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Renal > Infection > Flashcards

Infection Flashcards

1
Q

In a normal urinary tract the urine in the kidneys, ureter and bladder is normally _______

A

sterile

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2
Q

The lower end of the urethra is colonised by bacteria from the large bowel ___________

A

coliforms and enterococci

anaerobes are present but rarely cause infection

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3
Q

Define UTI?

A

Presence of microorganisms in the urinary tract that are causing clinical infection

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4
Q

Define Lower UTI?

A

Infection confined to the bladder (cystitis)

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5
Q

Define Upper UTI?

A

Infection involving the ureters +/- the kidneys

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6
Q

Define pyelonephritis?

A

UTI with kidney inflammation

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7
Q

Define complicated UTI?

A

UTI complicated by systemic sepsis, urinary abnormalities or stones

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8
Q

Define bacteriuria?

A

Presence of bacteria in urine, some people have chronic bacteriuria. It does not equal infection. Particularly older women.

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9
Q

Define cystitis?

A

Inflammation of the bladder, not always but can be due to infection

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10
Q

UTIs are more common in women or men why?

A

Women

Due to shorter wider urethra and proximity to opening of the anus

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11
Q

Describe what increases risks of UTIs in women?

A

Peaks in child bearing ages
Increased risk with sexual activity as bacteria can be massaged up the urethra (voiding before and after decreases risk)
Pregnancy increases risk

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12
Q

Who with UTI should you find/ not find a cause in?

A

Woman with 1 off UTI of child bearing age don’t need to investigate
All other groups should find an underlying cause

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13
Q

Apart from women what other group are at increased risk of UTIs?

A

Catheterised patients

Patients with abnormalities of urinary tract

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14
Q

Most common causative organism of UTIs?

A

E coli

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15
Q

List 7 organisms that can be involved in UTIs?

A 
E coli
Klebsiella
Proteus
Pseudomonas
Enterococci
Staph Saphrophyticus
Staph A
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16
Q

Describe E coli and UTIs?

A

Gram neg, coliform, bacilli

Most common cause of UTIs

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17
Q

Describe Klebsiella and UTIs?

A

Gram neg coliform, bacilli

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18
Q

Which organism is associated with formation of stones?

A

Proteus

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19
Q

Describe proteus and UTIs?

A

Gram neg, coliform, bacilli, associated with formation of stones and is foul smelling. Produces urease which breaks down urea to form ammonia, increasing urinary pH resulting in precipitation of salts and stone formation,. Swarming cultures, smells like burnt chocolate.

20
Q

Swarming cultures, smells like burnt chocolate?

A

Proteus

21
Q

Describe pseudomonas aeruginosa and UTIs?

A

Gram neg bacilli. NOT a coliform. Associated with catheters and UT instrumentation. Resistant to most oral antibiotics except ciprofloxacin (try not to use this though due to increase C diff risk)

22
Q

Describe enterococci and UTIs?

A

Gram positive strep, anaerobic, gamma haemolytic in chains, more common in hospital acquired infections. 2 types enterococcus faecalis and faecium.

23
Q

2 types of enterococci involved in UTIs?

A

Enterococci faecalis and enterococci faecium

24
Q

Enterococci are more common in __________

A

Hospital acquired infections

25
Q

What organism usually affects women of child bearing age?

A

Staphylococcus Saphrophyticus

26
Q

Describe staph saphrophyticus and UTIs?

A

Gram positive coagulase negative, staph in clusters. Usually affects women of child bearing age.

27
Q

Describe staph A and UTIs?

A

Gram positive, coagulase positive, cocci in clusters. Faculatatively anaerobic. Uncommon in UTI. Would occur due to bacteraemia.

28
Q

Is Staph A common in UTI? When would it occur?

A

uncommon

occurs due to bacteraemia

29
Q

Presentation of UTI? What suggest involvement of upper urinary tract?

A 
Dysuria
Frequency
Nocturia
Haematuria
If fever, loin pain or rigors worried about upper tract
30
Q

5 ways to sample urine?

A 
Midstream urine sample
Clean catch urine
Bag urine 
Suprapubic aspiration
Catheter specimens
31
Q

Describe how to get midstream sample?

A
  • First urine passed is most likely to be contaminated by urethral flora
    • Collect a midstream specimen of urine
    • Ideally wash perineum/ urethral meatus with sterile saline (not antiseptic)
    • Give patient a sterile foil bowl
    • First urine passed into toilet
    • Next part collected in foil bowl
    • Last urine passed in toilet
32
Q

Describe bag urine sample?

A

Done in babies

Negative rules out UTI but so much contamination if positive need suprapubic aspiration to confirm

33
Q

When do suprapubic aspirations tend to be done?

A

In babies and young children

34
Q

What container should urine samples be put in?

A

Red top boricon containers (contains preservative)

35
Q

Describe dipstick testing and UTIs?

A

• Leukocyte esterase- indicates presence of leukocytes in the urine - you can have these in urine for other reasons- it just means inflammation
• Nitrites- indicates the presence of bacteria in the urine (as large amounts of bacteria metablise nitrates to nitrites) Only coliforms can metabolise nitrates to nitries- enterococci do NOT give a positive test
• Protein - may see this in infection
• Blood- may see this in infection
NEED TO ASK IF PATIENTS HAVE SYMPTOMS- NO POINT SENDING IF PATIENTS DON’T HAVE SYMPTOMS

36
Q

What is Kass’s criteria and significant bacteriuria?

A

> 10^5 organisms/ml= SIGNIFICANT PROBABLE UTI
<10^3 organisms/ ml = NOT SIGNIFICANT BACTERURIA
In between query infection not infection
These criteria where made based on women of child bearing age

37
Q

A genuine UTI should be mixed or single growth?

A

Single

Unless there are abnormalities in tract

38
Q

Female lower UTI empirical treatment?

A

Nitrofurantoin or trimethoprim orally for 3 days

39
Q

Uncatheterised male UTI empirical treatment?

A

Get cultures

Nitrofurantoin or trimethoprim orally for 7 days

40
Q

Complicated UTI or pyelonephritis GP empirical treatment?

A

Co-amoxiclav or cotrimoxazole for 14 days

41
Q

Complicated UTI or pyelonephritis hospital empirical treatment?

A

Amoxicillin (or cotrimoxazole if pen allergic) and gentamicin IV for 3 days. Step down as guided by sensitivities.

42
Q

4 antibiotics can treat coliforms with?

A

Gentamicin IV
Amoxicillin (40%- some will be resistant)
Trimethoprim
Cotrimoxazole

43
Q

2 antibiotics can treat enterococci with?

A

Amoxicillin IV

Cotrimoxazole

44
Q

Pseudomonas is treated with?

A

ciprofloxacin

45
Q

Gentamicin is for _______ why

A

hospital use only and 3 days only, narrow therapeutic index, toxic to renal system and CN8, 3 days only

Renal (19 decks)

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