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Sem 3: Urinary > 9a.) UTIs > Flashcards

9a.) UTIs Flashcards

1
Q

UTIs are the commonest type of hospital acquired infection; true or false?

A

True

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2
Q

UTIs are a common source of what septicaemia?

A

Gram -ve septicaemia

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3
Q

State some defences of the urinary tract to infection

A
  • Regular flushing during voiding (removes organisms from distant urethra)
  • Antibacterial secretions into the urine and urethra
  • Acidity of urine
  • Vesico-ureteral valves (prevent urine from tracking back up ureters)
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4
Q

Why are UTIs more common in females? (2 reasons)

A
  • Between voiding organisms may ascend urethra and since urethra in females is shorter the organisms have greater possibility of invading bladder and other parts of urinary tract
  • During voiding short urethra may also cause turbulence and backflow
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5
Q

If colonisation of microorganisms occurs in bladder, what do we call this infection?

A

Cystitis

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6
Q

If colonisation of microorganisms occurs in kidney what do we call this?

A

Pyelonephritis

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7
Q

Describe the prevalence of UTIs with age for women

A
  • Infancy: incompetent vesicoureteric valve
  • Pre-school: poor hygiene & short urethra
  • ~20: sexual intercourse
  • Pregnant
  • Elderly
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8
Q

Describe the prevalance of UTIs with age for males

A
  • Infancy: incompetent vesicoureteric valve
  • Elderly: enlarged prostrate obstructing urine flow leading to stasis
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9
Q

State and explain some risk factors for developing UTIs

A
  • Female: short urethra
  • Obstructive causes:
    • Kidney stones
    • Enlarged prostrate
  • Pregnancy: progesterone relaxes smooth muscle- stasis and enlarged uterus compress urinary tract- stasis
  • Abnormal renal tract:
    • Vesico-ureteric reflux in children
    • Catheter
  • Impaired host defence:
    • Diabetes mellitus
    • Immunosupression
  • Neurological conditions affecting bladder emptying:
    • MS
    • Stroke
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10
Q

What type of bacteria cause majority of UTIs?

Which bacteria is most common cause?

A
  • Coliforms (gram -ve rods )- particularly enterobactericeae (which are found in large intestine)
  • Most common= Escherichia coli
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11
Q

State some virulence factors of E-coli

A
  • Flagella- movement
  • Pili- attachment
  • Capsular polysaccharide- colonisation
  • Haemolysin, toxins- damages host membranes and can cause renal damage
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12
Q

What is meant by a lower urinary tract infection?

A

Infection restricted to bladder and urethra

***Usually only involves superficial mucosa and has no long term effects

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13
Q

What is meant by an upper respiratory tract infection?

A

Infection affects the kidney and/or ureters

***Often involves deep medullary tissue and can permanently damage kidneys

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14
Q

UTI’s are most commonly caused by E-coli; however, what organism can cause UTIs in hospitlised patients and young women?

A

Coagulase negative Staphylococcus aureus (Staphylococcus saprophyticus)

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15
Q

UTIs in hospitalised patients UTIs can be caused by a wider range of organisms due to greater antibiotic selective pressure; state 2 organisms that can cause UTIs in hospitlised patients

A
  • Psuedomonas aeruginosa
  • Stapylococcus saprophyticus
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16
Q

Upper UTI infections can be caused by? (2)

A
  • Ascending routes of infection
  • Haematogenous spread
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17
Q

State the typical clinical presentation of someone with lower UTI (cystitis)

A
  • Dysuria
  • Cloudy urine
  • Nocturia or frequency
  • Urgency
  • Suprapubic tenderness
  • Haematuria
  • Pyrexia (usually mild)
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18
Q

State the typical presentation of someone with pyelonephritis (upper UTI infection)

A
  • +/- symptoms of cystitis
  • High fever +/- rigors
  • Loin pain & tenderness
  • Nausea/vomitting
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19
Q

Dysuria can be caused by things other than UTIs; state some examples

A
  • STIs
  • Post sexual intercourse
  • Contact with irritants
  • Symptoms of menopause e.g. atrophic vagina
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20
Q

Define an uncomplicated UTI

A

Infection caused by a typical/usual organism in a patient with normal urinary tract and normal urinary function

*can occur in males and females of any age

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21
Q

Define a complicated UTI

A

One or more factors that predispose to persistent infection, recurrent infection or treatment failure e.g.

  • Abnormal urinary tract
  • Virulent organism
  • Impaired host defence
  • Impaired renal function
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22
Q

In practice, most cases of UTIs in children, men and pregnant are managed as complicated or uncomplicated?

A

Complicated

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23
Q

How does treatment for pyelonephritis differ from treatment for cystitis?

A

Treatment for pyelonephritis requires:

  • Further investigation
  • Longer treatment
24
Q

Do we take a urine culture if it is a complicated UTI?

