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GERR > Lecture 32: Urinary Tract Infection > Flashcards

Lecture 32: Urinary Tract Infection Flashcards

1
Q

what are the 2 key pathogens involved in UTI

A
  • E coli

- proteus

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2
Q

what family does E coli belong to

A

enterobacteriaceae –> found in the gut

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3
Q

what is bacteriuria

A

presence of bacteria in the urine

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4
Q

what does asymptomatic bacteriuria mean

A

presence of significant amounts of bacteria in the urine w/o symptoms of UTI

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5
Q

what would be considered significant bacteria in the urine

A

> 100,000 bacteria/ml of urine

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6
Q

what is an important factor about the urine sample to be collected

A

must be mid stream urine sample

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7
Q

what measurement of bacteriuria would be considered unlikely to be significant

A

< 1000 bacteria/ml or urine

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8
Q

what body sites and fluids are considered sterile

A
  • blood
  • cerebrospinal fluid
  • joint fluid
  • most body tissues beneath epi
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9
Q

what body sites/ fluids are considered non sterile

A

any site/fluid/tissue assc. w/ a mucosal surface that communicates w/ outside environment

e.g. skin, GIT., upper resp tract

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10
Q

why do non-sterile samples need to be brought to the lab quickly

A

bacteria in the sample will be replicating during transit so any delay means the sample won’t be representative of bacteria inside Px

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11
Q

what is the classic triad of UTI symptoms

A
  • frequency
  • urgency
  • dysuria
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12
Q

what examples of people can develop asymptomatic bacteriuria

A
  • elderly
  • pregnant women
  • those with neurological impairment that prevents them sensing or expressing symptoms
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13
Q

what are other symptoms to look for in catheter Px w/ UTI other than triad

A
  • confusion
  • smelly urine
  • fever
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14
Q

what group of people are an exception to the rule about only treating people w/ symptoms

A

pregnant women

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15
Q

what are the basic principles of diagnosing infection

A
  • take sample from inflamed organ site e.g. urine
  • take blood also if sepsis suspected
  • ## take samples (bacterial culture) before giving antibiotics
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16
Q

who can be treated for UTI w/o sample of urine being sent for culture and why

A
  • women if their symptoms are convincing and a bedside test (urine dipstick) is suggestive of infection

why
- in some non hospital settings e.g. GP almost certainly a delay in getting samples to labs

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17
Q

what is cystitis

A

inflammation of the bladder

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18
Q

differentiate complicated and uncomplicated cystitis

A

uncomplicated:
- lower UTI either in men or non-pregnant women who are healthy

complicated:
- assc. w/ risk factors that ^ risk of infection or risk of failing antibiotic therapy

19
Q

what are the standard antibiotic drug choices and what is their bacterial target

and what other choices are there

A

standard:
- trimethoprim
- nitrofurantoin
target:
- E coli

other:
- fosfomycin
- pivmecillinam

20
Q

what reasons might cause UTI treatment to fail

A
  • anatomy or functional problems
  • impeded flow
  • old age and prostates
  • pregnant uterus
  • stones
  • plastic in urinary tract
  • resistant bacteria
21
Q

name a complication that can arise from complicated UTI

A

pyelonephritis (kidney infection)

22
Q

give the symptoms of pyelonephritis

A
  • UTI triad
  • loin pain
  • fever
23
Q

give drug options for treating pyelonephritis

A
  • co-amoxiclav
  • gentamicin

use therapeutic drug monitoring (TDM) as gentamicin can be nephrotoxic

24
Q

what is therapeutic drug monitoring

A

measuring the actual concentration of drug in Px blood to ensure not causing harm

25
Q

what are the risks for pregnant woman w/ UTI

A

pregnant uterus means that obstruction of urine is more likely so pregnant women w/ significant bacteriuria w/ or w/o symptoms have 30% estimated risk of developing upper UTI incl. pyelonephritis

26
Q

outline the treatment for asymptomatic bacteriuria in pregnancy

A
  • start w/ dipstick: leukocyte-esterase +/- nitrates
  • MSU
  • give nitrofurantoin, cefalexin (guided by cultures)
  • repeat later in pregnancy
27
Q

what drug should be avoided in treatment of asymptomatic bacteriuria in pregnant women

A

trimethoprim

28
Q

what is a risk for children w/ UTI

A

renal scarring

29
Q

what is a common predisposing factor for children for renal failure later in life

A

recurrent UTI in childhood

30
Q

what symptoms of UTI are looked for in children or elderly w/ cognitive impairment

A

atypical symptoms

  • distress
  • fever
  • poor feeding in infant
  • worsening confusion
  • agitation
31
Q

in children what symptoms may localise to the urinary tract

A
  • abdominal pain
  • loin pain
  • changes in continence
  • triad
32
Q

what is used as primary screening for UTI in children

A

dipstick test

33
Q

is dipstick test a sensitive test or specific test

A

sensitive test (highly)

34
Q

what is the difference between a sensitive and specific test

A

sensitive:
- high -ve predictive value –> -ve test = no disease

specific:
- high +ve predictive value –> +ve test = disease

35
Q

what Rx is given empirically to children w/ UTI

A
  • cephalosporin cefalexin

- co-amoxiclav

36
Q

list some of the common challenges of UTI in old age

A
  • co-existing conditions that lead to cognitive or physical disability –> ^ chance of unnecessary Rx
  • ^ post void residual volume (esp ^ in prostate obstruction) –> more infections
  • catheters
  • greater vulnerability to C diff when exposed to antibiotics
  • delirium secondary to UTI exacerbates dementia
  • institutional living and hospitalisation –> ^ exposure to medical interventions and antibiotic resistant organisms
37
Q

what is a common reason for recurrent UTI in older men

A

bacterial prostatitis

38
Q

what risk factors are there for bacterial prostatitis

A
  • older men
  • younger men more sexually active –> STIs
  • if man has undergone instrumentation of urethra (post procedure)
39
Q

give some symptoms of prostate infection

A
  • perineal or rectal pain
  • ejaculatory pain
  • urinary retention
  • prostate swelling or tenderness
40
Q

how is bacterial prostatitis diagnosis facilitated

A

urine samples and blood culture

41
Q

what is the treatment for bacterial prostatitis and what are the assc. issues

A
  • fluoroquinolone drugs e.g. ciprofloxacin
  • serious side effects
  • can drive antibiotic resistance and C diff infection
42
Q

what is the first line Rx for catheter assc. UTI and why

A
  • catheter removal
  • catheter is a foreign body which can become colonised w/ bacteria
  • biofilm can be present on the surface of colonised medicinal plastic
43
Q

what is biofilm

A

collaborative multicellular community of bacteria

44
Q

what is the issue w/ biofilm

A 
very difficult (almost impossible) to remove physically and so is a common cause of recurrent infection 
- generally impermeable to antibiotics and resistant to host immune responses

GERR (46 decks)

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