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3 - II > Common Infections/UTI/Cellulitis > Flashcards

Common Infections/UTI/Cellulitis Flashcards

1
Q

What are the features of inflammation?

A

inflammation
- pain = dolor
- redness = rubor
- swelling = tumor
- heat = calor
- loss of function

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2
Q

What are the types of UTI?

A

uncomplicated UTI - infection in a structurally and/or functionally normal urinary tract in non-pregnant women

complicated UTI - infection in a structurally and/or functionally abnormal urinary tract, post urological surgery, pyelonephritis, children, pregnancy

catheter associated UTI - have similar symptoms to complicated/uncomplicated UTIs but different causes therefore different treatment

recurrent UTI - defined as two separate culture proven episodes of acute UTIs and associated symptoms within 6 months or >3 UTIs in 12 months

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3
Q

Where are lower and upper UTIs located?

A

UTI can affect anywhere in the urinary tract
- upper UTIs are more severe than lower UTIs

urethra - urethritis = lower UTI
bladder - cystitis = lower UTI
ureter - urethritis = upper UTI
kidneys - pyelonephritis = upper UTI

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4
Q

What are the causative pathogens of UTIs? Which are the most common causes?

A

gram negative (most found in the GIT)
- E.coli = most common cause
- proteus spp
- klebsiella sp
- pseudomonas aeruginosa (most common cause in catheter associated UTIs)

gram positive (most found on the surface of the body/skin)
- enterococci spp
- staph saprophyticus

anaerobes

gram negative > gram positive

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5
Q

What are the risk factors for UTIs?

A

menopause - due to reduced levels of oestrogen

sexual activity

catheters - are a route of entry for bacteria

blockage of urinary tract - allows residual volume of urine to accumulate and act as a bacterial reservoir

weakened immune system

diabetes - more prone due to poor circulation, high glucose level, poor bladder emptying

pregnancy - due to changes in urinary tract

elderly - due to weakened bladder

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6
Q

What are the signs and symptoms of UTI?

A

cloudy urine
dysuria - pain upon urination
urinary urge or frequency
haematuria - blood in urine
polyuria
malaise
fever
confusion or agitation = especially in older people
foul/strong smelling urine
pelvic pain

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7
Q

What are the symptoms of pyelonephritis?

A

fever - temperature > 37.9 and rigours (shaking/chills)
flank pain - pain in the back, over the kidneys
nausea and/or vomiting

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8
Q

How can patients be tested for UTIs?

A

urine dip stick
- detect presence of bacteria
- changes colour if urine contains the following substances above normal range
= leukocytes (bacterial infection, sign of WBCs), nitrites (gram negative bacteria), haemoglobin (blood in urine)
- can check the pH of unrine

visual look
- cloudy or smelly urine

mid stream urine sample
- detect presence of bacteria
- allows urine to flush out ureteral contaminant
- preferably done in the mornings when bacterial count is higher

ultrasound, computerised tomography (CT) scan or magnetic resonance imaging (MRI)
- for recurrent UTIs suggesting urinary tract abnormality

urine culture
- detect cause of bacterial infection

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9
Q

When should a urine dipstick not be performed?

A

urine dipsticks should not be performed on people aged >65 years old
- due to increased vulnerability

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10
Q

What is the treatment for uncomplicated UTIs?
women

A

uncomplicated UTIs
- non-pregnant women = 3 day treatment

first line
- nitrofurantoin MR 100mg twice a day
= avoid if eGFR < 45ml/min
= avoid if close to birth/at term = increased risk of miscarriage

  • trimethoprim 200 mg twice a day
    = if risk of resistance is low

second line
- pivmecillinam 400mg initial dose then 200mg three times a day

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11
Q

What is the treatment for uncomplicated UTIs?
men

A

uncomplicated UTIs
- men = 7 days

first line
- trimethoprim 200mg twice a day
- nitrofurantoin MR 100mg twice a day
= avoid if eGFR < 45ml/min

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12
Q

What is the treatment for complicated UTI?
pregnant women

A

complicated UTIs
- pregnant women = 7 days

first line
- nitrofurantoin MR 100mg twice a day
= avoid if eGFR < 45ml/min
= avoid if close to birth/at term = increased risk of miscarriage

second line
- amoxicillin 500 mg three times a day
= only if culture results are available and susceptible

  • cefalexin 500 mg twice a day
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13
Q

What UTI treatment should be avoided in pregnant women and why?

A

trimethoprim should be avoided
- has teratogenic risk
= is a folate antagonist

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14
Q

Why should pregnant women always be treated for UTIs even if asymptomatic?

A

due to risk of
- premature labour
- pyelonephritis
- developmental delay in foetus
- foetal death

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15
Q

What is cellulitis?

What is the difference between cellulitis, erysipelas and abscess?

A

acute infection of the skin and subcutaneous tissue
- develops suddenly and spreads quickly

cellulitis - affect deeper dermis and subcutaneous fat
erysipelas - affects epidermis/upper dermis
abscess - affects dermis and subcutaneous space/tissue, is a collection of pus

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16
Q

What are the causative pathogens of cellulitis?

A

gram positive (most found on the skin surface and are the most common cause)
- staphylococcus aureus
- beta haemolytic: streptococcus (Groups A, C and G)

gram negative (rarely cause)
- pseudomonas aeruginosa

diabetics or vascular insufficiency
- gram positive
- anaerobes = Clostridium sp

17
Q

What are the risk factors for cellulitis?

A

poor circulation
oedema
peripheral vascular disease
diabetes
fungal skin infection
recent vaccination
obesity
immunosuppression

18
Q

What are the signs and symptoms of cellulitis? How can it be diagnosed?

A

acute inflammation
- swelling, pain, redness, heat, loss of function

spreading erythema (redness)

systemic symptoms
- fever, tachycardia, hypotension

diagnosis
- skin swabs (if skin is broken), blood cultures (if systemic symptoms are present), draw around the edge of the raised area (monitor spread)

19
Q

What is the treatment for cellulitis?

A

first line
- flucloxacillin 500mg-1g four times a day for 5-7 days

first line - penicillin allergy
- clarithromycin 500mg twice a day
- erythromycin 500mg four times a day (used in pregnancy)
- doxycycline 200mg on the first day then 100mg daily

severe infection
- cefuroxime 750mg-1.5g three or four times a day IV
- co-amoxiclav 500/125mg three times a day

20
Q

What antibiotics should be added if MRSA infection is present alongside cellulitis?

A

vancomycin 15-20mg/kg two or three times a day IV

teicoplanin initially 6mg/kg every 12 hours for three doses then 6mg/kg once a day IV

21
Q

What antibiotics should be avoided in cellulitis and why?

A

penicillins
- staphylococcus secretes penicillinase/beta lactamase which breaks down the beta lactam ring in penicillins resulting in loss of function
= cannot use benzylpenicillin, ampicillin. amoxicillin

  • flucloxacillin can be used as its too large to be affected by beta lactamase

3 - II (26 decks)

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