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Y3 Medicine: Infectious Diseases > Cystitis (Female) > Flashcards

Cystitis (Female) Flashcards

1
Q

What is cystitis?

A

A lower urinary tract infection (UTI) is an infection of the bladder (also known as cystitis) usually caused by bacteria from the gastrointestinal tract.

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2
Q

How do uncomplicated and complicated UTIs differ?

A

Uncomplicated UTI- UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities.

Complicated UTI- UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection.

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3
Q

What are the risk factors for complicated UTIs?

A

Risk factors for complicated UTI include structural or neurological abnormalities of the urinary tract, urinary catheters, virulent or atypical infecting organisms and co-morbidities such as poorly controlled diabetes mellitus or immunosuppression.

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4
Q

What are “recurrent” UTIs?

A

Recurrent UTI is usually defined as two or more episodes of UTI in six months or three or more episodes in one year. It is more common in women and can be due to:

  • Relapse- infection due to the same strain of organism
  • Reinfection- infection due to a different organism
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5
Q

What are catheter associated UTIs?

A

Catheter associated UTI is a symptomatic infection of the bladder or kidneys in a person who is catheterised or who has had a urinary catheter in place within the previous 48 hours.

The longer a catheter has been in situ the more likely bacteria will be found in the urine- asymptomatic bacteriuria in non-pregnant women does not routinely need treatment.

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6
Q

What is bacteriuria?

A

Bacteriuria is the presence of bacteria in the urine- the person may or may not be symptomatic.

Asymptomatic bacteriuria is the presence of significant levels of bacteria in the urine in a person without signs or symptoms of UTI.

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7
Q

Briefly describe the various mechanisms of entry for bacteria to enter the urinary tract

A

Entry of bacteria to the urinary tract can be:

  • Retrograde- bacteria ascend through the urethra into the bladder
  • Via the blood stream- more likely in people who are immunosuppressed
  • Direct- for example with insertion of a catheter into the bladder, instrumentation or surgery
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8
Q

Give examples of caustive organisms of UTIs

A
  • Escherichia coli (70-95%)
  • Staphylococcus saprophyticus
  • Proteus mirabilis
  • Klebsiella species
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9
Q

What are the risk factors for UTIs in pre-menopausal women?

A
  • Sexual intercourse
  • Past medical history of UTI in childhood
  • Having a mother with history of UTI
  • Diaphragm use, especially when used with spermicide
  • Pregnancy
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10
Q

What are the risk factors for UTIs in post-menopausal women?

A
  • History of UTI before menopause
  • Urinary incontinence
  • Atrophic vaginitis
  • Cystocele
  • Increased post-void urine volume
  • Urine catheterisation and reduced functional status in elderly institutionalised women
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11
Q

What are the signs of UTIs?

A
  • Changes in urine appearance or consistency:
    • Urine may appear cloudy to the naked eye, or change colour or odour
    • Haematuria may present as red/brown discolouration of urine or as frank blood
  • Suprapubic discomfort or tenderness
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12
Q

What are the symptoms of UTIs?

A
  • Dysuria- discomfort, pain, burning, tingling or stinging associated with urination
  • Frequency
  • Urgency
  • Nocturia
  • Fever
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13
Q

With regards to signs and symptoms, when may pyelonephritis be suspected?

A

Pyelonephritis should be suspected in people with fever, loin pain or rigors.

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14
Q

What are the red flags for UTIs?

A

Red flags such as haematuria, loin pain, rigors, nausea, vomiting, and altered mental state- consider the possibility of serious illness such as sepsis.

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15
Q

What investigations should be ordered for UTIs?

A
  • Urine dipstick
  • Urine culture and sensitivity
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16
Q

Why investigate using urine dipstick?

A

Perform a urine dipstick test as the first diagnostic test in women aged under 65 years with urinary tract symptoms where they have:

  • Only 1 of the 3 key signs or symptoms (dysuria, nocturia, or cloudy-looking urine or
  • None of the 3 key signs or symptoms but other severe symptoms of urgency, frequency, visible haematuria, or suprapubic tenderness

May show positive for nitrite and leukocytes.

