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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
Q

What is a complicated UTI?

A

• Anything which isn’t in a healthy woman (Pregnancy, treatment failure, suspected pyelonephritis, males, pediatric)

26
Q

How is an uncomplicated UTI investigated?

A

• No need for urine culture

Infection indicated by Nitirite/Leukocyte esterase dipstick testing

27
Q

What is leukocyte esterase?

A

• An enzyme produced by WBCs which can be detected in the urine in the event of infection

28
Q

What does a positive nitrite test usually indicate?

A

• That the cause of the UTI is a gram negative organism (usually e.coli)

Gram -‘ves

29
Q

What investigations need to occur in a complicated UTI?

A

• A urine sample must be take, from which a culture will be drawn so bacteria can be identified

30
Q

Give four methods of collecting a urine sample

A
  • Mid stream specimen
    • Adhesive bag over genitalia
    • Catheter sample from special tube in catheter
    • Suprapubic aspiration
31
Q

How are urine samples collected?

A

• Mid stream, as urethera’s normal flora should not be collected

32
Q

How can samples be collected from small children?

A

• Adhesive bag places over genitals

33
Q

What is the issue with using an adhesive bag to collect urine from children?

A

• False positive rate of 20%

34
Q

Where are catheter samples collected from?

A
  • Needle placed up catheter tube

* Not from the bag

35
Q

What is suprapubic aspiration of urine?

A

• Needle placed through suprapubic region of pelvis into bladder and urine aspirated up

36
Q

How are collected samples stored between collection and culture?

A
  • Transported at 4*C with a small amount of boric acid in collection tube
    • Prevents bacterial division
37
Q

• Prevents bacterial division

What investigations can be performed on cloudy urine?

A
  • Turbidity test

* Dipstick testing

38
Q

What is turbidity?

A

• Whether the urine looks cloudy - If so, indicative of UTI

39
Q

What are four dipstick tests which can be performed on urine?

A
  • 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
Q

In what 6 situations is microscopy used on urine culture?

A
  • Kidney disease
    • Suspected endocarditis
    • Children under 6
    • Schistosomiasis
    • Suprapubic aspirate
    • When requested
41
Q

What is urine culture and what needs to occur before infection can be confirmed?

A

• A number of colony forming units must occur - >100,00 per ml (10^5 cfu/ml) distinguished bacteriuria/contamination

42
Q

What are the five main advantages of urine culture?

A 
• 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
Q

What 5 details are needed to correctly interpret a urine culture?

A 
• Clinical details 
		○ Symptoms 
		○ Previous antibiotics
	• Quality of specimen 
	• Delays in culture
	• Microscopy
	• Organsims location
44
Q

What is sterile pyuria?

A

Pus in urine

45
Q

What does sterile pyuria indicate?

A

• A UTI is present but unable to be cultured

46
Q

Give three situations where sterile pyuria would be present?

A
  • 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
Q

What are three other causes of UTI symptoms

A
  • Vaginal infection/inflammation
    • Sexually transmitted pathogens
    • Mechanical/physical/chemical causes
48
Q

What are general treatments for UTI?

A
  • Increase fluid intake

* Address underlying disorders

49
Q

How is an uncomplicated UTI treated?

A
  • 3 day course of antibiotics

* 3 day course reduces the selection pressure for resistance

50
Q

What is given for complicated UTI treatment?

A

5 day course antibiotics

51
Q

Should amoxicillin be used to treat complicated UTI’s?

A

• No

50% of isolates (bacteria) resistance

52
Q

How should pyelonephritis/septicaemia be treated?

A
  • 14 day course of antibiotics

* Use more potent agent with systemic activity

53
Q

When is antibiotic prophylaxis indicated?

A

• Three or more episodes of UTI in one year

No treatable underlying condition

54
Q

What is antibiotic prophylaxis

A
  • Single, low, nightly dose of antibiotics to prevent bacteria build up in static urine
    • All breakthrough infections documented
55
Q

What is pyelonephritis?

A

• Infection in kidney

56
Q

What is the worst case scenario in a UTI?

A
  • Bacteria manage to invade blood stream from urinary tract

* Gram negative septicaemia will occur

57
Q

What are you likely to see in a culture of contaminated urine?

A

• Simple Squamous Epithelial cells

58
Q

What is sensitivity of a test?

A

The rate of true positives

59
Q

What is specificity of a test?

A

Rate of true negatives

Semester 3 - Urinary (33 decks)

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