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YEAR 5: Microbiology and Infection > MI: Urinary Tract Infection > Flashcards

MI: Urinary Tract Infection Flashcards

1
Q

What is bacteriuria and cystitis?

A
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2
Q

In which situation is asymptomatic bacteriuria clinically significant?

A

Pregnancy - associated with increased risk of complications

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3
Q

What is the difference between uncomplicated and complicated UTI?

A
  • Uncomplicated - infection in a structurally and neurologically normal urinary tract
  • Complicated - infection in a urinary tract with functional or structural abnormalities (includes indwelling catheters and calculi)
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4
Q

In which groups of patients are UTIs considered ‘complicated’?

A
  • Men
  • Pregnant women
  • Children
  • Hospitalised patients
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5
Q

Which organism most commonly causes UTI?

A
  • E. coli*
  • Serogroups:* O1, O2, O4, O6, O7, O8, O75, O150, and O18ab, cause a high proportion of infections
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6
Q

How do virulence factors affect E.coli’s ability to cause UTI?

A

The more virulence factors a strain expresses the more severe an infection - certain virulence factors are more likely to cause pyelonephritis than other

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7
Q

List some other organisms that cause UTI.

A
  • Proteus mirabilis
  • Klebsiella aerogenes
  • Enterococcus faecalis
  • Staphylococcus saprophyticus
  • Staphylococcus epidermidis (can cause infection in the presence of prosthesis (e.g. procedures, indwelling catheters))
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8
Q

Which virulence factor allows S. saprophyticus to stick to the urinary tract epithelium?

A

P-fimbriae

NOTE: S. saprophyticus causes infection in young women

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9
Q

List some antibacterial host defences in the urinary tract.

A
  • Urine (osmolality, pH, organic acids)
  • Urine flow and micturition
  • Urinary tract mucosa (bactericidal activity, cytokines)
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10
Q

What is an ascending UTI?

A

The infection ascends from the female introitus and periurethral area.

More common in women as the female urethra is short and is in proximity to the warm moist vulva and perianal areas, increasing the risk of contamination

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11
Q

List some causes of urinary tract obstruction.

A

Extra-renal

  • Valves, stenosis or bands
  • Calculi
  • BPH
  • Extrinsic ureteral compression

Intra-renal

  • Nephrocalcinosis
  • Nephropathy (uric acid, analgesic, hypokalaemic)
  • Polycystic kidney disease

Neurogenic malfunction

  • Poliomyelitis
  • Tabes dorsalis (demyelinating condition caused by advanced syphilis)
  • Diabetic neuropathy
  • Spinal cord injuries
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12
Q

What is vesicoureteric reflux?

A
  • A condition in which urine can reflux into the ureters
  • It results in a residual pool of infected urine in the bladder after voiding
  • It can result in scarring of the kidneys
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13
Q

Describe how UTI can become established via the haematogenous route.

A

The kidney is a frequent site for abscesses in patients with S. aureus bacteraemia or endocarditis (not really a UTI)

NOTE: Gram negative bacilli like E. coli rarely spreads via the haematogenous route

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14
Q

Outline the symptoms of UTI in:

  1. Neonates and childrne < 2 years
  2. Children > 2 years
A

Neonates and children < 2 years:

  • Failure to thrive
  • Vomiting
  • Fever

Children > 2 years:

  • Frequency
  • Dysuria
  • Abdominal pain
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15
Q

List some symptoms of upper UTI.

A
  • Fever (and rigors)
  • Flank pain
  • Lower urinary tract symptoms
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16
Q

Describe the symptoms of UTI in older patients.

A
  • Mostly asymptomatic
  • Atypical symptoms (e.g. confusion)

NOTE: classic symptoms such as frequency and dysuria are common in older people and does not necessarily suggest that there is an infection

17
Q

List some investigations for uncomplicated UTI.

A
  • Urine dipstick
  • MSU for urine MC&S
  • Bloods - FBC, CRP, U&E
18
Q

List some further investigations that may be considered in complicated UTIs.

A
  • Renal ultrasound scan
  • IV urography
19
Q

What are nitrites in the urine specific for?

A

They are produced by E. coli

20
Q

What does nitrite-negative leukocyte-positive urine suggest?

