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US > Session 9: Urinary Tract Infection > Flashcards

Session 9: Urinary Tract Infection Flashcards

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1
Q

Risk factors of UTI

A

Sex - female

Obstructive causes

Neurological conditions

Pregnancy

Abnormal renal tract

Impaired host defence

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2
Q

Why are females more likely to get UTIs?

A

Shorter urethra

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3
Q

Give examples of obstructive causes that can lead to UTIs.

A

Stones

Enlarged prostate

Retroperitoneal fibrosis

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4
Q

Why might neurological conditions cause an increased risk of UTIs?

Give examples.

A

Because the bladder might not be emptying properly leading to residual urine.

MS and stroke e.g.

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5
Q

Explain how pregnancy can lead to increased risk of UTIs.

A

Enlarged uterus leading to obstruction of ureter, bladder, urethra.

Progesterone leading to relaxation of musculature of the urinary tract leading to stasis.

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6
Q

Give examples of abnormalities in the renal tract.

A

Vesico-ureteric reflux (most commonly in children)

Indwelling urinary catheter

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7
Q

Give examples of impaired host defences that can lead to UTIs.

A

Diabetes Mellitus

Immunosuppression

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8
Q

Give examples of lower UTIs.

A

Bacterial cystitis

Abacterial cystitis

Prostatitis

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9
Q

Give exampes of Upper UTIs.

A

Acute pyelonephritis

Chronic interstitial nephritis

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10
Q

Give example of asymptomatic UTIs.

A

Covert bacteriuria

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11
Q

Give some examples of major defences against UTIs.

A

Regular flushing of bacteria (voiding)

Vesico-ureteral valves to prevent reflux

Immunological factors

Mucosal barriers

The acidity of the urine

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12
Q

What are the most common pathogens of UTIs.

A

Gram-negative rods and especially enterobactericeae.

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13
Q

Give example of an enterobactericeae that is very common in UTIs.

A

Escherichia coli

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14
Q

Virulence factors of E. coli making them very common in UTIs.

A

Flagella for movement to ascend the UT.

Pili for attachment

Capsular polysaccharide for colonisation and resist host defences.

Haemolysin to damage the membranes and also cause renal damage.

Toxins.

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15
Q

Give examples of other pathogens that can cause UTIs.

A

Coagulase-negatie staphylococci (S. saprophyticus)

Gram-negative bacteria like Pseudomonas aeruginosa

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16
Q

In which people might coagulase-negative staphylococci cause UTIs?

A

Young women and in hospitalised

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17
Q

In which people might Pseudomonas aeruginosa cause UTIs?

A

Hospitalised patients, mainly because of greater antibiotic selective pressure.

Diabetes Mellitus

Cystic fibrosis

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18
Q

What is cystitis?

A

Inflammation of the bladder.

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19
Q

Clinical presentation of bacterial cystitis.

A

Dysuria

Cloudy urine

Nocturia or frequency

Urgency

Suprapubic tenderness

Haematuria

Pyrexia (usually mild)

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20
Q

Clinical presentation of pyelonephritis.

A

+/- symptoms of cystitis.

High fever

Loin pain

Nausea/vomiting

Rigors

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21
Q

Definition of an uncomplicated UTI.

A

Defined as an infection by as usual organism, in a patient with a normal urinary tract and a normal urinary function.

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22
Q

Definition of a complicated UTI.

A

One or more factors that predispose the patient to either persistent or recurrent infection. Also treatment failure.

23
Q

Give examples of predisposing factors leading to a complicated UTI.

A

Abnormal urinary tract (obstruction/reflux)

Virulent (uncommon) organism

Impaired host defence

Impaired renal function

24
Q

Can UTIs in children, men and some cases of pyelonephritis be defined as uncomplicated UTIs?

A

No, usually not because they are not as common. Even though they can technically be deemed uncomplicated in practice most children, men and also pregnant women are investigated for their UTIs as if they were complicated.

25
Q

How would you investigate a UTI?

A

Urine culture.

26
Q

In what UTIs are urine cultures done?

In what UTIs are they not?

A

Complicated UTIs in e.g. pregnancy, treatment failure, recurrent infections, pyelonephritis, complications, male, children.

Not in uncomplicated UTIs.

27
Q

Explain how urine culture can be collected.

A

Mid-stream urine sample is the most common way.

