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Clinical Pathology > Theme 4 Lecture 5: Urinary Tract Infections > Flashcards

Theme 4 Lecture 5: Urinary Tract Infections Flashcards

1
Q

What is a UTI?

A
  • An infection of any part of your urinary system

- an immune response, gibing rise to symptoms. if there are no symptoms, the bacteria are not causing harm

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2
Q

What are the risk factors for UTIs?

A
  • female sex –> 10:1 female: male ratio to short urethra
  • anything that leads to urinary stasis - pregnancy, prostatic hypertrophy, stones, strictures, neoplasia
  • urological instrumentation e.g catheters
  • sexual intercourse
  • fistulae
  • congenital abnormalities e.g VUR
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3
Q

Which parts of the urinary tract should have bacteria, and which shouldnt?

A
  • kidney, ureter shouldn’t have any bacteria
  • urethra, perineum will have bacteria
  • bladder is debatable (as you get older it is more common to have asymptomatic bacteria)
  • essentially, the further you go up the urinary tract, the less you should have any bacteria
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4
Q

What makes up perineal flora? (found in the urethra)

A
  • skin flora (mainly coagulase negative staphylococci)
  • lower GI tract flora
  • enterobacterales (coliforms - usually enteric gram -ve bacilli)
  • gram +ve cocci - enterococcus spp
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5
Q

Where are the two places invading bacteria in the perineum can come from?

A
  1. endogenous
    - most infections are caused by gut bacteria
  2. haematogenous spread (rare)
    - seeding of bacteria to the urinary tract via the blood
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6
Q

What are the organisms that commonly cause UTIs?

A
  • E.coli
  • staphylococcus saprophyticus (CNS)
  • proteus mirabilis
  • enterococcus spp
  • klebsiella spp
  • pseudomonas aeruginosa
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7
Q

How do you know if you should treat UTIs?

A
  • clinical signs and SYMPTOMS

- and microbiology results guide you to the culprit and appropriate, directed treatment

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8
Q

What are the symptoms of UTIs? (14)

A
  • urgency
  • systemic - fever, pain
  • retention
  • loin
  • rigors
  • fevers
  • back pain
  • frequency
  • pus
  • polyuria
  • dysuria
  • supra-pubic pain
  • haematuria
  • nocturia
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9
Q

What are the symptoms of cystitis (lower UTI)?

A
  • dysuria
  • frequency
  • urgency
  • supra-pubic pain or tenderness
  • polyuria, nocturia, haematuria
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10
Q

What is pyelonephritis?

A
  • swollen kidney and ureter also filled with pus

- infection of kidney/renal pelvis

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11
Q

What are the symptoms of pyelonephritis?

A
  • 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 features make a UTI a ‘complicated’ UTI?

A
  • underlying abnormalitity e.g stone
  • urinary stasis
  • presence of ‘foreign body’
  • catheter
  • biofilm
  • children < 10-12
  • men < 65
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13
Q

What is a CA-UTI?

A

Catheter associated UTIs:
indwelling catheterisation results in bacteriuria - they should be removed the moment they are not needed

biofilm formation (bacteria forming around the catheter) –> colonisation

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14
Q

In what patient groups is antibiotic prophylaxis indicated?

A
  • previous symptomatic CA-UTI with catheter change/removal
  • traumatic catheterisation (if t has taken two or more attempts to insert a catheter)
  • purulent/ urethral suprapubic catheter exit site discharge
  • colonisation with staph aureus inc MRSA
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15
Q

What is a urinary ‘ostomies’

A

holes we make to get urine out other than catheters

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16
Q

What are the two types of urinary ‘ostomies’?

A
  1. nephrostomy - percutanoeus straight into kidney
  2. ileal conduit/ urostomy - short section of ileum removed and used to drain ureters directly into a stoma on the anterior abdominal wall after cystectomy
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17
Q

What is urosepsis and what are the symptoms?

A

Systemic signs of infection related to any underlying urinary source of infection:

  • urinary
  • rigors
  • nausea, vomiting, diarrhoea
  • +/- haemodynamic compromise
  • raised inflammatory markers (CRP, WCC)
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18
Q

what is ‘urethral syndrome’

A

symptoms of lower UTI without any demonstrable infection

19
Q

What is a perinephric urinary tract abscess?

