Session 7 Flashcards
Why are women more prone to UTIs?
They have a shorter urethra therefore the bacteria have a shorter distance to travel before they reach the bladder
What can increase the risk of a UTI?
Female
Obstructions eg enlarged prostate, prolapse, pregnancy
Neurological issues eg Incomplete emptying, residual urine will sit for hours
What is ureteric reflux?
The vales that usually contract to prevent urine going back up the ureters and either absent or not fully formed. This causes an ascending infection.
What bacterial factors help increase the chances of a UTI?
Fimbriae to allow attachment to the host epithelium
K antigen to help produce a polysaccharide capsule
Urease to break down urea, making the environment more favourable for growth
What are some of the clinical syndromes associated with UTIs?
Cystitis (Inflammation of the bladder)
Frequency (Going to toilet more)
Dysuria (Pain on passing urine, usually burning)
Acute Pylenephritis (Infection has reached the Kidney)
Septicaemia and/or shock
Signs/symptoms of a lower tract UTI
Sometimes a low grade fever
Dysuria
Frequency
Urgency
Signs/symptoms of an upper tract UTI
Fever
Loin pain (Usually unilateral)
Dysuria
Frequency
What investigations can you do for an uncomplicated UTI?
Usually middle aged female with no comorbidities. No need to culture, infection indicated by presence of nitrate/leucocyte esterase on the dipstick test
What investigations can you do for a complicated UTI?
Usually Male, co morbidities, pregnancy
Need to culture urine - collect from catheter bag or midstream (midstream as the beginning flushes out any extra bacteria, so only get bacteria from the bladder)
What screening or urine can you do near the patient?
Turbidity Dipstick for leucocyte esterase Nitrite Haematouria Proteinuria
What tests can you do on urine in the lab?
White cells
Red cells
Bacteria
Good to help decide what antibiotics to use (Sensitivity testing - Have antibiotic discs and see which one causes the biggest zone of inhibition)
What is sterile pyuria?
Urine that contains white cells, but appears sterile by standard culture techniques.
It is usually caused by the patient being on antibiotics already, urethritis, vaginal infection, TB
How do you treat a UTI?
Antibiotics (3 day course of trimethroprim or nitrofurantoin for uncomplicated UTI and 5 day course of antibiotics same as above except cephaoxin too for complicated UTI - not Amoxicillin as around 50% resistant)
Increased fluid intake (To allow more natural flushing)
Address any underlying disorders
Post treatment follow up
What is important to remember when treating simple cystitis?
A 3 day course is as simple as a 5 or 7 day course, but limiting it to 3 days help to reduce the selection pressure for resistance.
Usually treat with trimethroprim or nitrofurantoin
How could you treat pyelnephritis?
IV antibiotics eg co-amoxiclav, ciprofloxacin, gentamicin (IV only as nephrotoxic)
