mumps Tuberculosis – can be associated with renal TB Brucellosis Candida
67
what are the non- | infectious causes of Epididymo-orchitis
Amiodarone | Behcets disease
68
What are the symptoms of Epididymo-orchitis?
Acute onset –usually unilateral scrotal pain +/- swelling Urethritis symptoms UTI Symptoms
69
What are the signs of Epididymo-orchitis?
unilateral swelling and tenderness of epididymis +/- testes, urethral discharge, hydrocoele, erythema +/- oedema of scrotum, pyrexia
70
what must be ruled out before making a diagnosis of epididymo-orchitis?
TESTICULAR TORSION
71
what are the features suggestive of testicular torsion?
Short duration of pain Associated nausea/abdo pain Previous short duration orchalgia (pain in the tesitis)
72
How do we investigate epididymo-orchitis?
Urethral smear looking for STI - eg gonorrhoea and NAAT dipstick MSU - culture and sensitivity CRP and ESR to monitor infection and response to treatment
73
what is the treatment of epididymo-orchitis?
• Analgesia • Antibiotics - if sexually transmitted Ceftriaxone and Doxycycline for 14 days and refer to GUM if non-sexually transmitted - Ofloxacin or Ciprofloxacin - quinilone for 14 days • Sexual abstinence • Supportive underwear • Contact tracing
74
what is the classical triad of symptoms for pyelonephritis?
loin pain fever pyuria
75
what are the modes of infection of pyelonephritis?
• Ascending Urethra colonised with bacteria and this enters urethra in intercourse • Haematogenous - S.aureus/Candida • lymphatic spread
76
what are the investigations done for pyelonephritis?
• Abdominal examination - Tender loin - Renal angle tenderness - PV: rule out tubal/ovarian/appendix pathology • Bloods (FBC, U+E, CSR) including cultures • U/S scan - Rule out obstruction in upper tract • MSU
77
how is pyelonephritis treated?
Fluid replacement – increased losses IV Abx – Broad spectrum eg. Co-amoxiclav/Ciprofloxacin +/- Gentamicin Drain obstructed kidney Catheter – to monitor fluid balance, part of sepsis 6 Analgesia Complete 7-14 days (depending on choice of antibiotic)
78
what are the complications of pyelonephritis?
renal abscess | Emphysematous pyelonephritis- gas accumulation in the tissues of the kidney which is life-threatening

Urology/Renal (14 decks)

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