Common Infections (UTI, Cellulitis, Skin/Soft Tissue, Respiratory Tract)

Question 1

What is the difference between a complicated and uncomplicated UTI?

Answer 1

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)

Question 2

What is cystitis?

Answer 2

It is inflammation of the bladder, also considered as a lower UTI infection.

Question 3

Which type of UTI is considered more dangerous?

Answer 3

Upper UTI infections, as they are caused by microorganisms from the kidneys

Question 4

Why are women more prone to UTI’s?

Answer 4

Because they have shorter urethras, so bacteria can spread more easily.

Question 5

Which gram -VE bacteria mainly causes UTI’s, and where does it originate form?

Answer 5

E.coli, which originates in the GIT.

Question 6

Why are older women more at risk of UTI’s?

Answer 6

Because of alkalisation of their vaginal fluid (post-menopausal), which results in enhanced binding of the pili of E.coli.

Question 7

What are some risk factors of UTI’s?

Answer 7

1. Catheters - allowing bacteria to enter
2. Blockages in kidneys
3. Immuno-suppressed people
4. Pregnant women - growing uterus causes a blockage in the urinary tract
5. Elderly

Question 8

What are the symptoms of a UTI?

Answer 8

1. Cloudy urine
2. Blood in urine - haematuria
3. Polyuria
4. Pelvic pain
5. Urinary urge or frequency

Question 9

What are the symptoms of pyelonephritis?

Answer 9

1. Temperature
2. Shaking/chills
3. Back pain
4. Nausea/vomiting

Question 10

Why are urine samples for a suspected UTI taken in the morning?

Answer 10

Because bacteria replicate rapidly overnight, so urine sample taken in the morning to show their presence.

Question 11

What are the diagnostic tests performed for a UTI?

Answer 11

1. History of symptoms
2. Urine dip stick
3. Visual ‘look’ and smell of urine
4. Mid-stream urine sample - microscopy, cultures
5. Ultrasound

Question 12

What do urine dip-sticks test for?

Answer 12

WBCs, nitrites from gram -VE bacteria, haemoglobin (from RBCs), and pH.

Question 13

What type of patients are not treated for a UTI?

Answer 13

Asymptomatic non-pregnant women <65yrs old.

Question 14

Why should urine dip-sticks not be performed in patients >65yrs old, and what test do they perform instead?

Answer 14

1. They are more unreliable
2. Older adults have bacteria present but they could be asymptomatic

• Cultures would be taken instead

Question 15

What is the 1st and 2nd line treatment for an uncomplicated UTI (referring to St Georges guidelines)?

Answer 15

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

Question 16

What is the 1st and 2nd line treatment for complicated UTI’s (related to St George’s guidelines)?

Answer 16

1st line: Co-amoxiclav 1.2g IV TDS for 7 days (or 625mg orally TDS)

2nd line: Ciprofloxacin 500mg BD for 7 days

Question 17

What is cellulitis, and where can it occur?

Answer 17

It is an acute infection of the skin developing rapidly and suddenly. They can occur in:

1. Hands
2. Feet
3. Legs

Question 18

What is an abscess in the skin?

Answer 18

A collection of pus within the dermis or subcutaneous layer of the skin.

Question 19

What is the difference between cellulitis and erysipelas?

Answer 19

Cellulitis involves the deeper dermis, whereas erysipelas involves the upper dermis.

Question 20

What are some risk factors of cellulitis?

Answer 20

1. Diabetes
2. Oedema
3. Poor circulation
4. Obesity

Question 21

What are the symptoms of cellulitis?

Answer 21

1. Acute inflammation: rubor, calor, dolor, tumor
2. Spreading erythema (redness)
3. Systemic symptoms

Question 22

What are the diagnostics test performed for cellulitis?

Answer 22

1. Skin swabs if the skin is broken
2. Systemic symptoms - bloods
3. Drawing around the edge of the raised area

Question 23

What is the 1st and alternative choice antibiotic for cellulitis and erysipelas?

Answer 23

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)

Question 24

Which drugs do we use for severe cellulitis/erysipelas infections?

Answer 24

1. Co-amoxiclav: 500/125mg TDS for 7 days

2. Clindamycin 150-300mg QDS for 7 days

Question 25

What is community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)?

Answer 25

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

Question 26

What are the risk factors of respiratory tract infections?

Answer 26

1. Smoking
2. Elderly
3. Heart conditions
4. Lung conditions - asthma/COPD
5. Alcoholics
6. Diabetics

Question 27

What are some symptoms of respiratory tract infections?

Answer 27

1. Cough
2. SOB
3. Chest pains
4. Sputum production
5. Chest signs of consolidation - silent chest, hyperinflation, etc

Question 28

What does CURB-65 stand for?

Answer 28

C: confusion 
U: urea 
R: respiratory rate 
B: blood pressure 
65: if >65years old

Question 29

What are the outcomes for the CURB-65 scores (/5)?

Answer 29

0-1: oral antibiotics given, treated at home
2: hospital supervised treatment
3-5: severe pneumonia, cultures needed, hospital admission, bloods, intensive care

Question 30

What are the 2 antibiotics used as 1st line treatment for a CURB-65 score of 0-1?

Answer 30

Doxycycline: 200mg STAT, then 100mg OD

OR

Erythromycin: 500mg QDS if pregnant

Question 31

What are the antibiotics given for a CURB-65 score of 2-5?

Answer 31

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