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Clinical Pathology (RIP) > T11 - L5 Urinary Tract Infections > Flashcards

T11 - L5 Urinary Tract Infections Flashcards

1
Q

what parts of the urinary tract are considered sterile and considered colonised?

A

sterile:

  • kidney
  • ureter
  • bladder (usually)

colonised:
- urethra

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2
Q

what makes up the perineal flora?

A

skin flora
- mainly coagulase negative staphylococci

lower GI tract flora

  • anaerobic bacteria
  • aerobic bacteria e.g. enterbobacterales (coliforms) / gram positive cocci e.g. Enterococcus spp.
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3
Q

What is an Urinary Tract Infection?

A
  • Cystitis (lower UTI)
  • Pyelonephritis (upper UTI)
  • Urethral syndrome
  • significant bacteriuria
  • asymptomatic bacteriuria
  • sterile pyuria
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4
Q

what is the clinical term for a lower UTI?

A

cystitis

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5
Q

what is the clinical term for a upper UTI?

A

Pyelonephritis

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6
Q

what is pyuria?

A

the presence of pus in the urine, typically from bacterial infection.

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7
Q

what is bacteriuria?

A

the presence of bacteria in the urine.

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8
Q

what are symptoms of cystitis?

A
  • Dysuria
  • Frequency
  • Urgency
  • Supra-pubic pain or tenderness
  • Polyuria, nocturia, haematuria
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9
Q

what is polyuria?

A

excessive or an abnormally large production or passage of urine (greater than 2.5 L or 3 L over 24 hours in adults). Frequent urination is usually an accompanying symptom.

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10
Q

what is nocturia?

A

wake up during the night because you have to urinate

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11
Q

what is pyelonephritis?

A
  • Infection of the kidney and/or renal pelvis
  • Symptoms of lower UTI
  • Loin/abdominal pain or tenderness
  • Fever

Other signs of systemic infection:

  • Rigors, nausea, vomiting, diarrhoea
  • Elevated CRP, WBC
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12
Q

what is urethral syndrome?

A

abacterial cystitis

symptoms of a lower UTI without demonstrable infection

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13
Q

what is the epidemiology of urethral syndrome?

A

30-50 year old women

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14
Q

what else can cause urethral symptoms as opposed to bacteria?

A

STIs

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15
Q

what is classed as “significant” bacteriuria?

A

> 105 cfu/mL = “significant” bacteriuria

104-105 cfu/mL = probable infection

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16
Q

what is asymptomatic bacteriuria?

A

no symptoms of a urinary tract infection

But cultured urine sample grows a single organism in significant numbers

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17
Q

what is “sterile pyuria”?

A
  • pus cells in urine

- nor organisms grown

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18
Q

what are predisposing factors of UTIs?

A
  • female sex -10:1 female:male ratio
  • urinary stasis
  • urological instrumentation
  • sexual intercourse
  • fistulae
  • congenital abnormalities (VUR)
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19
Q

which congenital abnormality predisposes a patient to UTIs?

A

VUR

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20
Q

which type of fistulae predisposes a patient to UTIs?

A

Recto-vesical

vesico-vaginal

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21
Q

what may cause a UTI due to urinary stasis?

A
  • pregnancy
  • prostatic hypertrophy
  • stones
  • strictures
  • neoplasia
  • residual urine (poor bladder emptying)
22
Q

what is a complicated UTI?

A

Underlying abnormality (structural / functional)

e. g.
1) Urinary stasis – obstruction / retention

2) Presence of “foreign body”
- Catheter / other device / renal calculi
- Biofilm

23
Q

what is a uncomplicated UTI?

A

absence of underlying abnormality

absence of “foreign body”

24
Q

what is an endogenous source of a UTI?

A 
enteric flora (gut flora):
- Perineum
Movement of bacteria along a lumen
- Fistulae
Movement of bacteria from the genital/GI tract to the urinary tract

haematogenous spread (rare)
- Seeding of bacteria to the urinary tract via the blood
E.g Staphylococcus aureus

25
Q

what can cause sterile pyuria?

