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3 Urinary Unit > 17 UTIs > Flashcards

17 UTIs Flashcards

1
Q

What are the major clinical urinary tract infection syndromes and what are their associated symptoms?

A
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2
Q

What are the defence mechanisms that protect from a urinary tract infection? (5)

A
  1. Regular flushing- voiding
  2. Antibacterial secretions in urine and urethra
  3. Vesico-ureteral valves
  4. Urine acidity
  5. Mucosal barriers
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3
Q

Identify some pathogens that are known to cause UTIs (and what patients they might affect).

A
  • Gram-negative rods
    • Enterobactericeae (coliforms)
      • Eg Escherichia coli
  • Gram-positive cocci
    • Coagulase-negative staphylococci
      • Staphylococcus saprophyticus
        • Young women and hosptialised patients

Other (hospitalised patients= susceptible)

Pseudomonas aeruginosa

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4
Q

What host factors cause an increased liklihood of acquiring a UTI (eg short urethra in females)?

A
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5
Q

Outline the pathogenesis of UTIs caused by bacterial factors (ie how do they overcome a patients normal defence mechanisms? Give examples

A
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6
Q

How should a urine sample (investigating a suspected UTI) be collected and stored?

A
  • Collection:
    • Midstream urine (avoid contamination- discard first part)
  • Storage:
    • Refrigerated
    • Collected in container with boric acid
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7
Q

What tests can be carried out on a urine sample? (REMEMBER interpretation of culture results- depend on clinical details)

A
  • Dipstick
    • WBCs (leukocyte esterase)
    • Nitrite (presence of nitrate-reducing bacteria)
    • Blood
  • Lab
    • Microscopy- RBCs, WBCs, squamous epithilial cells
    • Culture- number of bacterial colonies
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8
Q

Why might repeat specimens be required? (50% of women with clinical features of cystitis don’t have positive urine cultures)

A
  • Why?
    • Low bacterial count
    • Evidence of contamination
    • Sterile pyuria (WBCs with no bacterial growth)
  • What may have caused this?
    • Prior antibiotic
    • Urethritis (eg chlamydia)
    • Vaginal infection
    • Non-infective inflammation eg tumour/chemicals
    • Urinary tuberculosis (collect 3 early morning urine samples if suspected)
    • Appendicitis
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9
Q

Outline how UTIs should be treated:

A
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10
Q

Useful graph showing UTI prevalence by age- male and female

A
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11
Q

What are the virulence factors for E.coli?

A
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12
Q

Differentiate between the symptoms that might present with a lower UTI and an upper UTI:

A
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13
Q

Dysuria may also be caused by other causes of urethral inflammation (urethritis), give some of these other causes:

A
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14
Q

What is the definition of an ‘uncomplicated UTI’?

A
  • Normal urinary function
  • Normal bacteria (eg e.coli)
  • Patient has normal urinary tract

Males and females- any age

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15
Q

What is the definition of a complicated UTI?

A

1+ factors - predisposing to persistent infection/ recurrent infection/ treatment failure

Eg.

  • Abnormal urinary tract
  • Virulent organism (staph aureus)
  • Impaired host defence
  • Impaired renal function
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16
Q

In what circumstances might ‘uncomplicated UTIs’ need to be considered as ‘complicated’?

A

If uncomplicated in men, children, pregnant women

17
Q

In what circumstance would a urine culture for a (suspected) UTI need to be carried out?

A

Complicated UTI

18
Q

What substances in the urine can be detected with a urine dipstick?

A

Blood

Urea

Nitrites

Ketones

Glucose

Leucocyte esterase

pH

Protein

19
Q

In which patients is a urine dipstick not useful?

A

Patients >65yrs (asymptomatic infection= common)

Catheterised patients

(will have positive dipstick even in absence of infection)

20
Q

If a patient presents with dysuria, nocturia and cluody urine is a dipstick necessary?

A

No- high chance of UTI

21
Q

Useful microscopic view of acute UTI and contaminated urine

A
22
Q

What might we be looking for if imaging of the urinary tract is carried out on a patient with a UTI? (4)

A
23
Q

Why is asymptomatic bacteriuria only screened for in pregnancy? (Common in elderly and indwelling catheters)

A

Pregnancy- untreated–> hgiher risk for premature labour and pyelonephritis

24
Q

In what circumstances might a 5-7 day course of antibiotics be given for a lower UTI? (rather than 3 days)

A
  • Complicated UTI:
    • Male
    • Pregnant
    • Underlying disorders
25
Q

Name some anitbiotics which can be used to treat uncomplicated UTIs. Which of these should not be given again within 3 months?

A

Nitrofurantoin

Trimethoprim (high resistance in leicester)

Pivmecillinam

Fosfomycin

26
Q

Name some antibiotics which can be used to treat a complicated UTI:

A
  • Nitrofurantoin
  • Trimethoprim
  • Pivmecillinam
  • Fosfomycin
  • Cefelexin
27
Q

Name which antibiotics should be used to treat pyelonephritis/septicaemia.

(consider systemic activity and nephrotoxicity)

A

(NOT nitrofurantoin/fosfomycin- no systemic activity)

  • Co-amoxiclav
  • Ciprofloxacin
  • Gentamicin (IV only and nephrotoxic)
28
Q

When might prophylaxis be given to a patient for UTIs?

A

>3 epidodes in one year and no treatable underlying condition

  • eg trimethoprim, nitrofurantoin*
  • Document any breakthrough infections*

3 Urinary Unit (23 decks)

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