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Block G -- Infection > Dr. Rubin -- Urinary Tract Infection > Flashcards

Dr. Rubin -- Urinary Tract Infection Flashcards

1
Q

% chance of UTI being the cause of fever in feverish newborns

A

UTI

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2
Q

3 examples of sites that a UTI can occur

A
  • Bladder
  • Kidney
  • Prostate

Basically, anywhere along the urinary tract

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3
Q

Define cystitis

A

Infection at level of bladder

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4
Q

Define pyelonephritis

A

Infection involving renal parenchyma (kidney)

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5
Q

Define renal abscess

A

Puss collection with severe pyelo or spread from blood stream

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6
Q

Define bacteria prostatitis

A

Infection of the prostate gland

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7
Q

Source of bacteria for UTI

A

Gut flora

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8
Q

5 factors that facilitate the ascent of gut flora bacteria up the urinary tract

A
  • Pili
  • Obstruction
  • Neurologic disease leading to poorly functioning bladder
  • Pregnancy
  • Reflux (urine going up the ureters)
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9
Q

2 most common pathogens of UTI

A
  • E. coli (85%)
  • *Staphylococcus Saprophyticus *(5 - 15% in young women)
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10
Q

3 virulence factors of E. coli that explain why it is the most common pathogen for UTI

A
  • P Fimbriae/pili allow for bacteria to attach
  • Hemolysins (may break down host cells)
  • Aerobactin (scavenge for iron)
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11
Q

4 pathogens that account for a minority of causes of UTI

A
  • Enterobacteriaceae
  • Enterococcus
  • Yeast
  • Group B streptococcus
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12
Q

3 urea splitting organisms that may form struvite stones in UTI

A
  • Proteus
  • Morganella
  • Providencia
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13
Q

What is the likely pathogen if the UTI involves an indwelling plastic (i.e. catheter)

A

Could be anything because a biofilm forms and traps unusual organisms

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14
Q

Most important behavioral factor to prevent UTI

A

Most important = periodic, complete, normal voiding (wash out bacteria and cells to which they are attached)

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15
Q

Describe 1 behavioral risk for UTI and why

A

Sexual intercourse:

  • Mechanically allows bacteria to ascend (but voiding can clear bacteria)
  • Spermicide use kills normal flora (lactobacillus), which maintains and acidic milieu and prevents colonization
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16
Q

How can a UTI become complicated

A

If a patient has structural or functional abnormalities of the GU tract that compromise voiding

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17
Q

7 structural or functional abnormalities of the GU tract that can compromise voiding

A
  • Obstruction to flow
    1. UPJ obstruction
    2. Stones
    3. Posterior urethral valves (pediatric)
  • Increased access
    1. Indwelling urinary catheters
    2. Vesico-ureteral reflux
  • Preganancy
    1. Urinary stasis due to hormones
    2. Obstruction from fetus
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18
Q

5 lower tract symptoms of UTI

A
  • Dysuria
  • Frequency
  • Urgency
  • Discomfort in suprapubic or lower back area
  • Gross hematuria
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19
Q

2 situations where UTI is unlikely

A

If symptoms are in between voids or if there is vaginal symptoms

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20
Q

Upper tract or pyelonephritis symptoms

A
  • High fever
  • CVA tenderness
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21
Q

8 presenting symptoms of UTI in pediatrics

A
  • Fever
  • Irritability
  • Afebrile
  • Poor feeding
  • Vomiting
  • Diarrhea
  • Jaundice
  • Poor weight gain
22
Q

Potential presentation of UTI due to indwelling catheter

A

May just be fever alone

23
Q

Presentation of UTI with spinal cord injury

A

Increased spasticity of lower limbs

24
Q

Presentation of UTI with MS

A

Increased fatigue and deterioration

25
Q

Clinical presentation of UTI in senior citizens

A

Altered sensorium

26
Q

3 symptoms of UTI in the presence of bacterial prostatitis

A
  • Fever
  • Pelvic pain
  • Urinary retention
27
Q

Most sensitive urinalysis test

A

Leukocyte esterase

28
Q

Good urinalysis method to rule in UTI

A

Nitrite

29
Q

3 cases where nitrite urinalysis can produce a false negative

A
  • No nitrates in diet
  • Insufficient dwell time in bladder
  • Non-enzyme producing organism = enterococcus
30
Q

Disadvantage of using blood and/or protein as UTI test

A

Poor sensitivity and specificity

31
Q

2 disadvantages of using microscopy asa urinalysis technique

A
  • Technologist dependent (very wide range of sensitivity and specificity)
  • If analyzed > 3 hours after collection, sensitivity drops by 35%
32
Q