Clean catch (children)

Collection bag

Catheter sample

Supra-pubic aspiration

28
Q

If there is a delay in examination of the urine culture sample, what needs to be done to the urine?

A

Refrigerate or collected in containers with boric acid.

This is to prevent bacterial multiplication

29
Q

How would you screen for UTIs?

A

Urine dipstick test

30
Q

What are you looking for on a urine dipstick for UTIs?

A

Leucocyte esterase (WBC count)

Nitrites (Nitrate-reducing bacteria)

Blood

pH

Protein

31
Q

Definition of significant bacteruria.

A

>105 colony forming units (cfu)

32
Q

When is urine dipstick for screening of UTIs useful?

A

Suspected uncomplicated UTI in females <65 years old.

Ruling out infection in children >3 months old

33
Q

When is urine dipstick not useful?

A

Patients >65 y

Catheterised patients

34
Q

How else might you screen for UTIs?

A

Visual inspection of urine.

35
Q

When might you use urine dipstick in suspected UTIs?

A
36
Q

Why might imaging be done in UTIs?

A

Considered in all children with UTIs.

Valuable in septic patients to see if there is any renal involvement like pyelonephritis

Check for posterior urethral valves in men

Check for vesico-ureteric reflux in children and women.

37
Q

What is sterile pyuria?

A

When there is raised white cells but no growth of the urine culture.

38
Q

Give causes of sterile pyuria.

A

Prior antibiotics

Urethritis like chlamydia or gonococci

Vaginal infection/inflammation

Tuberculosis

Appendicitis

Fastidious organisms

Non-infective inflammation like tumours or chemicals.

39
Q

When tuberculosis is suspected, how should urine culture be collected?

A

Three early morning urine specimens.

40
Q

In around 50% of women can present with clinical features of cystitis but do not have positive urine cultures.

What is this called?

A

Abacterial cystitis or urethral syndrome.

41
Q

Proposed aetiology of abacterial cystitis.

A

Infection with low counts of bacteria

Infection with fastidious organisms

STI (e.g. chlamydia)

Non-infective inflammation

42
Q

What is asymptomatic bacteruria?

A

When there are significant levels of bacteria in the urine but there are no UTI symptoms.

43
Q

In which people is asymptomatic bacteruria common?

A

Elderly patients

Indwelling catheters

44
Q

When is asymptomatic bacteriuria screened for and treated?

Why?

A

In pregnancy because if it goes untreated it can lead to higher risks of premature labour or pyelonephritis.

45
Q

General treatment of UTIs.

A

Increased fluid intake

Regular analgesia like paracetamol or ibuprofen

Address the underlying disorder

46
Q

Treatment of uncomplicated UTI.

A

A 3 day course of nitrofurantoin, trimethoprim, pivmecilinam or fosfomycin.

Trimethoprim is becoming increasingly resistant.

47
Q

Why is it only a 3 day course for uncomplicated UTIs?

A

It is more or less as effective as a 5 day or 7 day course.

Also reduces the selection pressure for resistance.

48
Q

Treatment of complicated UTIs.

A

E.g. in males, pregnant women, catheterised etc…

Nitrofurantoin, trimethoprim, pivmecillinam, fosfomycin or cefelexin.

5-7 days course

49
Q

What antibiotic is used in UTI of pregnant women?

A

Cefelexin

50
Q

Treatment of pyelonephritis or septicaemia.

A

Systemic treatment of 7-14 days of pyelonephritis.

IV-treatment such as co-amoxiclav, ciprofloxacin, or Gentamicin.

Gentamicin needs to be IV only and can be nephrotoxic.

51
Q

When might prophylaxis of UTIs be needed?

A

When the infection is recurrent at 3 or more episodes in a year even when behavioural and personal hygiene measures have been made.

Can commonly be made as a single nightly dose of nitrofurantoin e.g.

52
Q

Give examples of structural renal abnormalities that can elad to increased risk of developing UTIs.

A

Duplex ureters

Duplex kidneys

Pelvic kidney

Polycystic kidney

Reflux disease.

53
Q

Give examples of infections that can cause immune-mediated glomerulonephritis.

A

Post-streptococcal glomerulonephritis

Endocarditis-associated glomerulonephritis

Hep B

Hep C

HIV

54
Q

Connection between kidney function and infection.

A

Decreased kidney function increases the likelihood of infection.

Also patients with advanced kidney disease are less likely to mount an immune response to vaccinations.

US (29 decks)

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