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REGUB > L9: Urinary Tract Infections > Flashcards

L9: Urinary Tract Infections Flashcards

1
Q

How do oral contraceptives and spermicides increase a woman’s risk of a UTI?

A

they decrease the amount of protective lactobacilli present in the vaginal flora

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2
Q

List 2 reasons why the incidence of UTI in males increases with age

A
  1. prostatic enlargement

2. loss of bactericidal activity of prostatic secretions

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3
Q

List the 3 “routes of infection”/possible ways a UTI may be acquired

A
  1. Ascending (from anal area)
  2. Haematogenous (from BSI)
  3. Direct (typically from fistula – vesico-colic fistula)
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4
Q

What is the most common “route of infection”/way to acquire a UTI?

A

ascending route - infected by bacteria from anal area

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5
Q

List some of the localizing symptoms that are associated with an acute UTI

A
  • suprapubic pain (cystitis)
  • flank pain (pyelonephritis)
  • dysuria
  • frequency
  • urgency
  • nocturia
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6
Q

What is dysuria?

A

painful or difficult urination

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7
Q

List some of the systemic symptoms that are associated with an acute UTI

A
  • fever
  • rigors
  • acute confusional state/delirium in elderly
  • nausea
  • anorexia
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8
Q

If a patient has both localizing and systemic symptoms associated with their UTI what is this called?

A

complicated infection

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9
Q

List ALL of the causative pathogens of community-acquired UTI

A

A. GRAM NEGATIVE BACILLI
i) Enterobacterales: E. coli, P. mirabilis, K. pneumoniae, Enterobacter spp., Citrobacter spp.

ii) Pseudomonas aeruginosa

B. GRAM POSITIVE COCCI

    • Staph. saprophyticus*
    • Strep. agalactiae
    • Enterococcus faecalis*
    • Enterococcus faecium*
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10
Q

List some of the MOST COMMON causative pathogens of community-acquired UTI? [5]

A
  • E. coli
  • P. mirabilis
  • Staph. saprophyticus
  • Enterococcus faecalis
  • Enterococcus faecium
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11
Q

What is the MOST common pathogen causing UTI? Which serotypes of E. coli are more successful uropathogens?

A

E. coli

- serotypes 01, 02, 04

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12
Q

Staph. saprophyticus cause UTIs. Which population does Staph. saprophyticus usually affect?

A

young women - causes uncomplicated cystitis

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13
Q

Enterococci can cause a UTI. Which population does enterococci affect?

A
  • critically ill

- immunoscompromised pts

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14
Q

Pseudomonas aeruginosa is a gram negative bacillus that causes which type of UTI? Which population does it normally affect?

A

complicated infection in…

    • critically ill
    • immunocompromised
    • structural urinary tract abnormalities
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15
Q

Which uropathogen is associated with a sweet odour?

A

Pseudomonas aeruginosa

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16
Q

Which uropathogen produces a pigment?

A

Pseudomonas aeruginosa

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17
Q

List some of the causative pathogens of healthcare associated UTI

A
  • enterobacterales
  • pseudomonas aeruginosa
  • enterococcus faecalis/faecium
18
Q

What are the predisposing factors for health-care associated UTIs?

A
  • presence of urinary catheters
  • pts who had manipulation of the urinary tract
  • urinary stasis
  • dehydration
  • debility (physical weakness)
19
Q

To confirm a UTI, you need 2 things which are:

A
  1. Presence of Clinical Symptoms

2. Supporting Evidence for UTI

20
Q

What is an asymptomatic bacteriuria?

A

bacteria in the urine without the symptoms of a UTI

21
Q

Asymptomatic bacteriuria usually does not needed to be treated. In which cases does an asymptomatic bacteriuria need to be treated? [2]

A
  1. pregnancy

2. pts who had a manipulation of the urinary tract

22
Q

What samples can be taken to diagnose a UTI?

A
  • mid stream urine (MSU)
  • catheter specimen urine (CSU)
  • blood cultures (if systemically unwell)
23
Q

What are some things that may be found in the urine of a patient with a UTI?

A
  • bacteria
  • leukocytes
  • nitrites
24
Q

If there is a mixed growth present on the colony culture of a UTI patient’s urine - what does this mean?

A

specimen likely contaminated

25
Q

When treating a UTI in a female with cystitis, what will the duration of treatment be? How will this be administered

A

3 days

PO (oral route)

26
Q

When treating UTIs in males or patients with urinary catheters in situ, what will the duration of treatment be? How will this be administered?

A

7 days

PO (oral route) typically

27
Q

When treating complicated UTIs, UTI w/ pyelonephritis and UTI w/ BSI, what will the duration of treatment be? How will this be administered?

A

7-14 days

IV

28
Q

Why do asymptomatic bacteriuria need to be treated in pregnancy? What are the possible complications?

A
  • risk that it will progress to UTI and pyelonephritis

- more likely to suffer miscarriage or premature labour

29
Q

List some of the risk factors of UTIs in children

A
  • poor urine flow
  • previous UTIs
  • vesicoureteric reflux (VUR)
  • dysfunctional voiding
  • abdominal mass (external compression)
30
Q

List some of the clinical symptoms of UTI in children

A
  • fever
  • irritability
  • increased frequency
  • dysuria
  • foul smelling urine
  • haematuria
31
Q

List the 3 investigations/tests that can be done to investigate UTI in children

A
  1. Ultrasound
  2. Dimercaptosuccinic Acid (DMSA) Scan
  3. Micturating Cystourethrogram (MCUG)
32
Q

What does a DMSA scan show?

A
  • used to detect UTI in children

- determine residual renal parenchymal defects

33
Q

What does a MCUG test show?

A
  • used to detect UTI in children

- used to determine if vesicoureteral reflux

34
Q

Why do patients with diabetes mellitus have an increased risk of UTIs?

A
  • bladder dysfunction (due to neuropathy)
  • vascular disease
  • glucose in urine (supports bacterial growth)
35
Q

What is the clinical presentation of acute pyelonephritis?

A
  • pain in flank, renal angle
  • systemic symptoms (fever, rigors, nausea, vomiting, BSI…)
  • may not have symptoms of cystitis (dysuria, urgency)
36
Q

What is the treatment for acute pyelonephritis?

A
  • empiric cefuroxime + gentamicin

- drainage, if pus or abscess present

37
Q

What is sterile pyuria?

A

WBC or pus cells present in the urine, but there is a sterile urine culture (nothing growing in culture)

38
Q

List the causes of sterile pyuria?

A
  • antimicrobial therapy
  • tumour
  • urinary stones
  • chlamydia urethritis or other STI
  • TB (less common)
  • brucellosis (less common)
39
Q

What are the symptoms of renal tuberculosis?

A
  • sterile pyuria
  • increased frequency
  • painless haematuria
  • malaise
  • fever
  • weight loss
  • persistent symptoms for weeks or months
40
Q

How can a renal tuberculosis be diagnosed? (specimen + test)

A

early morning urine (on 3 consecutive days)

– mycobacterial culture for up to 8 weeks

REGUB (22 decks)

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