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Medicine II > Nephro: Urinary Tract Infections > Flashcards

Nephro: Urinary Tract Infections Flashcards

1
Q

in which population are UTIs common

A

sexually-active women

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2
Q

what are UTIs in men and children associated with

A

abnormalities in the urinary tract

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3
Q

pathogenesis of UTI

A

colonic flora migrates into the perivaginal and perineal and transurethral regions, causing infection there

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4
Q

complications of UTIs

A

gram negative septicaemia and renal scarring

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5
Q

risk factors for UTIs

A
  • changes in vaginal pH (more acidic)
  • antibiotic prophylaxis
  • recent/frequent intercourse
  • highly concentrated urine
  • urinary stasis or incomplete bladder emptying
  • older age
  • eradication of
  • vaginal commensal organisms
  • renal/bladder stones
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6
Q

what are the most common organisms to cause UTIs

A
  • E.coli
  • Staph sapro
  • Klebsiella
  • Enterococcus faecalis
  • Proteus mirabilis
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7
Q

genetic predisposition to UTIs

A

some women have expressed receptors which aid the fimbriae of E.coli to stick to the urothelium

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8
Q

what is virulence?

A

how severe or harmful a disease is

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9
Q

how can you classify UTI

A

upper and lower urinary tract infections

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10
Q

signs and symptoms of lower urinary tract infection

A
  • dysuria
  • frequency
  • urgency
  • nocturia
  • suprapubic pain/tenderness
  • offensive urine/frank haematuria
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11
Q

what should you ask in a history of UTI

A
  • sexual history
  • new partners
  • use of contraceptives and if so, which
  • recent antibiotic use
  • previous UTIs
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12
Q

signs and symptoms of a UTI in the elderly

A
  • confusion

- incontinence

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13
Q

which symptoms make vaginitis more likely to be the case

A
  • vaginal irritation

- discharge

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14
Q

signs and symptoms of an upper urinary tract infection

A
  • fever
  • chills
  • rigors
  • nightsweats
  • N&V
  • loin pain
  • costovertebral angle tenderness
  • septic shock
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15
Q

in which populations are symptoms of an upper urinary tract infection less likely to be present

A

immunocompromised and children

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16
Q

investigations for UTI

A
  • urine dipstick
  • microscopy
  • culture and sensitivity
17
Q

what to look out for in a urine dipstick

A
  • positive leucocyte esterase
  • positive nitrite reductase
  • some proteinuria
18
Q

what type of casts are suggestive of pyelonephritis?

A

WBC casts

19
Q

what is the window of time where samples should be cultured?

A

there is a 2hr window; if you cannot culture by that time, refridgerate it, it will buy some time (around 2 days)

20
Q

what to check from a clean catch MSU

A
  • microscopy
  • pyuria
  • organisms
21
Q

criteria for a positive diagnosis of a UTI

A
  • culture of a urinary pathogen (10^5 units/mL is standard)

- lower in young women, men and pyelonephritis

22
Q

what should you exclude if there are persistent symptoms despite treatment

A
  • urethritis

- vaginitis

23
Q

which populations need close attention?

A
  • symptoms lasting more than 2 weeks
  • recurrent UTis
  • men
  • children
  • pregnant women
  • diabetics
  • immunocompromised
  • associated stones
  • known abnormal urinary tract
  • indwelling catheter
24
Q

radiological investigations for UTI

A
  • plain AXR
  • US kidneys
  • CTKUB
  • DMSA scanning
  • prostate assessment
  • cystoscopy
  • CT scanning w/w/o contrast
25
Q

which investigation should you use in a patient with recurrent UTIs

A

cystoscopy

26
Q

general treatment of UTI

A
  • antibiotics depending culture and sensitivity results (cipro, levafloxacin, seprin, cephalosporin)
  • high-fluid uptake (>2L/day)
27
Q

treatment of an uncomplicated UTI

A
  • start with empirical therapy
  • antibiotics for 3 days like cipro, levo and co-trimoxazole
  • ampicillin and amoxicillin are less effective in eliminating vaginal and periurethral colonisation
  • if symptoms persist, culture the urine and treat for 2 weeks
  • 7 days treatment in pregnancy (do not use sulfonamides here)
28
Q

what should you do in a suspected STD

A
  • pelvic exam
  • urine for GCgonococcus and Ctrachomatis
  • treat with doxycycline for 7 days or azithromycin 1g single dose
29
Q

how should you treat pyelonephritis

A
  • admit the patient
  • urine and blood cultures
    14 days of IV and oral combined of antibiotics
  • treat IV until afebrile and 2-week oral antibiotics (cipro/levo)
  • rehydration, pain relief, antiemetics
  • rehydration with normal saline
30
Q

what is empirical therapy?

A

treat depending on an educated guess rather than systematic things, until the C&S come back

31
Q

how would you treat UTIs in immunocompromised?

A

additional single dose aminoglycoside eg gentamicin

32
Q

which antibiotics are given IV for UTIs

A
  • fluoroquinolone IV (cipro, levo)
  • ampicillin + gentamicin
  • 3rd gen cephalosporin
33
Q

criteria for recurrent UTIs

A

more than 4 culture-proven UTIs per year

34
Q

management of recurrent UTIs

A
  • ask for a sexual history and whether it could have caused this
  • increased fluid intake and frequent voiding
  • discourages spermicides
  • oestrogen creams PV in post-menopausal women
  • prophylaxis for a year (and if there is no underlying cause identified)
35
Q

lifestyle advice for recurrent UTIs

A
  • wipe front to back
  • voiding after intercourse
  • personal hygiene
  • panty-hose tights or synthetic fibres
36
Q

which antibiotics are given for UTIs caused by sexual activity

A

co-trimoxizole or nitrofurantoin

37
Q

how to give low-dose antibiotic prophylaxis

A
  • rotation of 3 month cycles
  • NF
  • cephalexin
  • co-trimoxazole
  • amoxicillin
  • trimethrophin

Medicine II (16 decks)

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