Kidney and Urinary Tract Infections Flashcards

1
Q

What is a urinary tract infection (UTI)?

A
  • Refer to an infection of any part of urinary system from kidney to bladder
  • Presence of characteristic symptoms + significant bacteruria
  • Significant bacteruria = > 105 colony forming units/ml
  • In absence of symptoms, this bacteruria is termed asymptomatic bacteruria
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2
Q

UTIs can be categorised depending on the location of the infection.

What is the difference between upper and lower UTI?

A
  • Upper UTI → infection of kidney (pyelonephritis)
  • Lower UTI → infection of baldder (cystitis)
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3
Q

What is the difference between uncomplicated and complicated UTI?

A
  • Uncomplicated → if occuring in healthy non-pregnant adult women
  • Complicated → Presence of factors that increase risk of treatment failure (eg. DM, structural, catheter, other devices and all UTIs in men); UTIs occuring in men are generally considered complicated as many occur in children and elderly in association with urological abrormalities, malignancy or immunosuppression
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4
Q

Which organisms are responsible for UTIs?

A
  • E. Coli (most common: 75-90%)
  • Proteus mirabilis
  • Klebsiella pneumoniae
  • Staphylococcus saprophyticus
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5
Q

What are ESBL infections?

A
  • A growing number of UTIs are extended-spectrum beta-lactamase (ESBL) E. Coli
  • Highly resistant to most beta-lactam abx
  • Growing cause of hosp-acquired infections associated w/ poor outcomes
  • Higher risk → prior administration of abx / length of ITU stay / urinary catheter presence
  • Rx → broad-spectrum abx eg. carbapenems
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6
Q

Why are UTIs uncommon in men?

A
  • Longer urethra
  • Prostatic secretions have antimicrobial properties
  • Periurethral drier than women’s
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7
Q

What are the risk factors for UTIs?

A
  • Recent sexual intercourse
  • Diabetes
  • History of UTIs
  • Spermicide use
  • Catheters (major RF in secondary care)
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8
Q

What are clinical features of UTI?

A
  • Dysuria / Frequency / Urgency
  • Incontinence
  • Suprapubic/flank pain
  • Haematuria
  • N+V / Fever / Rigors
  • Confusion
  • Costovertebral angle tenderness
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9
Q

What is urosepsis?

A
  • UTI → Sepsis
  • Suspect if SIRS going on (2 or more of below):
    • Temp > 38C or < 36C
    • HR > 90 bpm
    • RR > 20
    • WCC > 12 or < 4
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10
Q

What is the definitive diagnosis of UTI based on?

A
  • Typical clinical features associated with positive lab evidence of pyuria +/- bacteriuria
  • In young, non-pregnant females a clinical diagnosis suffices
  • In complicating factors, further lab testing is necessary → urine dip, MC+S
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11
Q

What does urine dipstick show for UTI?

A
  • Leucocytes
  • Nitrites

Urinary MC+S can help guide antibiotic sensitivities

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12
Q

What other investigations can be done for UTI?

A

Used for those who don’t respond to treatment, present w/ severe infection or have atypical presentation or underlying comorbidities

  • FBC / U+Es / CRP → raised inflammatory markers + impaired renal fxn (?AKI)
  • USS or CT for complicated or uncomplicated UTI that doesn’t respond to treatment → abscess, haemorrhage, calculi, obstruction and emphysematous pyelonephritis
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13
Q

Management of UTIs involves the prescription of appropriate antibiotic therapy according to local guidelines and concordance with any culture results.

What is the management for uncomplicated UTI?

A
  • Trimethoprim (CI: pregnancy) or Nitrofurantoin (CI renal impairment)
  • Trimethoprim 200mg BD 3d (women) or 7-14d (men)
  • Nitrofurantoin 50mg QDS or 100mg MR BD 3d (women) or 7-14d (men)
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14
Q

What is the treatment for acute uncomplicated pyelonephritis that doesn’t require admission to hosp?

A
  • Oral fluroquinolone 500mg eg. Ciprofloxacin 12hrly for 14 days
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15
Q

What is the treatment for acute complicated cystitis?

A

Oral course fluoroquinolone

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16
Q

What is the treatment for urosepsis or acute severe pyelonephritis?

A
  • IV co-amoxiclav 1.2g 8hrly or ceftriaxone