A

UTI caused by non-coliform bacteria

21
Q

List some patient groups in whom culture and sensitivities should be performed.

A
  • Pregnancy
  • Children
  • Pyelonephritis
  • Men
  • Catheteristed
  • Failed antibiotic treatment
  • Abnormalities of the genitourinary tract
  • Renal impairment
22
Q

What does the presence of white cell in the urine (pyuria) suggest?

A

Infection

23
Q

What does the presence of sqaumous epithelial cells in the urine suggest?

A

Contamination

24
Q

What is the microbiological definition of UTI?

A

Culture of single organisms > 105 colony forming units/mL with urinary symptoms

NOTE: this threshold may be reduced for organisms that are known to cause UTI (e.g. E. coli and S. saprophyticus)

25
Q

What number of white cells in the urine represents inflammation?

A

More than 104/mL

26
Q

In which patient groups should screening of the urine for white cells for MC&S NOT be performed?

A

Immunocompromised patients, pregnant women and children

27
Q

List some causes of sterile pyuria (white cells in urine but no culture growth).

A
  • STIs (e,g, chlamydia)
  • TB
  • Prior antibiotic treament (MOST COMMON)
  • Calculi
  • Catheterisation
  • Bladder cancer
28
Q

What type of agar is used for urine culture? What do the colours suggest?

A

Chromogenic agar

  • Pink = E. coli
  • Blue = other coliforms
  • Light blue = Gram-positives
29
Q

List some methods of sampling urine for investigations.

A
  • MSU
  • Catheterisation
  • Suprapubic aspiration (usually in young children)
30
Q

What type of therapy may be needed for patients with UTIs caused by ESBL producing organisms?

A

Outpatient parenteral antibiotic therapy (OPAT)

31
Q

Outline the treatment options for:

  1. Uncomplicated UTI in women
  2. UTI in pregnant or breastfeeding women
  3. UTI in men
  4. Pyelonephritis or systemically unwell with a UTI
  5. Catheter-associated UTI
A
  1. Uncomplicated UTI in women
    • Cefalexin 500 mg BD PO for 3 days OR
    • Nitrofurantoin 50 mg POQ QDS for 7 days (check renal function)
  2. UTI in pregnant or breastfeeding women
    • Cefalexin 500 mg BD PO for 7 days
    • 2nd line: co-amoxiclav 625 mg TDS PO for 7 days
  3. UTI in men
    • Cefalexin 500 mg BD PO for 7 days OR
    • Ciprofloxacin 500 mg BD PO for 14 days if suspicion of prostatitis
    • Chronic prostatitis: ciprofloxacin 500 mg BD PO for 4-6 weeks
  4. Pyelonephritis or systemically unwell with a UTI
    • Co-amoxiclav 1.2 g IV TDS
    • Consider adding IV amikacin or gentamicin
    • Penicillin allergy: ciprofloxacin 400 mg IV BD
  5. Catheter-associated UTI
    • Remove catheter (but give stat doses before removal of infected catheter)
    • Gentamicin 80 mg STAT IV/IM 30-60 mins before procedure OR
    • Amikacin 140 mg STAT IV/IM 30-60 mins before procedure
32
Q

In which groups of patients is a short course of antibiotics not appropriate?

A
  • Women with a history of UTI caused by antibiotic resistant organisms
  • More than 7 days of symptoms
  • Men
33
Q

In which patients do Candida UTIs tend to occur?

A

Patients with indwelling catheters

34
Q

How should Candida infections due to catheters be treated?

A

Remove the catheter

NOTE: there is no evidence of oral fluconazole being better than no intervention

35
Q

In which exceptional cases should Candida UTI be actively treated?

A
  • Renal transplant patients
  • Patients waiting to undergo elective urinary tract surgery
36
Q

Which part of the kidney is more susceptible to infection?

A

Renal medulla

37
Q

What is the main treatment option for pylenephritis?

A

Co-amoxiclav with or without gentamicin

38
Q

List some complications of pyelonephritis.

A
  • Perinephric abscess
  • Chronic pyelonephritis (scarring, renal impairment)
  • Septic shock
  • Acute papillary necrosis

YEAR 5: Microbiology and Infection (24 decks)

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