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Microbiology - Y3 > Primary Care - UTIs > Flashcards

Primary Care - UTIs Flashcards

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1
Q

What abbreviation is used to remember the different stages that must be covered when contacting microbiology?

A

HD - MAP

  • H - history
  • D - diagnosis
  • M - microbiology results
  • A - antibiotic plan
  • P - plan (non-antibiotic)
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2
Q

What can it mean if epithelial cells are present in a urine culture?

A
  • epithelial cells are skin or vaginal cells
  • this means that a MSU sample has been contaminated by skin or perineal flora
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3
Q

What diagnosis would be made here and why?

Would you want any further investigations?

A

asymptomatic bacteruria

  • this is NOT a UTI as the patient is asymptomatic
  • you would not want to do any further investigations or start antibiotics as this patient is not high risk
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4
Q

In this case, where should the MSU been sent to instead of microbiology?

A
  • the patient had no symptoms and there was no indication to screen for asymptomatic bacteruria
  • the MSU should not have been sent to microbiology
  • it should have been sent to biochemistry to look for microalbuminaemia
  • this is a marker of diabetic nephropathy
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5
Q

What is the definition of asymptomatic bacteruria?

What are the 3 main risk factors?

A

it is the presence of bacteria in the urine of an asymptomatic patient

Risk Factors:

  • increasing age
  • women who are sexually active
  • diabetes
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6
Q

What organisms cause asymptomatic bacteruria?

A

the bacteria isolated are similar to those causing UTIs, which are gut bacteria

  • E. coli
  • Klebsiella
  • Proteus
  • Enterobacter
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7
Q

Who needs to be screened and treated for asymptomatic bacteruria and why?

A

patients who can develop complications from asymptomatic bacteruria:

  • pregnant women
    • ​associated with a higher rate of pyelonephritis
  • those undergoing urological procedures
    • ​if there are bacteria in the urinary tract, manipulation of the urinary tract can lead to infection / bacteraemia
  • post-renal transplant
    • ​may negatively affect the transplant
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8
Q

Why is screening for asymptomatic bacteruria not recommended?

A

most patients have no adverse consequences and derive no benefit from antibiotic therapy

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9
Q

What is the difference between colonisation and infection?

A

Colonisation:

  • the presence of bacteria on body sites that are exposed to the environment which do not cause infection

Infection:

  • presence of micro-organisms causing damage to body tissues
  • this usually occurs in the presence of acute inflammation
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10
Q

How can you tell the difference between a UTI and asymptomatic bacteruria?

What is the difference in management?

A
  • you cannot tell the difference from an MSU result as they both show growth of bacteria
  • you can only tell the difference clinically and if the patient has symptoms or not
  • colonisation (AB) does not require treatment, whereas infection (UTI) needs antibiotic treatment
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11
Q

In young women presenting with urinary frequency and dysuria when is an MSU sent?

A
  • usually in young women with lower UTI symptoms, an MSU is only sent when there is failure to respond to initial treatment
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12
Q

What is the diagnosis?

Why?

A

pyelonephritis (upper UTI)

  • there are symptoms of lower UTI - dysuria, frequency & urgency
  • but also the presence of fever and LOIN PAIN
  • fever can present in lower UTI, but it tends to not be as persistent
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13
Q

Which organisms typically cause pyelonephritis (upper UTI)?

A

Gram negative organisms:

  • most commonly enterobacteriaceae (gut bacteria)
    • E. coli
    • Proteus
    • Klebsiella
  • Pseudomonas aeurguinosa if there is an abnormal renal tract or catheter

Gram positive organisms:

  • very rarely S. aureus - which can cause a renal abscess in IVDUs
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14
Q

How would you investigate upper UTI?

A
  • urine dip (unless catheter in situ)
  • MSU / CSU before starting / changing antibiotics
  • blood cultures (if systemically unwell)
  • renal ultrasound (if patient is in hospital)
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15
Q

Which antibiotics would you use to initially treat an upper UTI?

A
  • start with broad spectrum antibiotics that will cover enterobacterciae
  • make sure the patient is not allergic
  • if the patient is not systemically unwell, they can have PO antibiotics
  • this is usually ciprofloxacin or co-amoxiclav
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16
Q

Which 3 antibiotics cannot be used to treat upper UTI and why?

A
  • nitrofurantoin
  • pivmecillinam
  • fosfomycin
  • these are not active against upper UTIs as they do not penetrate the kidney parenchyma sufficiently
  • they are active in lower UTIs as they are concentrated in the urine
17
Q

How should the antibiotic being used to treat an upper UTI be changed after time?

When should this occur?

A
  • antibiotic choice should be reviewed at 48-72 hours with patient response and microbiology results
  • need to ensure antibiotics are effective against the identified infection
  • want to choose a more narrow-spectrum antibiotic to reduce the incidence of side effects
18
Q

What does ESBL stand for?