17
Q

In which patients should a urine culture and sensitivity testing be ordered for?

A
  • Are pregnant
  • Are older than 65 years
  • Have symptoms that are persistent or do not resolve with antibiotic treatment
  • Have recurrent UTI (2 episodes in 6 months or 3 in 12 months)
  • Have a urinary catheter in situ or have recently been catheterised
  • Have risk factors for resistance or complicated UTI such as abnormalities of genitourinary tract
  • Have atypical symptoms
  • Have visible or non-visible (on urine dipstick) haematuria
18
Q

What type of urine sample is needed for urine culture or sensitivity?

A

Mid-stream urine sample.

19
Q

Briefly describe the treatment for UTI

A

Advise the woman on self-care measures:

  • Simple analgesia such as paracetamol (or if preferred and suitable, ibuprofen) can be used for pain relief
  • Encourage intake of enough fluids to avoid dehydration

Consider the need for antibiotics depending on severity of symptoms, risk of complications, and previous urine culture results and antibiotic use.
If prescribing an immediate antibiotic- treat according to sensitivities from recent urine culture (if available), otherwise treat empirically taking account of local antimicrobial resistance patterns.

20
Q

What is the first-line antibiotic of choice for UTIs?

A

Nitrofurantoin 100mg modified-release twice a day for 3 days (if eGFR ≥45ml/minute).

21
Q

What other antibiotics can be used to treat UTIs?

A

Trimethoprim 200mg twice a day for 3 days (if low risk of resistance).

Pivmecillinam (a penicillin) 400mg initial dose, then 200mg three times a day for a total of 3 days.

Fosfomycin 3g single dose sachet.

22
Q

What advice can be given to women with recurrect UTIs?

A

Discuss behavioural and personal hygiene measures, advise the woman to:

  • Avoid douching and occlusive underwear
  • Wipe from front to back after defaecation
  • Avoid delay of habitual and post-coital urination
  • Maintain adequate hydration

In postmenopausal women consider prescribing vaginal oestrogen if underlying cause has been investigated and behavioural/hygiene measures alone are ineffective or inappropriate.

23
Q

Briefly describe antibiotic prophylaxis in recurrent UTIs

A

Consider antibiotic prophylaxis if underlying cause has been investigated and behavioural/personal hygiene measures and vaginal oestrogen (in postmenopausal women) are ineffective or inappropriate.

Ensure that any current UTI has been adequately treated then consider a trial of daily antibiotic prophylaxis:

  • First choice- Trimethoprim 100mg at night or Nitrofurantoin (if eGFR ≥45ml/ minute) 50 to 100mg at night
  • Second choice- Amoxicillin 250mg at night (off label indication) or Cefalexin 125mg at night
24
Q

What are the complications of UTIs?

A
  • Pyelonephritis
  • Rrenal and peri-renal abscess
  • Acute kidney injury (AKI)
  • Urosepsis
25
Q

What differentials should be considered for UTIs?

A
  1. Pyelonephritis
  2. Over-active bladder
  3. Urothelial carcinoma of the bladder or upper urinary tract
  4. Non-infectious urethritis
26
Q

How does UTI and over-active bladder differ?

A

Differentiating signs and symptoms:

  • Urinary urgency and frequency in the absence of a UTI

Differentiating investigations:

  • Negative urine dipstick, microscopic urinalysis, and urine culture
27
Q

How does UTI and urothelial carcinoma of the bladder or urinary tract differ?

A

Differentiating signs and symptoms:

  • Microscopic and/or gross haematuria in the absence of a UTI

Differentiating investigations:

  • Positive urine cytology
  • Tumour seen on cystoscopy or upper tract imaging
28
Q

How does UTI and non-infective urethritis differ?

A

Differentiating signs and symptoms:

  • Dysuria, possibly with irritative voiding symptoms, in the absence of a UTI

Differentiating investigations:

  • Negative urine dipstick, microscopic urinalysis, and urine culture

Y3 Medicine: Infectious Diseases (15 decks)

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