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Y4 - UTI Flashcards

(100 cards)

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1
Q

How are UTIs split up?

A

Upper UTI
- pyelonephritis

Lower UTI

  • cystitis
  • urethritis
  • prostatitis
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2
Q

In what population do most UTIs occur?

A

Child bearing females

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3
Q

How does the treatment of upper UTIs differ to lower UTIs?

A

Upper UTIs need antibx that will penetrate the kidneys and also tend to need longer Rx

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4
Q

How are UTIs classified?

A

Complicated

Uncomplicated

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5
Q

What is an uncomplicated UTI?

A

Occurring in an individual who lacks structural or functional abnormalities

(Mostly healthy females of childbearing age)

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6
Q

What are complicated UTIs?

A

Predisposing lesion of UT e.g. congenital abnormality, stone, catheter, prostatic hypertrophy, obstruction or neurological deficit which interferes with the normal flow of urine and urinary tract defences

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7
Q

Define recurrent UTI

A

Multiple symptomatic infections with asymptomatic periods

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8
Q

Define reinfection

A

Infection caused by different organism that isolated previously (most recurrent UTIs)

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9
Q

Define relapse

A

Repeated infections with same initial organism and usually indicate a persistent infectious source

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10
Q

What is asymptomatic bacteriuria?

A

> 10^5 bacteria/ml urine without symptoms

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11
Q

In which group of individuals is asymptomatic bacteriuria most common?

A

Elderly

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12
Q

Define symptomatic abacteriuria?

A

Symptoms of frequency and dysuria in absence of significant bacteriuria

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13
Q

Should you treat asymptomatic bacteriuria?

A

No
Doesn’t reduce frequency of UTIs
It leads to drug resistant bacteria, e.g. C. diff infections

ONLY exception in Rx in pregnancy and if patient undergoing urological procedures

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14
Q

Define significant bacteriuria

A

> 10^5 bacteria/ml CFU of urine in clean catch specimen

NB: a bacterial count of 100 CFU/ml has a high positive predictive value of cystitis in symptomatic women

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15
Q

Less than 10^5 CFU may represent true infection, especially if there are what things?

A

Concurrent antibacterial drug administration
Rapid urine flow
Low urine pH
Upper tract obstruction

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16
Q

Micro-organisms causing UTIs usually originate from where?

A

Bowel flora

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17
Q

What bacteria most commonly cause uncomplicated UTIs?

A

E. coli (85%)
S. sacrophyticus (5-15%)
K. pneumoniae, proteus sp., pseudomonas, enterococcus (5-10%)

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18
Q

True or false:

If staph epidermis is isolated from a urine culture, the patient may be in serious danger

A

False

S. epidermis is usually a contaminant in this situation

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19
Q

What do complicated UTIs occur as a result of?

A

Anatomic, functional, pharmacological factors that predispose to persistent infection, recurrent infection or treatment failure

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20
Q

What bacteria mostly cause complicated UTIs?

A

E. coli (50%)
K. pneumoniae, Proteus spp., Pseudomonas, Enterococcus, Enterobacter spp.

OFTEN more resistant pathogens!

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21
Q

What is the 2nd most common cause of UTIs in hospitalised patients?

A

Enterococcus faecalis

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22
Q

What might staph aureus isolate from a UTI indicate?

A

There is bacteraemia producing metastatic abscesses in the kidney

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23
Q

In what sort of patients are UTIs due to candida spp. most common?

A

Chronically ill and chronically catheterised

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24
Q

In which patients are UTIs due to multiple organisms more common?