What does it mean if a culture is ESBL positive?

A

extended spectrum beta lactamase

  • ESBL positive culture means there are bacteria present that produce ESBLs
  • these are enzymes that break down beta-lactam antibiotics, making the bacteria multi-drug resistant
19
Q

What would the diagnosis be in this scenario?

Why?

A

Catheter associated UTI (CAUTI)

  • symptoms of a UTI (fever, suprapubic tenderness, etc.) with the presence of a catheter
  • if the patient has loin pain or extremely severe symptoms, this should be treated as an upper UTI and not CAUTI
20
Q

Why does a CAUTI occur?

Why is it a clinical diagnosis?

A
  • diagnosis is clinical and not microbiological as nearly all CSUs will grow bacteria due to colonisation of the catheter
  • all CSUs have raised WCC as as soon as you insert the catheter, it irritates the bladder and causes an inflammatory response
  • the presence of plastic allows it to become colonised by bacteria, leading to positive culture
21
Q

If CAUTI is suspected, what is the next course of action?

A

a CSU should be sent to guide antibiotic choice

do NOT dipstick on a catheter sample as this will always be positive

22
Q

What 3 reasons might there be for someone not responding to antibiotic treatment?

A

Poor source control:

  • if you don’t get rid of the source of infection, the patient is unlikely to improve
  • e.g. changing a urinary catheter

Wrong antibiotic:

  • wrong empiric antibiotic
  • wrong dose
    • ensure correct dose for patient age, weight, diagnosis and renal function
  • wrong route of administration
    • antibiotics should be given IV if the patient is septic or treating a deep-seated infection
  • inadequate duration of therapy
    • most infections take 24-48 hours to respond to antibiotic therapy

Antimicrobial resistance:

  • if the patient has an ESBL positive (multi-drug resistant) organism
23
Q

How should source control be tackled in a CAUTI?

A

catheter change under antibiotic cover

  • catheter should be removed if no longer indicated
  • it should be changed under antibiotic cover if needed
  • it can be changed immediately if the patient is on regular IV antibiotics to cover the urinary tract
  • or after 48 hours of suitable PO antibiotics
  • or within 1 hour of giving a STAT dose of prophylactic gentamicin
24
Q

What is important to consider if a patient has an ESBL positive culture and they are in hospital?

A
  • as ESBLs are capable of breaking down most beta-lactam antibiotics, this makes the organism multi-drug resistant
  • ESBLs are carried on plasmids which can spread from one bacteria to another
  • this means they are an infection control hazard and the patient needs to be source isolated
25
Q

What diagnoses would you be considering in this patient?

What other investigations would you want to do?

A

Lower UTI:

  • there is frequency and dysuria

Chronic bacterial prostatitis:

  • recurrent UTIs occurring that are due to the same organism

Other investigations:

  • MSU
  • PR exam to look for a tender prostate
  • first pass urine for chlamydia PCR if STI risk factors are present (e.g. new sexual partner)
26
Q

What is the definition of prostatitis?

A

inflammation of the prostate which can be acute or chronic

27
Q

What is acute prostatitis and how does it present?

A

acute infection of the prostate that is sudden in onset

  • presents with sudden onset lower urinary tract symptoms
    • e.g. increased frequency and dysuria
  • presents with obstructive symptoms
    • ​e.g. hesitancy and nocturia
  • as well as perineal pain, malaise and fever
28
Q

What is chronic prostatitis?

A

chronic inflammation of the prostate, which is usually non-infective

it can rarely be due to bacterial infection

29
Q

How does chronic prostatitis commonly present?

A
  • lower urinary tract infection symptoms
  • obstructive symptoms
  • perineal pain
  • WITH recurrent isolation of the SAME urinary pathogen in MSU
  • symptoms come and go over several months and relapse after short courses of antibiotic therapy
30
Q

What symptom is present in acute prostatitis that is not present in chronic prostatitis?

A

fever

31
Q

What investigations are conducted when prostatitis is suspected?

What would these show?

A

PR exam:

  • shows tender, enlarged prostate

MSU:

  • will grow E. coli, Klebsiella, enterococci, pseudomonas or S. aureus

Chlamydia PCR:

  • this involves use of a first pass urine sample if STI is suspected
32
Q

What is the treatment for acute prostatitis?

Which antibiotics should be used?

A
  • IV antibiotics if patient is systemically unwell
    • piperacillin-tazobactam
    • ciprofloxacin
    • aztreonam
    • gentamicin
  • with PO switch based on culture results
  • antibiotic duration is 2-4 weeks
33
Q

What is the treatment for chronic prostatits?

What antibiotics are used?

A
  • antibiotics are chosen based on culture results
  • these must be suitable oral agents that will penetrate the prostate
  • e.g. trimethoprim or ciprofloxacin
  • antibiotics should be taken for 4 weeks
34
Q
A

Microbiology - Y3 (2 decks)

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