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GERR > Lecture 32: Urinary Tract Infection > Flashcards

Lecture 32: Urinary Tract Infection Flashcards

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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

Study These Flashcards
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

Study These Flashcards
A

standard:
- trimethoprim
- nitrofurantoin
target:
- E coli

other:
- fosfomycin
- pivmecillinam

20
Q

what reasons might cause UTI treatment to fail

Study These Flashcards
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

Study These Flashcards
A

pyelonephritis (kidney infection)

22
Q

give the symptoms of pyelonephritis

Study These Flashcards
A
  • UTI triad
  • loin pain
  • fever
23
Q

give drug options for treating pyelonephritis

Study These Flashcards
A
  • co-amoxiclav
  • gentamicin

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

24
Q

what is therapeutic drug monitoring

Study These Flashcards
A

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

25
what are the risks for pregnant woman w/ UTI
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
outline the treatment for asymptomatic bacteriuria in pregnancy
- start w/ dipstick: leukocyte-esterase +/- nitrates - MSU - give nitrofurantoin, cefalexin (guided by cultures) - repeat later in pregnancy
27
what drug should be avoided in treatment of asymptomatic bacteriuria in pregnant women
trimethoprim
28
what is a risk for children w/ UTI
renal scarring
29
what is a common predisposing factor for children for renal failure later in life
recurrent UTI in childhood
30
what symptoms of UTI are looked for in children or elderly w/ cognitive impairment
atypical symptoms - distress - fever - poor feeding in infant - worsening confusion - agitation
31
in children what symptoms may localise to the urinary tract
- abdominal pain - loin pain - changes in continence - triad
32
what is used as primary screening for UTI in children
dipstick test
33
is dipstick test a sensitive test or specific test
sensitive test (highly)
34
what is the difference between a sensitive and specific test
sensitive: - high -ve predictive value --> -ve test = no disease specific: - high +ve predictive value --> +ve test = disease
35
what Rx is given empirically to children w/ UTI
- cephalosporin cefalexin | - co-amoxiclav
36
list some of the common challenges of UTI in old age
- 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
what is a common reason for recurrent UTI in older men
bacterial prostatitis
38
what risk factors are there for bacterial prostatitis
- older men - younger men more sexually active --> STIs - if man has undergone instrumentation of urethra (post procedure)
39
give some symptoms of prostate infection
- perineal or rectal pain - ejaculatory pain - urinary retention - prostate swelling or tenderness
40
how is bacterial prostatitis diagnosis facilitated
urine samples and blood culture
41
what is the treatment for bacterial prostatitis and what are the assc. issues
- fluoroquinolone drugs e.g. ciprofloxacin - serious side effects - can drive antibiotic resistance and C diff infection
42
what is the first line Rx for catheter assc. UTI and why
- 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
what is biofilm
collaborative multicellular community of bacteria
44
what is the issue w/ biofilm
``` 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 ```

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