Common Infections (UTI, Cellulitis, Skin/Soft Tissue, Respiratory Tract) Flashcards
What is the difference between a complicated and uncomplicated UTI?
Complicated: a UTI infection due to an abnormal urinary tract structure; this includes in pregnancy and children
Uncomplicated: a UTI infection in a normal urinary tract structure (in non-pregnant women)
What is cystitis?
It is inflammation of the bladder, also considered as a lower UTI infection.
Which type of UTI is considered more dangerous?
Upper UTI infections, as they are caused by microorganisms from the kidneys
Why are women more prone to UTI’s?
Because they have shorter urethras, so bacteria can spread more easily.
Which gram -VE bacteria mainly causes UTI’s, and where does it originate form?
E.coli, which originates in the GIT.
Why are older women more at risk of UTI’s?
Because of alkalisation of their vaginal fluid (post-menopausal), which results in enhanced binding of the pili of E.coli.
What are some risk factors of UTI’s?
- Catheters - allowing bacteria to enter
- Blockages in kidneys
- Immuno-suppressed people
- Pregnant women - growing uterus causes a blockage in the urinary tract
- Elderly
What are the symptoms of a UTI?
- Cloudy urine
- Blood in urine - haematuria
- Polyuria
- Pelvic pain
- Urinary urge or frequency
What are the symptoms of pyelonephritis?
- Temperature
- Shaking/chills
- Back pain
- Nausea/vomiting
Why are urine samples for a suspected UTI taken in the morning?
Because bacteria replicate rapidly overnight, so urine sample taken in the morning to show their presence.
What are the diagnostic tests performed for a UTI?
- History of symptoms
- Urine dip stick
- Visual ‘look’ and smell of urine
- Mid-stream urine sample - microscopy, cultures
- Ultrasound
What do urine dip-sticks test for?
WBCs, nitrites from gram -VE bacteria, haemoglobin (from RBCs), and pH.
What type of patients are not treated for a UTI?
Asymptomatic non-pregnant women <65yrs old.
Why should urine dip-sticks not be performed in patients >65yrs old, and what test do they perform instead?
- They are more unreliable
- Older adults have bacteria present but they could be asymptomatic
- Cultures would be taken instead
What is the 1st and 2nd line treatment for an uncomplicated UTI (referring to St Georges guidelines)?
1st line: Nitrofurantoin MR 100mg BD for 3 days
2nd line (if allergic or renal impairment): pivmecillinam 400mg, then 200mg BD for 3 days
- 5 days for men
What is the 1st and 2nd line treatment for complicated UTI’s (related to St George’s guidelines)?
1st line: Co-amoxiclav 1.2g IV TDS for 7 days (or 625mg orally TDS)
2nd line: Ciprofloxacin 500mg BD for 7 days
What is cellulitis, and where can it occur?
It is an acute infection of the skin developing rapidly and suddenly. They can occur in:
- Hands
- Feet
- Legs
What is an abscess in the skin?
A collection of pus within the dermis or subcutaneous layer of the skin.
What is the difference between cellulitis and erysipelas?
Cellulitis involves the deeper dermis, whereas erysipelas involves the upper dermis.
What are some risk factors of cellulitis?
- Diabetes
- Oedema
- Poor circulation
- Obesity
What are the symptoms of cellulitis?
- Acute inflammation: rubor, calor, dolor, tumor
- Spreading erythema (redness)
- Systemic symptoms
What are the diagnostics test performed for cellulitis?
- Skin swabs if the skin is broken
- Systemic symptoms - bloods
- Drawing around the edge of the raised area
What is the 1st and alternative choice antibiotic for cellulitis and erysipelas?
1st choice: flucloxacillin 500mg-1g QDS for 5-7 days
Alternatives (if penicillin allergy): clarithromycin (500mg BD 5-7 days), or erythromycin in pregnancy (500mg QDS 5-7 days), or doxycycline (200mg for 1 day, then 100mg OD for 5-7 days)
Which drugs do we use for severe cellulitis/erysipelas infections?
- Co-amoxiclav: 500/125mg TDS for 7 days
2. Clindamycin 150-300mg QDS for 7 days
What is community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)?
CAP: A person gets infected with pneumonia outside of a healthcare centre.
HAP: A patient being in hospital for >48h and experiences signs of pneumonia
What are the risk factors of respiratory tract infections?
- Smoking
- Elderly
- Heart conditions
- Lung conditions - asthma/COPD
- Alcoholics
- Diabetics
What are some symptoms of respiratory tract infections?
- Cough
- SOB
- Chest pains
- Sputum production
- Chest signs of consolidation - silent chest, hyperinflation, etc
What does CURB-65 stand for?
C: confusion U: urea R: respiratory rate B: blood pressure 65: if >65years old
What are the outcomes for the CURB-65 scores (/5)?
0-1: oral antibiotics given, treated at home
2: hospital supervised treatment
3-5: severe pneumonia, cultures needed, hospital admission, bloods, intensive care
What are the 2 antibiotics used as 1st line treatment for a CURB-65 score of 0-1?
Doxycycline: 200mg STAT, then 100mg OD
OR
Erythromycin: 500mg QDS if pregnant
What are the antibiotics given for a CURB-65 score of 2-5?
Benzylpenicillin 1.2g IV, +
Doxycycline or erythromycin (if pregnant), or clarithromycin if cannot take doxycycline
Alternative if allergy to 1st line: levofloxacin 500mg IV BD
