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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
Clinical presentation of UTI in senior citizens
Altered sensorium
26
3 symptoms of UTI in the presence of bacterial prostatitis
* Fever * Pelvic pain * Urinary retention
27
Most sensitive urinalysis test
Leukocyte esterase
28
Good urinalysis method to rule in UTI
Nitrite
29
3 cases where nitrite urinalysis can produce a false negative
* No nitrates in diet * Insufficient dwell time in bladder * Non-enzyme producing organism = *enterococcus*
30
Disadvantage of using blood and/or protein as UTI test
Poor sensitivity and specificity
31
2 disadvantages of using microscopy asa urinalysis technique
* Technologist dependent (very wide range of sensitivity and specificity) * If analyzed \> 3 hours after collection, sensitivity drops by 35%
32
Describe how to maximise sensitivity and specificity of urinalysis (4)
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
3 ways to limit contamination of urine culture
* Mid stream * In-out cath * Bladder taps (for infants \<5 months)
34
4 general principles of UTI treatment
* 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
3 conditions where urine culture should be sent in cystitis
* Uncertain symptoms * History of frequent relapse * Pregnant
36
3 antibiotics for cystitis
* Most common = TMP/SMX (Septra) for 3 days * Quinolone (Cipro) for 3 days * Nitrofurnatoin (local bacterostatic) for 7 days
37
4 treatment options for pyelonephritis
* Ampicillin and aminoglycoside (Genta) * Genta alone * 3rd generation cephalosporin (Ceftriaxeon) * Oral = Septra or quinolone NOTE: Tailor based on C&S results
38
When to consider complicated infection in pyelonephritis
If not improvement by day 3
39
2 conditions where treatment for asymptomatic bacteriuria is indicated and why
* Pregnancy = can become pyelonephritis, which may precipitate premature labor * Urological procedure imminent = compromise of mucosa can lead to complication of spread into bloodstream
40
Criteria for recurrent uncomplicated UTIs meriting prophylaxis
2 episodes every 6 months or 3 every year ("Honeymoon cystitis")
41
2 prophylaxis treatments for recurrent uncomplicated UTIs
* Daily or alternate day low does Septra, OR following intercourse * Nitrofurantoin
42
Pro and con of using prophylactic Septra for recurrent uncomplicated UTIs
* Reduce gram negative flora in periurethral area * BUT increase incidence of resistant UTIs
43
Pro and con of nitrofurantoin as prophylaxis against recurrent uncomplicated UTIs
* Less impact than Septra on colonizing flora * Can intermittently sterilize urine through high urinary antimicrobial levels
44
2 risks of UTI in children
* Higher likelihood of having blood spread and complications (i.e. meningitis) * Higher likelihood of having some anomaly of the urinary tract
45
Age that requires septic workup including lumbar puncture
Under 6 - 8 weeks of age
46
Age that requires IV treatment
Under 1 month
47
When to use VCUG for infants with UTI and its purpose
Purpose = To detect reflux from bladder up the ureter Atypical UTI: * Recurrent * Non E. coli * Abnormal ultrasound * Bacteremia
48
When to consider prophylaxis for infants with UTI
If there is reflux (at least until they are toilet trained)
49
Difference in sex for incidence of UTI in neonatal period
* 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
Why is an uncircumsized penis a risk factor for UTI?
Uropathogenic organisms preferentially adhere to the mucosal inner surface of the foreskin rather than the keratinized external surface. Phimosis likely plays a role
51
Differences between signs and symptoms of neonates (i.e. compared to adults) (5)
* 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
VCUG use based on sex for children \>2 years with their first UTI
* VCUG for all boys, regardless of age * VCUG for girls, if recurrent and abnormal ultrasound

Block G -- Infection (23 decks)

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