A

Those with stones, indwelling catheters or chronic renal abscesses

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25
What factors predispose to UTIs?
Obstruction of the urinary tract - prevents flushing of bacteria/urinary stasis in bladder Conditions resulting in residual urine volumes Urinary catheter, mechanical instrumentation, pregnancy, use of spermicides and diaphragms
26
What sort of conditions may result in residual urine volumes increasing risk of UTI?
Prostatic hypertrophy, urethral stricture, calculi, tumours, drugs (e.g. anticholingeric agents), neurological malfunctions assoc. with stroke, diabetes and spinal cord injuries
27
What is the clinical presentation of a lower UTI?
Dysuria, frequency, nocturia, urgency, suprapubic heaviness, haematuria in women NO SYSTEMIC SYMPTOMS
28
What is the clinical presentation of a upper UTI?
Flank pain, costovertebral tenderness, abdominal pain, fever, nausea, vomiting, malaise
29
What is the clinical presentation of an elderly patient with a UTI?
Often no specific urinary symptoms | May have altered mental status, change in eating habits or GI symptoms
30
What is the clinical presentation of a catheterised patients with a UTI?
NO lower tract symptoms just flank pain and fever
31
What is the clinical presentation of acute bacterial prostatitis?
Perineal, sacral or suprapubic pain Fever, urinary retention Frequency, urgency, nocturia Digital palpation via rectum reveals swollen, tender, warm and indurated prostate
32
What tests can you use for UTI?
Dipstick (nitrates) Leukocyte esterase dipstick test (rapid screening for pyuria) - detects >10WBC/mm3 Urine culture - not in every one
33
What may cause a false negative dipstick for UTI?
Gram +ve pseudomonas that do not reduce nitrates Low urinary pH Frequent voiding and dilute urine
34
What is leukocyte esterase?
Found in neutrophils | So can help detect pyuria
35
Who do we do a urine culture in?
Children, men, elderly, pregnancy Patients with red flags Younger women with risk of upper tract infection Infection with bacteria not likely to respond to first line antibiotics
36
What are the ways of collecting a urine specimen?
MSSU Catheterisation in infants/v. old Plastic bag collection
37
Define pyuria
WBC > 10WBC/mm3
38
What does pyuria indicate?
Presence of inflammation
39
What is sterile pyuria associated with?
Urinary tuberculosis, chlamydial and fungal infections Calculi, tumours, SLE, pregnancy Most commonly undeclared presence of antibiotic in urine sample
40
What does haematuria indicate?
Nothing specifically | But may indicate other disorders, e.g. calculi or tumours
41
What does proteinuria indicate?
May indicate infection
42
What is your approach for treating cystitis?
If 3+ symptoms/1 severe symptom in non-pregnant with no discharge, treat empirically
43
How do you investigate UTIs?
Dipstick: non-pregnant & <65 & <3 symptoms MSU: pregnant, men, children, failure to respond to antibx Rx Blood tests if systemically unwell (FBC, E&E, CRP, blood culture) Imaging (USS, cystoscopy, urodynamics, CT in men with upper UTI, failure to respond to Rx, recurrent UTI (>2/yr), pyelonephritis, unusual organism, persistent haematuria)
44
How do you Rx UTIs in non-pregnant woman?
3+ symptoms of cystitis & no vaginal discharge: 3d course trimethoprim/nitrofurantoin If this fails --> MSSU culture & Rx according to antibiotic sensitivity Upper UTI - take urine culture & give broad spectrum antibx
45
What is UTI in pregnancy associated with?
Preterm delivery and intrauterine growth restriction
46
How do you Rx men with a lower UTI?
7 day course trimethoprim/nitrofurantoin | If symptoms suggest prostatitis (pain in pelvis, genitals, lower back and buttocks) consider 4wk course ciprofloxacin
47
How do you manage pyelonephritis?
Culture urine and start on antibiotics immediately Amoxicillin & gentamicin (renal function) 7-14 days Hospitalisation and IV antibiotics if patient unable to take PO
48
What are possible complications of pyelonephritis?
Perinephric/renal abscesses Nephrolithiasis with UTI Monitor CRP and if not improving may want to scan for these
49
What is urosepsis?
Sepsis with a source localised to the urinary tract
50
How do you Rx urosepsis?
7-10 days amoxicillin & gentamicin
51
How common is catheter associated UTI?
100% will get a UTI within 4 weeks NB urine from catheter always positive on dipstick and C&S
52
When do you diagnose catheter associated UTI?
ONLY if fever/other systemic manifestation of infection (e.g. malaise, altered mental status, fall in BP, metabolic acidosis, respiratory alkalosis)
53
How do you manage catheter associated UTI?
Catheter should be removed or swapped prior to antibiotic Rx | Antibiotics
54
What is the issue with catheter associated UTI?
They tend to form biofilms that cannot be removed by antibiotic treatment Bacteria produce crystals associated with the biofilm and during catheter removal these crystals can damage the urinary tract mucosa
55
Name two common causes of urethritis
Chlamydia trachomatis | Nesseria gonorrhoea
56
How does chlamydia present?
Usually asymptomatic in females | Can present with dysuria, discharge or PID
57
How do you investigate suspected chlamydia?
Send UA, urine culture (suspect in sterile pyuria) | Pelvic exam, send discharge from cervix/urethra for chlamydia PCR
58
How do you treat chlamydia?
1g single dose azithromycin | or 100mg doxycycline BID 7 days
59
How does gonorrhoea tend to present?
Dysuria, discharge, PID
60
How do you investigate suspected gonorrhoea?
Send UA, urine culture | Pelvic exam, send discharge from grain stain, culture, PCR
61
How do you treat gonorrhoea?
