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Clinical Pathology > CP4-5 urinary tract infections > Flashcards

CP4-5 urinary tract infections Flashcards

1
Q

What is a UTI?

A

When the urinary tract is invaded by a pathogenic organism

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2
Q

How do you diagnose a UTI?

A

By what symptoms the patient presents with

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3
Q

Why do we use cultures when a patient has a UTI?

A

To determine the causative organism not to diagnose

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4
Q

What are risk factors for a UTI?

A

Women
Urinary stasis
Urological instrumentation e.g. catheter
Sex
Fistulae
Congenital abnormalities

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5
Q

What parts of the urinary tract are classed as sterile?

A

Bladder, kidneys and ureter

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6
Q

What parts of the urinary tract are colonised?

A

Urethra

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7
Q

What flora is found in the urethra?

A

Perineal flora

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8
Q

What bacteria are commonly found in perineal flora?

A

Coagulase negative staphylococci
Entereobacterales
Enteric gram positive cocci
Anaerobes

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9
Q

What bacteria most commonly causes a UTI?

A

E.coli

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10
Q

What are 6 bacteria (other than e.coli) that can cause UTI? (In order of most common to least)

A

Staph saprophyticus
Proteus mirabilis
Enterococus species
Klebsiella species
Other coliforms
Pseudomonas aeruginosa

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11
Q

Why might results of a culture indicating a UTI be inaccurate?

A

Contamination due to poorly taken samples
Colonisation of catheter
Asymptomatic bacteruria

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12
Q

What is asymptomatic bacteriuria?

A
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13
Q

How does a patient with cystitis present?

A

Dysuria
Urgency and frequency of urination
Super-pubic pain or tenderness
Polyuria, nocturia, haematuria
Mainly in women

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14
Q

How might a patient with a catheter associated UTI present?

A

With a catheter or had one removed in past 48 hours
Fever
Supra-pubic tenderness
+/- dysuria, urgency/frequency of urination
Unexplained systemic symptoms like altered mental state

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15
Q

Why does a catheter cause UTIs?

A

Can be colonised (formation of bacterial biofilm) - does not always indicate infection
Manipulation/removal (particularly traumatic) can cause bacteraemia and local infection.
Antibiotic prophylaxis can be indicated in some patient groups

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16
Q

Why can you not use a urine dipstick test when a patient has a catheter?

A

As catheters aren’t sterile so will always show positive for bacteria

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17
Q

How do patients present with pyelonephritis?

A

Symptoms of lower UTI
Loin/abdominal pain or tenderness
Fever
Symptoms of systemic infection like rigours, nausea, vomiting, diarrhoea, elevated CRP and WBC

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18
Q

How do patients with acute bacterial prostatitis present?

A

Male
Lower UTI symptoms
Tender tense prostate on PR plapatuon
Acute retention
Potentially complications like micro abscesses and abscesses

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19
Q

What pathogens are known to cause acute bacterial prostatitis?

A

E.coli
Less commonly gram positive bacteria like s. Aureus and enterococcus

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20
Q

What are risk factors for acute bacterial prostatitis?

A

Abnormal anatomy e.g. cancer or BPH
Prostatic trauma/manipulation
Transrectal biopsies

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21
Q

How do patients with chronic prostatitis present?

A

Pain in and around genitalia and perineum
Lower UTI symptoms
Enlarged +/- tender prostate upon examination

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22
Q

What causes chronic prostatitis?

A

> 90% due to chronic pelvic pain syndrome if non bacterial
Bacterial = recurrent UTI with same organism or can be caused by chlamydia trachomatis

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23
Q

How do patients with urethritis present?

A

Dysuria
Frequency +/- urgency of urination
Urinary hesitance

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24
Q

What is an example of an STI causing urethra, symptoms?

A

Gonorrhoea

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25
Q

What causes thrush? What is a common symptom?

A

Thrush
Irritation and dysuria

26
Q

What is urethral syndrome?

A

Symptoms of lower UTI without any demonstrable infection aka abacterial cystitis or frequency-dysuria syndrome

27
Q

When is a patient classed as having recurrent UTIs?

A

> 2 infections in 6 month or >3 in a year

28
Q

What are risk factors for UTIs?

A

Renal or bladder stones
Having sex
Post menopausal low oestrogen
Anatomical abnormalities causing stasis

29
Q

What other diseases should be ruled out of a patient has recurrent UTIs?

A

Cancer
Prostatitis (in men)

30
Q

How will a patient with an infection at their nephrostomy site present?

A

Fever
Pain/tenderness at site
Heamaturia or purulent discharge +/- urosepsis

31
Q

What is nephrostomy?

A

Percutaneous drain straight into the kidney

32
Q

What is an ileal conduit/urostomy?

A

When a short section of ileum is used to drain the ureters directly to a stoma on the anterior abdominal wall after a cystectomy (removal of the bladder)

33
Q

What are symptoms of an infection or an ileal conduit/ urostomy?

