Lecture 39 - UTI Flashcards
Bladder dysfunction
- if get inflamed bladder then will have increase frequency of urination, and urgency, however will have hesitancy, and not much comes out
- if have dysuria and also inflamed bladder then likely to be cystitis (UTI)
-if lack these symptoms - then likely to be urethritis
How do we diagnose cystitis?
- Urine dipstick - cheap plastic, and this measures WBC, Leucocyte esterase - this means high no. of nuetrophils (pyuria)
- midstream urine - microscopy
- however problems with urine samples are that they are contaminated with what goes through urethra and orifice
- try and collect the end part of pee so that you dont get the contamination
Common practice method
- does the person have typical symtoms
- does dypstik show pyuria
- then treat
-if person still has symtoms at the end of the week tehn we send off a test to teh lab
Risk factors
Females - past UTI, sexular intercourse, diaphragm use, pregnancy, diabetes
Males - lack of cicumcision
-aids, msm
Also big risk if you are institutionalised and over teh age of 60
-neurological disease
Main bacteria that causes this
e.coli - main cause
staphylococus saprohpyticus
pylonephritis
when it gets up into the kidney
-but is mainly from ecoli because staphylococcus saprophyticus doenst usually make it to the kidneys
E coli
many different types of species that have different factors on them
- some have toxins that you can get colitis or dihorhea
- can also sequest iron,
- have fimbrae - can anchor to endothelium and damage it
- some have polysacharide caspule
- can release alpha haemolysin damages urethelial cells
- Damaged eurothelium then releases cytokines
- these cause symptoms
- recruits nuetrophils, then get dysuria ect occur
Defense mechanisms
microbial flora
urination - need to empty bladder fully, and often elderly people cannot so get more infections
urine - low pH
innate and adaptive immune system
treatment
- can resolve, but will take ages and be painful
- trimethoprine - antifolate drugs, stop dna being made, interfere with bacterial division do not kill them
- bacteriostatic antibiotics
-however some bacteria can become resistant to this, by just using folate hanging around instead of converting it, or by pumping the antibiotic out of the cell
also have trimethoprim
When do we avoid giving these antibiotics?
- in preganancy
- a high dose for long periods can supresses bone marrow function (dont give to people after a bone marrow transplant) - will prolong recovery
allegy - typical rash, can be veyr severe
Better to prescribe someone who is not in hopsital trimethprim (1 per day, 3 days) or nitrofuratoin ( 4 per day, 3 days)
- pateint adhence will be low with nirofuratoin
- better to give trimethprim even though it has more side effects
What are some factors that can contribute to recurrent infections?
Intercourse, form of contraception ( some people fidn this with latex) , abnormal urinary tract or urodynamics
need to void after intercourse
- complete bladder emtpying
- avoid diaphrag spermicides
Kidney infection - pylonephritis
- sever right sided flank pain radiating down to groin
- pain while passing urine
- haematuria, fever, nausea, tachycardia
what is appropriate management - symptoms and signs suggest pyelonephritis - an illness associated with
bacteria and moratility
-need to test urine sample and blood cultures ,also blood test to see if renal failure
Treatment
- often IV first then oral treatment
- gentamicin (may not beable to use with kidney function)
- cefuroxime/amoxycillin - clavulanate are alternatives
need to watch for signs/symptoms of septic shock
