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Semester 3 - Urinary > Session 7 - UTI > Flashcards

Session 7 - UTI Flashcards

1
Q

Outline the three main defences against UTI

A
  • Regular flushing during voiding
    • Length of urethra
    • Antibacterial secretions into urine
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2
Q

What does regular flushing during voiding do to help avoid UTIs?

A

• Removes organisms in distal urethra

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3
Q

Outline four host factors which predispose to UTI

A
  • Short urethra - More infections in female
    • Obstruction
    • Neurological - Incomplete emptying, residual urine
    • Ureteric reflex - Ascending infection from bladder, especially in children
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4
Q

Give four ways obstructions occur in the urethra

A
  • Enlarged prostate
    • Pregnancy
    • Stones
    • Tumours
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5
Q

Outline five bacterial factors which predispose micro-organisms to urinary tract infection

A
  • Fimbriae allow attachment to host epithelium
    • Faecal flora migrate across periurtheral area
    • K antigen permits production of polysaccharide capsule
    • Haemolysins damage host membranes and cause renal damage

Urease breaks down urea creating a favourable environment for bacterial growth

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6
Q

What bacteria types commonly cause UTI’s?

A

• Gram -‘ve bacteria

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7
Q

What is the commonest type of UTI?

A

• An infection of the lower tract - Cystitis

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8
Q

What is the most common cause of UTIs?

A

• Migration of e.coli from faecal flora across peri-urethral area

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9
Q

What can cause upper UTI’s?

A
  • Haematogeneous (blood borne) or ascending routes of infection
    • Upper UTI (pyelonephritis)
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10
Q

Give three types of lower UTI

A
  • Bacterial cystitis
    • Abacterial cystitis
    • Prostatitis
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11
Q

Give main symptoms of bacterial cystitis

A

• Frequency and dysuria, often with pyuria and haematuria

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12
Q

Give main symptoms of abacterial cystitis

A

• Frequency and dysuria, often with pyuria and haematuria

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13
Q

How could you tell the difference between bacterial and abacterial cystitis?

A

• Bacterial cystitis will be coupled with a bacteraemia

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14
Q

Give main symptoms of prostatitis

A

Fever, dysuria, frequency with perineal and lower back pain

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15
Q

Give two types of upper UTI’s

A

Acute pyelonephritis

Chronic interstitial nephritis

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16
Q

What are symptoms of acute pyelonephritis

A
  • Symptoms of cystitis

* Fever and loin pain

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17
Q

What are symptoms of chronic interstitial nephritis

A

Renal impairment following chronic inflammation - infection one of many causes

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18
Q

What is an asymptomatic UTI?

A
  • Covert Bacteriuria

* Detected only by culture

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19
Q

Give two examples of when an asymtpomatic UTI would be important?

A

Pregnancy

Childhood

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20
Q

What is the main organism responsible for UTI’s?

A

• Coliforms - e.coli - GRAM NEGATIVE SO STAINS PINK

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21
Q

What bacteria cause young women and hospitalised patients to develop UTI’s?

A

Staph Saprophyticus

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22
Q

Why is there a difference between the bacteria types which cause UTI in hospital and the community?

A

• Hospital provides extra risk factors, such as catherterisation which can provide a biofilm surface

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23
Q

What are two types of UTI?

A
  • Complicated

* Uncomplicated

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24
Q

What is an uncomplicated UTI?

