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Urinary System > Lecture 8.1: Urinary Tract Infections > Flashcards

Lecture 8.1: Urinary Tract Infections Flashcards

1
Q

What is a UTI?

A

Presence and multiplication of microorganisms in one or more structures of the urinary tract with organisms invading the surrounding tissues

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2
Q

Uncomplicated UTI Definition

A

UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities

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3
Q

Complicated UTI Definition

A

UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection

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4
Q

What is Bacteriuria?

A

The presence of bacteria in the urine

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5
Q

What is a Lower UTI?

A

An infection of the bladder or urethra

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6
Q

What is a Upper UTI?

A

An infection of the ureters and/or kidneys

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7
Q

What is a Recurrent UTI?

A
  • Usually defined as two or more
    episodes of UTI in six months or three
    or more episodes in one year
  • Can be due to either Relapse or
    Reinfection
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8
Q

What is considered a Relapsed UTI?

A

<7 days, same organism

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9
Q

What is considered a Reinfection UTI?

A

> 14 days, any organism

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10
Q

What is Catheter Associated UTI?

A

Symptomatic infection of bladder or Kidney in catharised person

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11
Q

Who gets UTIs?

A
  • Acute UTI- up to 50% of all women in
    their lifetime
  • 1/3 of women will have had episode
    cystitis by 24 yrs.
  • 20-30% women who have a UTI will
    have recurrence
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12
Q

What is Cystitis?

A

Cystitis is inflammation of the bladder, usually caused by an infection

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13
Q

What is Pyelitis?

A

It is an inflammation of the mucous membrane of the pelvis and calyces of the kidney

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14
Q

What is Pyelonephritis?

A

It is an inflammation of the mucous membrane of the pelvis, calyces of the kidney AND infection of the parenchyma

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15
Q

What are some general Risk Factors for UTI? (3)

A
  • Increased Age
  • Sex: Female
  • History of UTI
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16
Q

What are the Risk Factors for UTI?: Via Bacterial Entry

A
  • Shorter Urethra
  • Catheter
  • Sexual Activity
  • Incontinence
  • Immunocompromised
17
Q

What are the Risk Factors for UTI?: Via Urine Stasis (4)

A
  • Prostate (BPH)
  • Urethral Strictures
  • Stones
  • Pregnancy
18
Q

What are the Risk Factors for UTI?: Via Changes to Flora (3)

A
  • ABx Use
  • Diabetes
  • Menopause
19
Q

How do bacteria enter the urinary tract? (3)

A
  • Retrograde: ascending infection from
    urethra
  • Via blood/lymphatics
  • Direct (catheter, surgery,
    instrumentation)
20
Q

Which organisms are common causes of uncomplicated UTIs?

A
  • Escherichia coli (in 60 to 85% of cases,
    “UPEC”)
  • Staphylococcus saprophyticus
    (approximately 5–10% of cases,
    young, “honeymoon cystitis”)
21
Q

What are some (of the many) other pathogens that can commonly cause UTIs?

A
  • Proteus mirabilis (more common in
    males, associated with calculi)
  • Psuedomonas aeruginosa (often.
    hospital-acquired, antibiotic resistant)
  • Fungal & viral causes (candida,
    herpes, adenovirus in children)
22
Q

Bacterial virulence factors involved in infection in UTIs? (2)

A
  • Adhesion: fimbriae and adhesins
    allow attachment to uroepithelium
  • K antigens: capsule resistant to
    phagocytosis
23
Q

Natural Defences against UTIs (5)

A
  • Low pH, high concentration of urea
  • Regular flushing: removes bacteria
    from distal urethra
  • Mucin layer
  • Antibacterial secretions by urothelium
    into the mucin layer (RNAse 7,
    cathelicidn, Tamm-Horsfall protein)
  • Inflammation & exfoliation of cells
24
Q

What is Urethral Syndrome?

A

It is symptomatic abacteriuria, where you present with the clinical features of cystitis do not have positive urine cultures

25
Q

What are possible reasons for Urethral Syndrome? (4)

A
  • Infection with low counts of bacteria
  • Infection with fastidious organisms not
    detected on routine culture
  • Sexually transmitted infections e.g.
    Chlamydia
  • Non-infective inflammation e.g.
    chemical
26
Q

Symptoms of UTIs (8)

A
  • Dysuria (burning/pain upon urination)
  • Polyuria (increased frequent urination)
  • Urgency (a strong need/desire to
    empty the bladder)
  • Nocturia (PU more often at night)
  • Suprapubic tenderness/discomfort
  • Changes in urine (cloudy, colour
    change, odour change)
  • Haematuria (blood in urine)
  • Backpain, fever, loin pain, rigors =
    consider Pyelonephritis
27
Q

What on a Urine Dipstick is indicative of an UTI? (at least 1 or 2 of these)

A
  • Nitrites: Positive
  • Leucocytes: Positive
  • RBCs: Positive
28
Q

Cultures for UTIs are not routinely done, under what circumstances are they done? (8)

A

Culture when higher risk of complication:
* Pregnancy
* >65 yrs (if sx and antibx given)
* Suspected pyelonephritis
* Suspected UTI in men
* Failed antibiotic treatment or recurrent symptoms
* Recurrent UTI
* Abnormalities of the GU tract
* Renal impairment

29
Q

What are the Methods for Urine Collection for a Culture? (3)

A
  • Mid-stream Urine (MSU) sample
    preferred
  • Catheter technique
  • Pad sample
30
Q

Treatment of Uncomplicated Lower UTI

A
  • Short course of ABx (women 3 days,
    men 7 days) or delay
  • Nitrofurantoin (check eGFR) or
    Trimethoprim first line (but see local
    guidelines)
31
Q

Treatment of Pyelonephritis

A
  • Cefalexin or co-amoxiclav PO/IV
  • Supportive measures (fluids,
    analgesia)
  • ALWAYS safety net
  • Guided by results of culture
32
Q

What is Asymptomatic Bacteriuria?

A

Isolation of bacteria in an appropriately collected urine specimen from an individual without symptoms of urinary tract infection (UTI)

33
Q

Should be Asymptomatic Bacteriuria Treated?

A
  • Unless patient has systemic
    symptoms, not to be treated
  • Does not reduce morbidity/mortality
  • Does increase antibiotic resistance &
    risk of side effects
  • Except in pregnancy, then you treat it
34
Q

What percentage of patients who undergo short-term catheterisation (2-4 days) develop bacteriuria?

A
  • Between 10% and 30%
35
Q

What percentage of patients who undergo long-term catheterisation develop bacteriuria?

A
  • Between 90% and 100%
36
Q

How to UTIs present in Children? What is the course of action for Treatment?

A
  • Often present with non-specific.
    symptoms – consider other causes
  • If under 3 months, refer urgently to
    paeds
  • Otherwise dipstick
  • Culture – clean catch, pad, catheter,
    suprapubic
  • Ultrasound if complicated – assess for
    structural abnormalities
  • Only re-culture if complicated UTI
37
Q

First Line Antibiotics for Uncomplicated UTI (2)

A
  • Trimethoprim
  • Nitrofurantoin

Urinary System (15 decks)

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