A

Fever
Upper UTI symptoms if ascending infection
Redness, swelling and pus if para-stomal skin infection

34
Q

What complications can lead to a perinephric renal abscesses?

A

Commonly = gram negative bacilli infection
Uncommonly = complication of renal stones or diabetes or secondary to obstruction of infected kidneys

35
Q

What causes perinephric renal abscesses?

A

Usually gram negative bacilli

36
Q

What is an intro-renal abscess? What is it associated with?

A

An abscess caused by haematogenous spread (unilateral, single or renal cortex) of staph aureus which can be associated with classic acute pyelonephritis of the cortex or medulla.

37
Q

How will patients with urosepsis present?

A

Fever
Rigors
Nausea, vomiting and diarrhoea
+/- haemodynamic compromise
Raised inflammatory markers including CRP and WCC

38
Q

What makes a UTI an anatomical complicated UTI?

A

A UTI alongside:
Structural abnormalities e.g. enlarged prostate
Calculi
Obstruction
Vesico-ureteric reflux

39
Q

What makes a UTI a physiological complicated UTIs?

A

Pregnancy
Immunocompromise
Impaired renal failure

40
Q

What makes a UTI a iatrogenic complicated UTI?

A

Recent instrumentation
Indwelling catheter or other prosthetic material (including stents)

41
Q

What tests should be done for a UTI?

A

Urine culture and susceptibility testing
Inflammatory markers - monitor in severe infection
Imaging to look for stones, abscess or anatomical abnormalities in upper UTIs

42
Q

When should a dipstick test be used?

A

As a screen to rule out lower UTIs where diagnosis is clinically dubious in women under 65
Over 3 year olds

43
Q

What samples can be tested in the microbiology labs?

A

Urine
-mid stream
-Catheter urine
-clean catch for paediatric
-Supra-pubic aspirate
-nephrostomy or ileal conduit
Blood cultures

44
Q

When should blood cultures be taken for a UTI?

A

If suspect pyelonephritis or severe sepsis
Before starting IV antibiotics on any patient

45
Q

What is sterile pyuria?

A

When pus cells are (raised WCC) in urine and no organism grow with standard lab methods. A repeat sample is advised if symptoms continue.

46
Q

What causes sterile pyuria?

A

Inhibition of bacterial growth due to antibiotics or the sample is contaminated with antiseptic
Fastidious organisms
Urinary tract inflammation
Urethritis due to STI

47
Q

When should a UTI be further investigated?

A

If UTI in childhood
Pyelonephritis
In men
Recurrent UTIs
Red flags for cancer

48
Q

What non-antimicrobial management is used to treat UTIs?

A

Increase fluid intake
Anti inflammatories like NSAIDs
Cranberry juice + extracts potentially
Removal of catheter if no longer indicated
Drainage of obstruction or abscess if present.

49
Q

What is the criteria and antibiotic has to meet to be used for a UTI?

A

Gets into urine
Minimally toxic
Effective against likely organisms
Easily administered
Cheap

50
Q

What are examples of antibiotics for UTIs?

A

For lower UTI only:
Nitrofurantoin (inadequate for systemic infection)
Pivmecillinam
Fosformycin (oral formulation)

Trimethoprim

51
Q

How do you treat cystitis in women?

A

Self care including increased fluid +/- ibuprofen
3 days of oral antibiotics (can be delayed prescription to try self care first)

52
Q

How do you treat cystitis in men?

A

Oral antibiotics for 7 days

53
Q

How do you treat cystitis if patient has a catheter?

A

7 days of antibiotics

54
Q

How is pyelonephritis treated empirically?

A

Broad action antibiotics against the likely causative pathogen
E.g. cefuroxime, aztreonam, ciprofloxacin and gentamicin

55
Q

How is pyelonephritis treated directly?

A

With the narrowest spectrum antibiotic possible based on sensitivity results for 7-14 days depending on the antibiotic

56
Q

How long does pyelonephritis need treating for.

A

7-14 days

57
Q

How is prostatitis treated empirically?

A

IV pipercillin-tazobactam
IV/PO ciprofloxacin

58
Q

How is prostatitis treated directly?

A

With IV pipercillin-tazobactam or IV/PO ciprofloxacin
Or trimethoprim or co-trimoxazole

59
Q

How long is prostatitis treated for?

A

2-4 weeks uncles chronic bacterial prostatitis which is treated for longer

60
Q

Who is treated for asymptomatic bacteruria?

A

Pregnant people
Infants
People who are due to have a urological procedure

61
Q

Who does not require antibiotics for asymptomatic bacteruria?

A

Elderly patients
Catheterised patients

62
Q

What lifestyle modifications are recommended for adults with confirmed recurrent UTIs?

A

Increased fluid intake
Review of contraception
Peeing after sex
Oestrogen replacement in post-menopausal women

Clinical Pathology (65 decks)

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