A

• Vast majority of UTI’s

Found in healthy women

25
What is a complicated UTI?
• Anything which isn't in a healthy woman (Pregnancy, treatment failure, suspected pyelonephritis, males, pediatric)
26
How is an uncomplicated UTI investigated?
• No need for urine culture Infection indicated by Nitirite/Leukocyte esterase dipstick testing
27
What is leukocyte esterase?
• An enzyme produced by WBCs which can be detected in the urine in the event of infection
28
What does a positive nitrite test usually indicate?
• That the cause of the UTI is a gram negative organism (usually e.coli) Gram -'ves
29
What investigations need to occur in a complicated UTI?
• A urine sample must be take, from which a culture will be drawn so bacteria can be identified
30
Give four methods of collecting a urine sample
* Mid stream specimen * Adhesive bag over genitalia * Catheter sample from special tube in catheter * Suprapubic aspiration
31
How are urine samples collected?
• Mid stream, as urethera's normal flora should not be collected
32
How can samples be collected from small children?
• Adhesive bag places over genitals
33
What is the issue with using an adhesive bag to collect urine from children?
• False positive rate of 20%
34
Where are catheter samples collected from?
* Needle placed up catheter tube | * Not from the bag
35
What is suprapubic aspiration of urine?
• Needle placed through suprapubic region of pelvis into bladder and urine aspirated up
36
How are collected samples stored between collection and culture?
* Transported at 4*C with a small amount of boric acid in collection tube * Prevents bacterial division
37
• Prevents bacterial division | What investigations can be performed on cloudy urine?
* Turbidity test | * Dipstick testing
38
What is turbidity?
• Whether the urine looks cloudy - If so, indicative of UTI
39
What are four dipstick tests which can be performed on urine?
* Leukocyte esterase - Indicates presence of WBCs * Nitrite - Indicates presence of nitrate reducing bacteria * Haematuria - Present in UTI and many other conditions * Proteinuria - Present in UTI and many other conditions
40
In what 6 situations is microscopy used on urine culture?
* Kidney disease * Suspected endocarditis * Children under 6 * Schistosomiasis * Suprapubic aspirate * When requested
41
What is urine culture and what needs to occur before infection can be confirmed?
• A number of colony forming units must occur - >100,00 per ml (10^5 cfu/ml) distinguished bacteriuria/contamination
42
What are the five main advantages of urine culture?
``` • To investigate complicated UTIs • Gives epidemiology of isolates • Sensitivity testing • Specificity testing • Control of specimen quality ○ Can differentiate between properly collected and contaminated samples (poorly collected samples may contain epithelial cells) ```
43
What 5 details are needed to correctly interpret a urine culture?
``` • Clinical details ○ Symptoms ○ Previous antibiotics • Quality of specimen • Delays in culture • Microscopy • Organsims location ```
44
What is sterile pyuria?
Pus in urine
45
What does sterile pyuria indicate?
• A UTI is present but unable to be cultured
46
Give three situations where sterile pyuria would be present?
* Patient already treated with antibiotics * OR infected with bacteria that are difficult isolate or culture OR can be due to tuberculosis or appendicitis (appendix stuck on bladder
47
What are three other causes of UTI symptoms
* Vaginal infection/inflammation * Sexually transmitted pathogens * Mechanical/physical/chemical causes
48
What are general treatments for UTI?
* Increase fluid intake | * Address underlying disorders
49
How is an uncomplicated UTI treated?
* 3 day course of antibiotics | * 3 day course reduces the selection pressure for resistance
50
What is given for complicated UTI treatment?
5 day course antibiotics
51
Should amoxicillin be used to treat complicated UTI's?
• No 50% of isolates (bacteria) resistance
52
How should pyelonephritis/septicaemia be treated?
* 14 day course of antibiotics | * Use more potent agent with systemic activity
53
When is antibiotic prophylaxis indicated?
• Three or more episodes of UTI in one year No treatable underlying condition
54
What is antibiotic prophylaxis
* Single, low, nightly dose of antibiotics to prevent bacteria build up in static urine * All breakthrough infections documented
55
What is pyelonephritis?
• Infection in kidney
56
What is the worst case scenario in a UTI?
* Bacteria manage to invade blood stream from urinary tract | * Gram negative septicaemia will occur
57
What are you likely to see in a culture of contaminated urine?
• Simple Squamous Epithelial cells
58
What is sensitivity of a test?
The rate of true positives
59
What is specificity of a test?
Rate of true negatives

Semester 3 - Urinary (33 decks)

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