M - UTIs Flashcards
Define uncomplicated UTI
Infection of the urinary tract without any structural or functional abnormality
Define complicated UTI
infection of the urinary tract with functional or structural abnormalities
Complicated UTI is generally an infection in which kind of patients?
Male
pregnant
Indwelling catheters
Children
Prevalence of bacteriuria in young non-pregnant women?
1-3%
List the 4 most common bacterial causes of UTI
E. Coli
Staph. Saprophyticus
Proteus
Klebsiella
Clinical features of lower UTI in diff patients?
Generally: dysuria, frequency, urgency, haematuria
Children - vague (fever, irritability, vomiting,FTT)
Elderly - asymptomatic
Clinical features of pyelonephritis
Fever
Rigors
Flank pain
Gram +ve, coagulase -ve, UTI
- name 2 common causes
S. Saprophyticus
S. Epidermis (prostheses)
Extra renal causes of urinary tract obstruction
BPH, Calculi
Intrarenal causes of urinary tract obstruction
PCKD
SCD
Hypokalemic nephropathy?!
Neurogenic causes of renal tract obstruction
Poliomyelitis
Diabetic neuropathy
Spinal cord injury
Haematogenous route of UTI - what tends to cause this?
S. aureus bacteremia or endocarditis
If urine dip shows +ve leukocytes alone, what step should you take next?
Urine culture
Treat if severe Sx
what culture result is diagnostic of UTI?
^exception to this rule?
Culture of single organisms >10^4 colony forming units/mL
Accept lower number if E.Coli or S. saprophyticus
Urine microscopy - which cells, if you saw them, would be indicative of sample contamination
squamous epithelial cells
Causes of sterile pyuria (WBCs present and nothing on culture)
Prior treatment with Abx = top cause
calculi
catheterisation
bladder ca
TB or STD (not grown in normal culture)
Tx of pyelonephritis
Coamoxiclav +/- gentamicin
Uncomplicated UTI in female - tx?
Cephalexin or nitrofurantoin
UTI in man - Tx?
Cephalexin or ciprofloxacin
Catheter associated UTI - tx?
Gentamicin or amikacin
In whom would you consider a 7 day abx course for uncomplicated lower UTI ? list 3
- Men
- previous UTI with resistant organism
- > 7 days of Sx
Candida UTI - main cause?
Indwelling catheter
Complications of pyelonephritis - state 4
Chronic pyelonephritis
Abscess
Acute papillary necrosis
Septic shock
name the only staph bug to commonly cause UTI
staph saprophyticus
which bug causes stones in UTI
proteus mirabilis
which bug do you get in hospital with a cather
klebsiella aerogenes
which type of bacteria cause ascending UTI
gram -
which bug causes UTI via haematageneous route
staph aureus
LUTI Sx
Dysuria, frequency, urgency, pain suprapubic / on peeing
UTI Sx
fevers, rigors, flank pain, varied, some LUTI Sx too
features on urine dip to suggest UTI
leucocytes and nitrites
Ix for complicated UTI
Renal USS and IV urography
Cut off for lab to say bacteria has been grown?
Between 10^4 and 10^5 cfu/mL
Squamous epithelium in UTI sample. Meaning?
Poorly taken sample, as has cells from lower 1/3rd urethra
High WCC on microscopy but no bacteria grown. Meaning?
TB - not tested for routinely in microscopy so not grown
Sampling methods for UTI
MSU, catheterisation, suprapubic aspiration
Normal length of ABx Tx for UTI
3 days
List Abx to avoid in UTI in pregnant women
Nitrofurentoin and trimethoprim
Tx for UTI with catheter?
Take out catheter
Tx for fungal UTI
No Tx if no Sx - fluconazole is not effective
complications of pyelonephritis
Perinephritic abcess
Chronic pyelonephritis
Sepsis
Acute papillary necrosis
Prophylaxis for UTI?
No - controversial as can lead to resistance and adverse effects
