11:9: UTI Flashcards
What is bacteriuria?
- Bacteria in the urine
- Significant if over 10 to the fifth
What is cystitis?
- Infection of bladder characterized by dysuria, frequency, urgency and suprapubic pain
What is dysuria?
Painful or difficult urination
What is urethritis?
- Infection confined to urethra characterized by dysuria, and mucoid or purulent discharge from urethral meatus
What is acute pyelonephritis?
- Infection of kidney characterized by flank pain / tenderness and fever
- Often associated with dysuria, urgency, frequency
What is an uncomplicated UTI?
- Dysuria, frequency, and urgency with bacteriuria and pyuria
- Often seen in women
- On renal or urologic dysfunction or obstruction
What is a complicated UTI?
- Pyuria and document microbial pathogen
- Shows local and systemic signs: fever, chills, malaise, pain
- Occurs in presence of urinary tract abnormality
Most common route of UTI infection and how is it caused?
ASCENDING
- Gut flora reach bladder through urethra
- Perineal colonization in women
- Intercourse
- Catheterization
What is hematogenous route?
- Bacteria reach tract through blood
What is hemolysin?
- Enzyme produced by UTI bacteria forming pore in epithelial wall allowing bacteria to colonize
What does urease do?
Elevate urinary PH by breaking down urea making more hospitable environment for organisms
What is Type I (MS)?
- Mannose sensitive fimbriae that attaches to D mannose on many cells of bladder and lower tract
What are P fimbriae?
Attaches to P blood group antigens on RBC and urothelium of renal pelvis and kidney
What does iron scavenging allow?
- The UTI organism to grow and multiply
What causes most UTIs?
- E Coli 80%
2. Staph saprophyticus 15%
Risk factors for UTIs?
- Sexual intercourse
- Spermicide
3, PH - Voiding of urine empties bacteria
- Pregnancy
- Obstruction
- Catheterization
What is vesicoureteral reflux?
- Congenital condition carrying bacteria to renal pelvis
- Returns infected urine to bladder after voiding
Risk of UTI with catheterization?
3% - 10% per day under catheterization
Impact of age and sex on UTI?
- Females more at risk than males
- Equal risk in both genders in elderly
Why do elderly get UTIs?
- Bladder prolapse
- Prostate hypertrophy
- Incontinence
Clinical features of cystitis?
- Acute dysuria, urgency, frequency
- Suprapubic pain and tenderness
- Hematuria
- Pyuria
- Positive culture even at low levels
Risk factors for cystitis?
- Young sexually active women
- Anal sex in men
- Lack of circumcision
Differential diagnosis in women with dysuria?
- Cystitis
- Urethritis
- Vaginitis
What is special about dysuria in vaginitis?
Pain is external and not in urethra
What is external pain and not in urethra indicative of?
Vaginitis
Where is hematuria seen in women with dysuria?
Cystitis
When do we not see pyuria in women with dysuria?
Vaginitis
Clinical features of pyelonephritis?
- Acute flank pain, fever, and lower tract symptoms
- Costovertebral tenderness
- Bacteremia / septic shock
- Papillary necrosis
- WBC casts
What does WBC cast in urine tell you?
- Upper urinary tract infection
- Likely pyelonephritis
Clinical features of prostatitis?
1, Perineal and lower back pain
- Fever chills, dysuria
- Boggy tender prostate
How to get clean specimen in urine sample?
“Clean voided midstream urine”
- Want sample from midstream flow so it is not contaminated by organisms outside tract in genital tissue
- Want urine from bladder
Diagnostic definition of pyuria?
- 10 WBCs per microliter
- Mainstay diagnosis for UTI
What is leukocyte esterase?
- Noted in dipstick urine test indicating pyuria
What does nitire on dipstick test mean?
- Activity of bacterial nitrate reductase which is indicative of UTI
- May not work on some bacteria or small colony count
How to treat UTI?
- Treat all with symptoms regardless of age
2. Bacteriostatic agents work just fine
Treatment for acute cystitis?
- Culture or urinalysis not necessary
- Antibiotic for 3 - 5 days
Treatment for pyelonephritis?
- Urinalysis and culture indicated
- Antibiotics 5 - 14 days
Most significant risk factor for catheter associated UTI?
Duration of use
