(U)- Lower UTI Flashcards

1
Q

Why are women far more susceptible to UTIs?

A

Urethra is shorter, easier for bacteria to track up to bladder

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2
Q

What is the primary source of bacteria for UTI?

A

Faeces

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3
Q

How do lower urinary tract infections present?

A

Dyrsuria
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul smelling urine
Confusion (commonly only symptom in older patients)

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4
Q

What symptoms cause pyelonephritis to be suspected?

A

Fever
Loin/back pain
Nausea/vomiting
Renal tenderness

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5
Q

Why do nitrites in urine suggest bacteria?

A

Gram negative bacteria break down nitrates into nitrites

Best indication of infection

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6
Q

Why does raised leukocyte esterase suggest infection?

A

Leukocyte esterase is a product of leukocytes

Small numbers of leukocytes are normal in urine, significant numbers can be due to infection or other causes of inflammation

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7
Q

What is micro/macroscopic haematuria?

A

Microscopic haematuria
Blood identified on urine dipstick, but not seen on sample

Macroscopic haematuria
Blood visible in the urine

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8
Q

Which patients is a midstream urine sample important in?

A

Pregnant patients
Patients with recurrent UTIs
Atypical symptoms
Symptoms not improving with antibiotics

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9
Q

What is the most common causative organism of UTIs?

A

Escherichia coli

Gram-negative
Anaerobic
Bacilli

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10
Q

What are some less frequent UTI causes?

A

Klebsiella pneumoniae
(gram-negative anaerobic bacilli)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans

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11
Q

What antibiotics are appropriate in UTIs?

A

Trimethoprim high bacterial resistance association
Nitrofurantoin avoided in patients with eGFR < 45

Alternatives:
- Pivmecillinam
- Amoxicillin
- Cefalexin

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12
Q

How long should antibiotics be given for in UTIs?

A

3 days
Simple LUTI in women

5-10 days
Immunosuppressed women
Abnormal anatomy
Impaired kidney function

7 days
Men
Pregnant women
Catheter-related UTIs (NICE recommend changing catheter in catheter-related UTI)

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13
Q

What do UTIs in pregnancy increase the risk of?

A

Pyelonephritis
Premature rupture of membranes
Pre-term labour

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14
Q

What antibiotics may be given for UTI in pregnancy?

A

Nitrofurantoin NOT IN 3rd TRIMESTER

Amoxicillin
(Only after sensitivities are known)

Cefalexin

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15
Q

Why is nitrofurantoin avoided in the third trimester of pregnancy when treating a UTI?

A

Neonatal haemolysis risk

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16
Q

Why is trimethoprim avoided in pregnancy?

A

Folate antagonist

Folate is essential for normal development

Trimethoprim can cause congenital malformations, especiallyneural tube defects

Not known to be harmful later in pregnancy, but still avoided