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7. CP - Kidney and Urinary Tract Disease > (34) Urinary Tract Infection > Flashcards

(34) Urinary Tract Infection Flashcards

1
Q

Describe the flora of the urinary tract

A
  • kidneys + ureters = sterile
  • bladder = usually considered sterile
  • urethra = perineal flora (skin/lower GI flora)
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2
Q

The perineal flora is made up of skin flora and lower GI tract flora. What is skin flora made up of?

A

Predominantly coagulase-negative staphylococci

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3
Q

The perineal flora is made up of skin flora and lower GI tract flora. What is lower GI tract flora made up of?

A
  • anaerobic bacteria
  • aerobic bacteria eg. enterobacteriaceae (“enteric gram-negative bacilli”, “coliforms”)
  • gram-positive cocci eg. enterococcus spp.
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4
Q

What is cystitis?

A

Lower urinary tract infection

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5
Q

Cystitis is a syndrome of what collection of symptoms/signs?

A
  • dysuria
  • urinary frequency
  • urgency
  • supra-pubic pain/tenderness
  • polyuria, nocturia, haematuria
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6
Q

What is dysuria?

A

Painful or difficult urination

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7
Q

What is pyelonephritis?

A

Upper urinary tract infection (infection of kidney and/or renal pelvis)

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8
Q

What are the symptoms of pyelonephritis?

A
  • same symptoms as lower UTI
  • loin/abdominal pain/tenderness
  • fever
  • other evidence of systemic infection eg. rigor, nausea, vomiting, diarrhoea, elevated CRP, WBC
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9
Q

What is urethral syndrome also known as?

A
  • abacterial cystitis

- frequency-dysuria syndrome

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10
Q

Who does urethral syndrome mostly affect?

A

30-50 year old women

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11
Q

What are the symptoms of urethral syndrome?

A

Symptoms of lower UTI without demonstrable infection

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12
Q

What are the theorised causes of urethral syndrome?

A
  • hormonal imbalances
  • inflammation of Skene glands and paraurethral glands
  • reaction to certain foods
  • environmental chemicals
  • hypersensitivity following UTI
  • traumatic sexual intercourse
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13
Q

What criteria is used to diagnose urinary infection?

A

Kass criteria

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14
Q

How is significant bacteriuria diagnosed using Kass criteria?

A

10^5 cfu/mL = significant bacteria

10^4-10^5 cfu/mL = probable infection

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15
Q

What are the limitations of Kass criteria in diagnosis of UTI?

A
  • bacterial count is on a normal curve

- many symptomatic females have bacterial counts of

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16
Q

What is asymptomatic bacteriuria?

A
  • significant bacteriuria (with a single organism)

- no symptoms of UTI

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17
Q

What is sterile pyuria?

A
  • pus in urine

- no organisms grown

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18
Q

What are the predisposing factors for UTI?

A
  • female sex
  • urinary stasis
  • instrumentation
  • sexual intercourse
  • fistulae
  • congenital abnormalities
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19
Q

What is the female:male ratio for UTIs?

A

10: 1
female: male

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20
Q

Urinary stasis is a predisposing factor for UTI. What causes urinary stasis?

A
  • pregnancy
  • prostatic hypertrophy
  • stones
  • strictures
  • neoplasia
  • residual urine
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21
Q

Is sexual intercourse a predisposing factor for UTI?

A

Yes

Associated with recent sexual intercourse and commoner in sexually active women

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22
Q

What kind of fistulae are predisposing factors for UTI?

A
  • recto-vesical

- vesico-vaginal

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23
Q

What kind of congenital abnormality is a predisposing factor for UTI ?

A

Vesico-ureteric reflux (VUR)

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24
Q

Where are the potential sources of infection for UTI?

