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ANKI Infectious Diseases > [6] Urinary Tract Infections > Flashcards

[6] Urinary Tract Infections Flashcards

1
Q

What is a urinary tract infection?

A

An infection that affects any part of the urinary tract

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2
Q

What is cystitis?

A

An infection affecting the bladder

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3
Q

What is urethritis?

A

An infection affecting the urethra

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4
Q

What is pyelonephritis?

A

An infection affecting the kidneys

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5
Q

How serious are UTIs?

A

They can be very simple and self-resolve, or can be very serious if they become complicated

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6
Q

What is bacteruria?

A

The presence of bacteria in the urine

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7
Q

Is bacteruria symptomatic or asymptomatic?

A

Can be either

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8
Q

How should asymptomatic bacteruria be confirmed?

A

By two seperate urine samples

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9
Q

What is an uncomplicated UTI?

A

An infection of the urinary tract by a usual pathogen in a person with a normal urinary tract and normal kidney function

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10
Q

When does a complicated UTI occur?

A

When anatomical, functional, or pharmacological factors predispose the person to persistent infction, recurrent infection, or treatment failure

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11
Q

What is the most common pathogens in the community causing UTIs?

A

Gram -ve rods, particularly enterobacteriae, especially E. Coli

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12
Q

What bacteria might cause a UTI in young women and hospitalised patients?

A

Coagulase-negative staphylococci, e.g. Staph Saphrophyticus

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13
Q

Who is more likely to get a UTI with less common organisms?

A

Patients who have an underlying pathology and/or frequent infections, are immunosuppressed, or who are catheterised

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14
Q

What are the less common organisms causing UTIs?

A
  • Klebsiella
  • Proteus vulgaris
  • Candida albicans
  • Pseudomonas
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15
Q

What are the causes of UTIs?

A
  • Sexual activity
  • Pregnancy
  • Conditions that make it difficult to fully empty the bladder
  • Urinary catheter
  • Immunocompromisation
  • Antibiotic use
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16
Q

Give two examples of conditions that might make it difficult to empty the bladder

A
  • Prostatic hypertrophy
  • Constipation
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17
Q

Give two examples of things that can cause immunocompromisation

A
  • T2DM
  • Chemotherapy
  • HIV
18
Q

What are the symptoms of UTIs?

A
  • Urgency and frequency of urination
  • Dysuria or burning sensation
  • Strong smelling urine
  • Haematuria
  • Lower abdominal pain
  • Feeling tired or unwell
19
Q

What symptom might be seen in an older person with a UTI?

A

Changes in behaviour, including severe confusion and agitation

20
Q

What investigations should be done into UTIs?

A
  • History
  • Examination of bladder and kidneys
  • Dipstick analysis of urine
  • Urine microscopy and culture
  • Ultrasound evaluation
21
Q

What information should be obtained in the history for a UTI?

A
  • Any previous UTI
  • Sexual history
  • Antibiotic use
  • Any history of renal tract abnormality or diabetes
  • Use of immunosuppressant agents such as steroids
  • Family history
22
Q

What might be found on urine dipstick in UTIs?

A

Presence of nitrate and/or leukocytes, indicating a bacterial infection

23
Q

What indicates the presence of infection on urine microscopy?

A

Leukocytes

24
Q

When might urine culture be used in suspected UTI

A
  • To exlcude the diagnosis
  • In high risk patients
  • If the patient has failed to respond to earlier empirical treatment
  • In men with a history suggestive of UTI, regardless of results of urine dipstick test
25
Q

Give 3 examples of high risk UTI patients who should have a urine culture

A
  • Pregnant
  • Immunosuppressed
  • Have renal tract anomaly
26
Q

Which UTI patients do not require urine culture?

A

Non-pregnant women with a symptomatic lower UTI

27
Q

When might ultrasound evaluation be considered in UTI?

A

In acute, uncomplicated pyelonephritis

28
Q

Why should ultrasound evaluation be considered in acute, uncomplicated pyelonephritis?

A

To rule out urinary obstruction or renal stone disease

29
Q

What are the indications for referral in UTI?

A
  • Persistent non-response to treatment
  • History of renal tract disease or anomaly
  • Haematuria
  • Men with two or more episodes in three months
  • Suggestion of urinary tract obstruction in men
30
Q

What may many women find helpful in the prevention of UTIs?

A

Being made aware of the risk factors for recurrent infection, including the use of spermicide, frequent sexual intercourse, and having a new sexual partner

31
Q

What measures can be suggested to prevent UTIs?

A
  • Avoiding delay in urination
  • Wiping from front to back after defecation
  • Drinking cranberry juice

The evidence suggesting the efficacy of these measures is limited

32
Q

What are the first line agents in the empirical treatment of an uncomplicated UTI?

A

Trimethoprim or nitrofurantoin

33
Q

What % of E. Coli infections may be resistant to trimethoprim or nitrofurantoin?

A

10-20%

34
Q

How long should antibiotics be given for in an uncomplicated UTI?

A

3 days in women, 7 days in men

35
Q

What is first-line therapy in mild cases of uncomplicated pyelonephritis?

A

Oral ciprofloxacin for 7-10 days

36
Q

What are alternatives to oral ciprofloxacin in mild cases of uncomplicated pyelonephritis?

A

Co-amoxiclav and cephalexin

37
Q

What may be helpful in the prevention of recurrent UTIs?

A

Prophylactic low-dose antibiotics

38
Q

What prophylactic antibiotics can be used for recurrent cystitis associated with sexual intercourse?

A

Trimethoprime 100mg within 2 hours of intercourse

39
Q

What prophylactic antibiotic may be given to women with recurrent UTIs not associated with sexual intercourse?

A

6 month course of low-dose antibiotics

40
Q

What can be used for symptomatic relief in UTIs?

A

Paracetamol and/or NSAIDs

41
Q

What are the complications of UTIs?

A
  • Pyelonephritis
  • Perinephric and intrarenal abscess
  • Hydronephrosis or pyonephrosis
  • Acute kidney injury
  • Sepsis
  • Prostatitis
42
Q

What complications may develop from untreated asymptomatic bacteruria in pregnancy?

A
  • Pyelonephritis
  • Preterm delivery and low birth weight
  • Anaemia

ANKI Infectious Diseases (19 decks)

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