25
Do we take a urine culture if it is an uncomplicated UTI?
Not usually. Since in practise we treat most cases in children, men and pregnant women as complicated. This only really leaves the elderly and non-pregnant women of child bearing age. We don't usually take urine culture of healthy, non-pregnant woman of child bearing age
26
Urine must be cultured within 4 hours of collection to prevent bacterial multiplication; it this is not possible what 2 things can you do?
* Refrigerate * Boric acid preservative
27
Describe 5 methods by which you can obtain a urine sample
* **Mid-stream urine sample:** dont' need to clean before hand but may ask women to hold labia apart * **Clean catch in children**: clean gentials then wee into pot * **Collection bag**: take from catheter bag * **Catheter sample** * **Supra-pubic aspiration**: needle into bladder
28
What is the gold standard method for collecting a urine sample? Why is it not used?
* Suprapubic aspiration * Not used as invasive
29
Why is it not ideal to collect urine sample from a collection bag?
20% false positive
30
In what patient groups are urine dipsticks useful in?
* Females \<65 years old with suspected uncomplicated UTI to aid diagnosis * Children \>3 months to rule out infection
31
What does a urine dipstick test for?
* Leucocyte esterase * Nitrites *(coliforms break down nitrates into nitrites)* * Blood * pH * Protein
32
Give the value above which there is considered to be significant bacteriuria
**\>105 colony forming units** (cfu)of a **single organisms** per **ml** of urine
33
In what patient groups is a urine dipstick not useful?
* Patients \>65 *(often have asymptomatic infection [up to 50%])* * Cathertised patients *(will be invariably positive)*
34
Describe how you can decide whether or not to use a urine dipstick on a female \<65 years old
35
What does urine culture/screening in laboratory detect? (4)
* White cells * Red cells * Epithelial cells * Bacteria
36
State the purposes/aims of urine cultures
* Investigate complicated infections * Determine antibiotic sensitivities * Determine causative organism * Culture bacterial colonies to determine how much bacteria present
37
What does each of the following microscopy slides show
_Left_ * Acute UTI * Yellow= RBCs * Large transparent= WBCs * White dots= crystals _Right_ * Contaminated urine * Epithelial cells
38
In antibiotic susceptibility testing, what does a large zone of inhibiton mean?
Micoorganism is susceptible to that bacteria
39
What patients would we consider imaging of urinary tract for if we suspect a UTI?
* Considered in all children * Septic patients to identify renal involvement * Males: check posterior urethral valves * Reccurent infections
40
What is sterile pyuria? State some causes of sterile pyuria
* **Raised white cells in urine that is sterile**/has no bacterial growth Causes: * Prior antibiotics *(antibiotics have now killed microorganisms but white cells haven't returned to normal yet)* * Urethritis * Vaginal infections * Fastidious organisms * Urinary tuberculosis * TB * Appendicitis
41
What is asymptomatic bacteriuria? Who is it common in? Do we treat it?
* **Significant levels of bacteria in urine with no UTI symptoms** * **Elderly**, those with **long term catheters** * Screened for and **only treated in pregnancy**
42
Why do we treat asymptomatic bacteriuria in pregnant women?
If untreated leads to higher risk of premature labour and pyelonephritis
43
Describe how we manage UTIs. Include general management and also specific management of uncomplicated and complicated lower UTIs
_General_ * Increase fluid intake * Analgesia * Address underlying disorders _Uncomplicated lower UTI_ * 3 day course antibiotics _Complicated lower UTI_ * 5-7 day course antibiotics
44
If someone had a +ve urine sample from catheter, would we treat it?
Only if systemically unwell
45
What antibiotics do we use to treat uncomplicated and complicated lower UTIs? (give 2)
* Nitrofurantoin * Trimethoprim
46
Describe how you would treat pyelonephritis
* **7-10 day** course **systemic antibiotics**: * **Co-amoxiclav** * **Ciprofloxacin** (effective as 7 day course) * **Gentamycin** (IV ONLY. NEPHROTOXIC) * Possibly given IV unless
47
When might you consider giving someone prophylaxis for UTIs and what would you give them?
Consider prophylaxis if: * \> or equal to 3 episodes a year * Good personal hygiene * No treatable underlying condition * **Single nightly dose of the antibiotic** that was most effective in most recent culture
48
If you are suspect someone may have sterile pyuria due to urinary tuberculosis; how many urine samples must you take and when must you take them?
3 early morning urine samples
49
State some infections that can cause immune-mediated glomerulonephritis
* Post-streptococcal glomerulonephritis * Endocarditis associated glomerulonephritis * Hepatitis B * Hepatitis C * HIV
50
Describe symptoms of bacterial cystitis
* Frequency * Dysuria * Pyuria (WBCs or puss in urine) * Haematuria
51
Describe the symptoms of prostatitis
* Fever * Dysuria * Frequency * Perineal and low back pain
52
Chronic interstitial nephritis can be caused by infection; what is chronic interstitial nephritis
Inflammation of renal interstitium leading to renal impairment
53
What is covert bacteriuria?
Same as asymptomatic bacteriuria
54
About 50% of women who present with clinical features of cystitis do not have +ve urine cultures: * What do we call this? * What are some potential causes?
* Abacterial cystitis or urethral syndrome * Caused by: * If someone get's infection with low counts of bacteria * Infection with fastidious organisms not detected on urine culture * Sexually transmitted infections * Non-infective inflammation
55
Explain why childhood urinary tract infections must be investigated
* Major risk factor is vesicoureteric reflux * Caused by abnormal entrance of ureter into bladder such that the orifice may be enlarged and the flap valve is unable to stop urine reflux into ureters * Reflux usually resolves by adulthood but most of damage is done by age 5- causes chronc pyelonephritis * Can cause ESRD later in life if not recognised

Sem 3: Urinary (21 decks)

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