A
  • uncommon condition
  • renal stones and/or diabetes
  • secondary to obstruction of infected kidney
  • normally gram -ve bacilli
20
Q

What is a intrarenal urinary tract abscess?

A
  • haematogenous spread

- staph aureus common

21
Q

What is prostatitis?

A

inflammation of the prostate

22
Q

What are the signs and symptoms of acute bacterial prostatitis?

A
  • LUT symptoms
  • fever
  • tender, tense prostate on PR palpitation
  • acute retention
23
Q

What are the risk factors for acute bacterial prostatitis?

A
  • procedures involving the prostate
  • trans-urethral resection of prostate (TURP)
  • trans-rectal ultra-sound guided (TRUS)
  • indwelling urinary catheter
24
Q

What is chronic bacterial prostatitis

A

recurrent UTIs with the same organism

asymptomatic in between

25
Q

Which microbiological investigations are used for UTIs?

A
  • dipstick
  • ward-tests
  • urinalysis
26
Q

When should you not use microbiological investigations?

A
  • catheter samples (these always have bacteria)
  • unreliable in > 65y
  • in children: do not use if <3 months, 3m-3y can use, >3yr is reliable
27
Q

What do dipsticks tell us?

A
  • blood
  • protein
  • nitrite
  • white blood cells (leucocyte esterase)
28
Q

Why does the urine being investigated need to be mid-stream?

A
  • the initial stream will pick up the bacteria colonising the urethra
  • the midstream better represents any bacteria actually in the bladder
29
Q

What is ‘sterile pyruria’

A

-pus cells (raised WCC) in the urine but no organisms grown with standard lab methods

30
Q

What are some causes of sterile pyuria?

A
  • inhibition of bacterial growth e,g antibiotics (collect sample before starting)
  • specimen contaminated with antiseptic
  • ‘fastidious’ (hard to grow) organisms e.g mycobacterium tuberculosis, anaerobes
  • urinary tract inflammation
  • urethritis (sexually transmitted pathogens) - neisseria gonorrhoea, chlamydia trachomatis
31
Q

What do specialists do if they suspect urinary tuberculosis?

A
  • early morning urine sample (EMU) x3

- need to request acid fast bacilli (AFBs) specifically

32
Q

What are the 4 indications for further investigations of UTIs?

A
  • recurrent UTI
  • any UTI in male patient
  • any UTI in childhood
  • pyelonephritis
33
Q

What is the non-antimicrobial management methods of UTIs?

A
  • excess fluid intake
  • antiinflammatories e.g NSAID, ibruprofen
  • device removal if no longer needed
  • draining if obstruction/abscess
34
Q

What are the requirements of a good UTI antibiotic?

A
  • needs to get into urine
  • minimally toxic
  • effective against likely organisms
  • easily administered and cheap
35
Q

What are 4 examples of UTI antibiotics?

A
  1. nitrofurantoin
  2. pivmecillinam
  3. trimethoprim (although high resistance)
  4. fosfomycin
36
Q

What are the benefits and limitations of using nitrofuratoin?

A
  • inadequate for systemic infections
  • lower UTIs only
  • not good prostatitis

however:

  • has good activity with gram -ve and few gram +ve that cause UTIs
  • not huge issue with resistance as only used for bladder infections
37
Q

What is the treatment of cystitis for females?

A

short course of antibiotics for 3 days

38
Q

What is the treatment of cystitis for males?

A

longer course - 7 days

39
Q

Which antibiotics can we use to treat pyelonephritis?

A
  1. cefuroxime
  2. axtreonam
  3. ciprofloxacin
  4. gentamicin
    for 7-14 days depending on the antibiotic
40
Q

Why is it slightly more difficult to treat prostatitis?

A

most antibiotics have poor penetration into prostatic tissue

41
Q

What can we use to treat prostatitis and how long is the treatment duration?

A

Empirical options
-piperacillin-tazobactam or ciprofloxacin

Directed options:
as above or trimethoprim

duration is 2-4 weeks

42
Q

In which groups would you treat asymptomatic bacteruria?

A
  1. pregnant women - associated with upper UTI, pre-term delivery and low birth weight babies
  2. infants - prevent pyelonephritis and renal damage
  3. prior to urological procedures
43
Q

If a middle age male patient has recurrent UTI symptoms would you treat them?

A

yes as you must think about the prostate and treat with prostate active agent

Clinical Pathology (57 decks)

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