``` Ceftriaxone 125mg IM Cipro - 500mg Levofloxacin 250mg Ofloxacin 400mg Spectinomycin 2g IM ``` Remember to also treat for chlamydia when treating gonorrhoea
62
What are the classic UTI symptoms?
Dysuria, frequency of urination, suprapubic tenderness, urgency, polyuria, haematuria
63
Define cystitis
Inflammation of bladder
64
Define bacteriuria
Bacteria in the urine NB anterior urethra is not sterile so urethral organisms washed out during urination is NOT bacteriuria
65
Define pyuria
Pus cells (neutrophil polymorphs) in significant quantities in the urine
66
Define sterile pyuria
Negative urine culture but significant no. of pus cells present
67
Define acute pyelonephritis
Infection of upper urinary tract involving the kidneys
68
Define chronic pyelonephritis
Renal scarring and potentially loss of renal function Infection may be contributory cause, but other factors (e.g. diabetes, vesico-ureteric reflux and urinary obstruction) may also contribute
69
Women with mild/only 2 symptoms of cystitis or fewer should have what done?
MSU | If urine cloudy test with dipstick
70
What can dipsticks detect in the urine of someone with a UTI?
Nitrite (metabolic product produced by some bacteria) Protein (may be sign of inflammation) Leucocytes (leucocyte esterase is an enzyme found in leucocytes and is a marker of inflammatory response)
71
Men with a UTI should have what test done?
MSU collected and sent to the lab
72
Why does the incidence of UTI in men increase with age?
UTIs occur more often due to obstruction caused by prostatic hypertrophy
73
What is prostatitis usually due to in older men?
Coliforms
74
What is prostatitis usually due to in younger men?
STIs | Chlamydia/gonorrhoea
75
Who does pyelonephritis most commonly affect?
Women of childbearing age
76
What tend to be most the profound symptoms of pyelonephritis?
Loin pain Fever Systemically unwell (e.g. rigors, nausea, vomiting) May also have frequency, dysuria
77
What group of individuals are screened for asymptomatic bacteriuria?
Pregnant woman at booking by MSU culture | Treatment of those with significant bacteriuria takes place in this group as well
78
How do you test for renal tuberculosis?
Three early morning urines | ZN stain and TB culture
79
What condition that leads to a lot of UTIs in kids should you always be aware of?
Vesico-ureteric reflux | As it can lead to renal scarring
80
How do patients with chronic pyelonephritis tend to present?
Vague abdominal discomfort | May also have HTN
81
What radiological changes may you see with someone who has chronic pyelonephritis?
Clubbing of calyces with scarring of cortical parenchyma
82
What are the risk factors for UTIs?
Female sex (short urethra) Trauma to female urethra during sex & childbirth Pregnancy Anatomical abnormalities Renal cysts Pre-existing renal parenchymal damage Stones in urinary tract (kidney, ureter or bladder) Immunosupression (incl. DM, steroids) Instrumentation of urinary tract (e.g. cystoscopy) Presence of foreign body in urinary tract (e.g. catheter/stent)
83
Why is a short urethra a risk factor for UTI?
It is short and also because of its close proximity to the rectum transperitoneal introital colonisation with bacteria from the large bowel occurs
84
Why is there an increased risk of UTI in pregnancy?
Stasis of urine allows bacteria to flourish | Progesterone dilates ureters and physical pressure of foetus
85
What sort of anatomical abnormalities put patients at increased risk of UTIs?
Congenital pelvic-ureteric junction obstruction, VUR, duplex kidneys, horseshoe kidneys, urethral valves, prostatic enlargement, chronic urinary retention
86
Who do uncomplicated UTIs occur in?
Sexually active, health young women
87
Who do complicated UTIs occur in?
Everyone else | Children, men, patients with an abnormal renal tract
88
What do complicated UTIs require?
Investigation to include an upper renal tract scan (USS/CT) and bladder imaging (cystoscopy/post-void bladder scan) Urinary flow studies may also be used
89
When should you actually do tests when you suspect a UTI?
``` Women with mild/limited symptoms if dipstick testing is less conclusive UTI in men Suspected acute pyelonephritis Pregnant women Failure of antibx Rx Recurrent UTI Children ```
90
Define recurrent UTI
>2 UTI in 6m | >3 UTI in 1y
91
Where should catheter samples be taken from?
Catheter sampling port
92
How can you collect urine from children?
Clean catch is best Urine collection pads Catheter sample Suprapubic aspiration
93
Who is S. sacrophyticus UTI most common in?
Sexually active women
94
Why are those with proteus UTI more likely to get stones?
Proteus produces urease which splits urea to release ammonia thus making urine alkaline and encouraging stone formation
95
What spp are seen more commonly as the cause of UTIs in hospital patients?
Proteus, klebsiella, pseudomonas
96
What can microscopy of urine show?
Presence of cells, casts or organisms
97
What is significant pyuria?
>10 WBC/mm3 | this is a marker of inflammation
98
How do you treat pyelonephritis?
Ciprofloxacin for 7 days | Single episodes in men and recurrent episodes in women require further investigation
99
What antibiotics should be used for UTI in pregnancy?
NOT trimethoprim Nitrofurantoin can be used but not at term (can cause neonatal haemolysis) Cephalexin can generally be used
100
What advice can you give to someone who is repeatedly getting UTIs?
Drink plenty of fluids Empty bladder after sex Pay attention to personal hygiene Long term antibiotic prophylaxis (e.g. 1 tablet of nitrofurantoin or trimethoprim per night for up to 1y may be used to break cycle of recurrent infection)

Infection (22 decks)

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