A
  • perineum (movement of bacteria along a lumen)
  • fistulae (movement of bacteria from genital/GI tract to urinary tract)
  • haematogenous (seeding of infection from blood - rare)
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25
What organism causes 70-80% of UTIs in GP and 50% of UTIs in hospital?
E. coli
26
What is the 2nd commonest cause of UTI in GP? (after E. coli)
Staphylococcus saprophyticus (CNS) - 10-15% of UTI in GP but 0% in hospital
27
What is the 2nd commonest cause of UTI in hospital? (after E. coli)
Enterococcus spp. - 10-20% of UTIs in hospital, 1-5% of UTIs in GP
28
What are the potential organisms causing UTI?
- E. coli - staphylococcus saprophyticus (CNS) - proteus mirabilis - enterococcus spp. - klebsiella spp. - other coliforms - pseudomonas aeruginosa
29
What are the causes of sterile pyuria?
- inhibition of bacterial growth - "fastidious" (hard to grow) organisms - urinary tract inflammation
30
Inhibition of bacterial growth may cause sterile pyuria. Give examples
- unprescribed antibiotics | - specimen contaminated with antiseptic
31
"Fastidious" (hard to grow) organisms may be a cause of sterile pyuria. Give examples
- mycobacterium tuberculosis - haemophilus spp. - neisseria gonorrhoeae - anaerobes
32
Urinary tract inflammation may be a cause of sterile pyuria. Give examples
- renal or bladder stones | - other renal disease
33
How is catheter-related UTI caused?
Long-term indwelling catheterisation resulting in bacteriuria - biofilm colonisation
34
What do you need to distinguish between in catheter-related UTI?
Distinguish between colonisation and infection (clinical features)
35
How may bacteraemia be caused in catheter-related UTI?
By manipulation or catheter removal
36
When may antibiotic prophylaxis be used in catheter-related UTI?
- history of symptomatic urinary catheter-associated infection with previous catheter changes - purulent urtheral/suprapubic catheter exit site discharge - catheter or meatal/suprapubic catheter exit site colonisation with staphylococcus aureus (inc. MRSA)
37
What types of investigations are involved in urinary tract infection?
- dipstick testing (analysis) - blood tests - microbiological - imaging
38
What does dipstick testing look for?
- blood - protein - nitrite - white blood cells (leucocyte esterase)
39
Dipstick testing is of no diagnostic value in who?
Patients with indwelling urinary catheters unless these have been placed very recently
40
What samples are needed to test in microbiological investigations for UTI?
- urine | - blood
41
What are the different types of urine sample?
- mid-stream (MSU) - catheter urine (CSU) - "clean catch" - supra-pubic aspirate (SPA)
42
What is supra pubic aspiration (SPA)?
Involves putting a needle into the bladder just above the pubic bone. It may be used as a method to collect urine in child who is not toilet trained in an effort to diagnose a urinary tract infection
43
Why would you test the blood in suspected UTI?
In suspected pyelonephritis
44
What kind of microbiological tests would you do in UTI?
- microscopy - culture - sensitivity testing
45
What is used in red cap containers to preserve urine in transportation to the lab?
Boric acid
46
What are the stages in mid-stream urine testing?
1. sample procurement (careful instructions) 2. transport to lab (preservative) 3. sample processing (semi-quantitative culture) 4. interpretation of report
47
What does EMU stand for?
Early morning urine
48
Give an example of a special urine test and why you would use it
Early morning urine x3 - whole contents of bladder - suspected urinary tuberculosis
49
What might indicate further investigation into UTI?
- recurrent UTI - any UTI in male patients - any UTI in childhood - pyelonephritis
50
What further investigations might be necessary in UTI?
- renal tract ultrasound scan - specialised tests: - isotope scans (DMSA, DTPA,MAG3) - micturating cystorethrogram
51
What are the requirements for antibiotics for UTI?
- present in urine - minimally toxic - effective against likely organisms - easily administered - cheap
52
Give 4 examples of antibiotics used in UTI
- nitrofurantoin - pivmecillinam - trimethoprim - fosfomycin
53
What is treatment for cystitis in females?
- treatment pre-empts microbiology results | - short course of antibiotics (3 days)
54
What is the treatment for cystitis in males or in females with recurrence of symptoms?
- longer course of antibiotics (7 days)
55
What is the empiric treatment for pyelonephritis?
- cefuroxime, ciprofloxacin | - piperacillin-tazobactam (if >65 years old)
56
What is targeted therapy for pyelonephritis based on?
Sensitivity results
57
What is the duration of treatment for pyelonephritis?
7-14 days depending on antibiotic used
58
What specific groups would you treat for asymptomatic bacteriuria?
- pregnant - infant - prior to urological procedures
59
Why would you treat pregnant women for asymptomatic bacteriuria?
- association with upper UTI - pre-term delivery - low birth weight babies
60
Why would you treat infants for asymptomatic bacteriuria?
Prevention of pyelonephritis and renal damage
61
Why would you treat asymptomatic bacteriuria prior to urological procedures?
Prevention of UTI/bacteraemia
62
Who does not require antibiotics for asymptomatic bacteriuria?
Elderly, catheterised etc.
63
What kind of things are included in a microscopy report?
- sex - DoB - clinical details (symptoms and signs) - microscopy results - culture results - comment - type and date of urine sample

7. CP - Kidney and Urinary Tract Disease (5 decks)

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