A
  • inhibition of bacterial growth
  • “fastidious” (hard to grow) organisms
  • urinary tract inflammation e.g. stones
  • urethritis (sexually transmitted pathogens)
26
Q

which sexually transmitted pathogens can cause urethritis?

A

Neisseria gonorrhoeae

Chlamydia trachomatis.

27
Q

what “fastidious” (hard to grow) organisms can cause sterile pyuria?

A

Mycobacterium tuberculosis, Haemophilus spp., Anaerobes

28
Q

what is the most common organism to cause a UTI?

A

E. coli.

29
Q

what is a CATHETER ASSOCIATED UTI (CA-UTI)?

A

Manipulation or catheter removal may result in bacteraemia

30
Q

what foreign bodies can be inserted into the urological tract and can become colonised?

A

Nephrostomies

Urostomies

31
Q

what investigations can you do to confirm a UTI?

A
  • dipstick/urinalyis
  • blood tests
  • microbiological. lab testing
  • imaging
32
Q

why can you not use catheter samples for urinalysis?

A
  • catheter is not sterile
  • catherter is naturally colonised
  • do not expect “normal”/”sterile” results
33
Q

what are the different types of urine tests?

A
  • Mid-stream (MSU)
  • Catheter urine (CSU)
  • “Clean catch” – PAEDIATRIC sample
  • Supra-pubic aspirate (SPA)
34
Q

what samples would you test for a UTI?

A

urine

blood cultures

microscopy/cultute/sensitivity

35
Q

when would you use a Early morning urine (EMU) x3 test?

A

If suspected urinary tuberculosis

NB: Need to request Acid fast bacilli (AFBs) specifically

36
Q

what are indications of a UTI?

A
  • Recurrent UTI
  • Any UTI in male patient
  • Any UTI in childhood
  • Pyelonephritis
37
Q

what is the non-antimicrobial management of a UTI?

A
  • increase fluid intake
  • anti-inflammatories e.g. NSAID Ibuprofen
  • device removal if no longer indicated
  • drainage if obstruction/abscess
38
Q

which antibiotics are used for UTIs?

A

Nitrofurantoin
- Inadequate for systemic infections - Not for Upper UTIs.

Pivmecillinam

Trimethoprim

Fosfomycin

39
Q

what is treatment for cystitis in females?

A

short course of antibiotics (3 days)

40
Q

what is treatment for cystitis in males?

A

longer course of antibiotics (7 days)

41
Q

what would a recurrent UTI in a man indicate?

A

prostate

42
Q

what is empiric therapy for pyelonephritis?

A

broad action against likely pathogens:

  • Cefuroxime, Aztreonam, Ciprofloxacin, Gentamicin
43
Q

what is targeted therapy for pyelonephritis?

A

narrowest spectrum agent possible

44
Q

what is the duration of treatment for pyelonephritis?

A

7-14 days depending on antibiotic used

45
Q

in asymptomatic bacteriuria you only treat specific groups of people, who are they?

A
  • pregnant
  • infant
  • prior to urologica procedures
46
Q

what are the two types of abscess in the urinary tract?

A

perinephric
- gram-negative bacilli

intrarenal

47
Q

what is acute bacterial prostatitis?

A

Inflammation of prostate

  • acute bacterial
  • lower UTI symptoms
  • fever
  • tender tense prostate on PR palpation
  • uropathogens - E.coli
48
Q

what are features of chronic bacterial prostatitis?

A

Recurrent UTIs with same organism

Asymptomatic in-between.

49
Q

most antibiotics have poor penetration into prostatic tissue, which would you use for prostatitis?

A
  • Fluoroquinolones: ciprofloxacin

Trimethoprim / co-trimoxazole

50
Q

what are clinical features of a lower UTI?

A

dysuria, frequency

51
Q

what are clinical features of a upper UTI?

A

fever

flank/loin pain

plus LUT symptoms

Clinical Pathology (RIP) (49 decks)

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