34 Urinary Tract Infections Flashcards
Which organisms make up the perineal flora?
Skin: Coagulase -ve staphylococci.
Lower GI: enterbacteriaceae. Enterococcus.
Where is the boundary between upper and lower urinary tract infections?
Bladder.
What are the symptoms of cystitis? (7)
Dysuria. Urinary frequency. Urgency. Suprapubic tenderness. Polyuria. Nocturia. Haematuria.
What is pyelonephritis?
Infection of the kidney or renal pelvis.
What are the symptoms of pyelonephritis? (3)
Loin/abdominal pain/tenderness.
Fever.
Evidence of systemic infection.
What is urethral syndrome?
Who gets it?
Bacterial cystitis/frequency-dysuria syndrome.
30-50 y/o women.
Symptoms of UTI without demonstrable infection.
What is the definition of significant bacteriuria?
over 10^5 cfu/cml.
What are the limitations of significant bacteriuria? (4)
Some have symptoms below 10^5.
Lower counts significant in males (10^3).
Not applicable to catheter urine.
Bacterial count is normally distributed.
What is asymptomatic bacteriuria?
Who commonly has it?
Significant bacteriuria of a single organism, with no clinical symptoms.
Community dwelling females over 70.
What is sterile pyuria?
Pus cells in the urine with no organisms grown.
What are the predisposing factors for UTI? (6)
Sex: 10F : 1M. Urinary stasis. Instrumentation. Sexual intercourse. Fistulae. Congenital abnormalities: vesico-ureteric reflux.
What are the three sources of a UTI infection?
Perineal.
Fistulae (genital/GI tract).
Haematogneous (rare)/
What are the most common causes of UTI in a community setting? (3)
E.coli 70%. Staphylococcus saprophyticus (sexually active W). Proteus mirabilis (kidney stone related).
What are the most common causes of UTI in a hospital setting? (5)
E. coli. 50% Enterococcus. 20% Klebsiella. Coliforms. Pseudomonas aeruginosa.
What are the causes of sterile pyuria? (6)
Inhibition of bacterial growth (antibiotics, contamination).
Fastidious organisms: M.tubercuosis, Haemophilus, Neisseria gonorrhoea.
Inflammation: urinary stones, renal disease.
Why does long term indwelling catheterisation result in bacteriuria?
When might this change to bacteraemia?
Biofilm colonisation.
On manipulation/removal of catheter.
When should prophylaxis be used in catheterisation? (3)
History of symptomatic catheter associated UTI.
Purulent discharge from site.
Colonisation with staphylococcus aureus.
Which urine tests are used in UTI? (4)
Midstream (MSU).
Catheter urine (CSU).
Clean catch.
Supra-pubic aspirate.
When are blood samples taken in UTI diagnosis?
On suspicion of pyelonephritis.
When is an early morning urine sample taken?
Suspected urinary tuberculosis.
When does a UTI warrant further investigation? (4)
Recurrent UTI.
UTI in adult male.
UTI in childhood.
Suspected pyelonephritis.
Which antibiotics are used for UTI infection? (4).
Nitrofurantoin.
Pivmecillinam.
Trimethoprim.
Fosfomycin.
What is the treatment for cystitis?
Females: 3 day course antibiotics.
Males/recurrent cases: 7 day course antibiotics.
What is the empiric therapy for pyelonephritis? (2,2)
Cefuroxime, ciprofloxacin.
Piperacillin-tazobactam if >65y/o.
Who should be treated for asymptomatic bacteriuria? (3)
Pregnant (associated with upper UTI, pre-term baby + low birth weight).
Infants: prevention of pyelonephritis.
Prior to urological procedures.