Describe how to maximise sensitivity and specificity of urinalysis (4)

A

Combination of tests:

  • LE or nitrate + = sens 83 - 100% and spec 68 - 98%
  • Microscopy for WBC and bacteria = sens 99%
  • Anything positive on dip/microscopy
    • Sens = 100%, but spec poor
  • If dip/microscopy all negative
    • NPV = 100%
33
Q

3 ways to limit contamination of urine culture

A
  • Mid stream
  • In-out cath
  • Bladder taps (for infants <5 months)
34
Q

4 general principles of UTI treatment

A
  • Empiric therapy may be needed to be modified based on susceptibility testing
  • Antimicrobials excreted in urine preferred
  • Cystitis = only urinary antibacterial activity necessary
  • Pyelonephritis = need adequate drug level in urine and tissue and possible blood level
35
Q

3 conditions where urine culture should be sent in cystitis

A
  • Uncertain symptoms
  • History of frequent relapse
  • Pregnant
36
Q

3 antibiotics for cystitis

A
  • Most common = TMP/SMX (Septra) for 3 days
  • Quinolone (Cipro) for 3 days
  • Nitrofurnatoin (local bacterostatic) for 7 days
37
Q

4 treatment options for pyelonephritis

A
  • Ampicillin and aminoglycoside (Genta)
  • Genta alone
  • 3rd generation cephalosporin (Ceftriaxeon)
  • Oral = Septra or quinolone

NOTE: Tailor based on C&S results

38
Q

When to consider complicated infection in pyelonephritis

A

If not improvement by day 3

39
Q

2 conditions where treatment for asymptomatic bacteriuria is indicated and why

A
  • Pregnancy = can become pyelonephritis, which may precipitate premature labor
  • Urological procedure imminent = compromise of mucosa can lead to complication of spread into bloodstream
40
Q

Criteria for recurrent uncomplicated UTIs meriting prophylaxis

A

2 episodes every 6 months or 3 every year

(“Honeymoon cystitis”)

41
Q

2 prophylaxis treatments for recurrent uncomplicated UTIs

A
  • Daily or alternate day low does Septra, OR following intercourse
  • Nitrofurantoin
42
Q

Pro and con of using prophylactic Septra for recurrent uncomplicated UTIs

A
  • Reduce gram negative flora in periurethral area
  • BUT increase incidence of resistant UTIs
43
Q

Pro and con of nitrofurantoin as prophylaxis against recurrent uncomplicated UTIs

A
  • Less impact than Septra on colonizing flora
  • Can intermittently sterilize urine through high urinary antimicrobial levels
44
Q

2 risks of UTI in children

A
  • Higher likelihood of having blood spread and complications (i.e. meningitis)
  • Higher likelihood of having some anomaly of the urinary tract
45
Q

Age that requires septic workup including lumbar puncture

A

Under 6 - 8 weeks of age

46
Q

Age that requires IV treatment

A

Under 1 month

47
Q

When to use VCUG for infants with UTI and its purpose

A

Purpose = To detect reflux from bladder up the ureter

Atypical UTI:

  • Recurrent
  • Non E. coli
  • Abnormal ultrasound
  • Bacteremia
48
Q

When to consider prophylaxis for infants with UTI

A

If there is reflux (at least until they are toilet trained)

49
Q

Difference in sex for incidence of UTI in neonatal period

A
  • 1.5 - 5 times males : females
  • Highest in uncircumsized males
  • Incidence decreases in boys and increases in females during the first 6 months
    • By age 1 females outnumber boys 3 - 10:1
50
Q

Why is an uncircumsized penis a risk factor for UTI?

A

Uropathogenic organisms preferentially adhere to the mucosal inner surface of the foreskin rather than the keratinized external surface. Phimosis likely plays a role

51
Q

Differences between signs and symptoms of neonates (i.e. compared to adults) (5)

A
  • Lower grade fever OR afebrile
  • Fever is shorter and disappears more promptly on treatment
  • May just have no fever with:
    • Poor feeding
    • Lethargy
    • Grunting
    • Poor weight gain
  • OR pulminant sepsis
  • May be asymptomatic besides jaundice
52
Q

VCUG use based on sex for children >2 years with their first UTI

A
  • VCUG for all boys, regardless of age
  • VCUG for girls, if recurrent and abnormal ultrasound

Block G -- Infection (23 decks)

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