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Z Year3 Urology > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

What is the defintion of a UTI?

A

presence of a pure growth of >105 organisms per mL of fresh MSU

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2
Q

What are the 3 types of UTI?

A
  1. Urethritis – affects the urethra
  2. Cystitis – affects the bladder
  3. Pyelonephritis – affects the kidney
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3
Q

What is the most common cause of UTI?

A

Escherichia coli

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4
Q

What are RF for UTIs?

A
  1. Sexual intercourse
  2. Pregnancy
  3. Immunosuppression
  4. Catheterization
  5. Urinary tract obstruction (BPH, calculi)
  6. Female as shorter urethra and shorter distance between urethral + anal opening
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5
Q

What are the storage symptoms of a UTI?

A
  1. Increased frequency
  2. Urgency
  3. Dysuria
  4. Foul-smelling
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6
Q

What are the symptoms of acute pyelonephritis?

A
  1. flank pain
  2. fever
  3. malaise
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7
Q

What is the 1st line investigation for UTI?

A

urine dip

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8
Q

What would the urine dip show for a UTI?

A

+ve leucocytes and nitrites

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9
Q

What is the gold standard investigation for UTI?

A

MSU and MC&S – Gold standard:

1. Identify bacteria

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10
Q

What would MSU and MC&S show in pyelonephritis?

A

white cell casts

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11
Q

When do you do blood cultures in a UTI?

A

systemically unwell and risk or urosepsis

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12
Q

What is the management for UTIs?

A

empirical antibiotics (nitrofurantoin)

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13
Q

What is a UTI characterised by?

A

presence of >100,000 of colony-forming units per millilitre of urine. UTI may affect bladder (cystitis), kidney (pyelonephritis) or prostate (prostatitis).

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14
Q

What is the aetiology of UTIs?

A
  1. Escherichia coli (80%)
  2. Staphylococcus saprophyticus
  3. Klebsiella pneumoniae
  4. Proteus mirabilis
  5. Enterocci
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15
Q

What are RF for UTIs?

A
  1. Age >50 /Sex
  2. Urine outflow obstruction (BPH, stones, strictures etc.)
  3. Catheters (HAI)
  4. Diabetes Mellitus
  5. Pregnancy
  6. Immunosupression
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16
Q

What are white cell casts strong indicators of?

A

pyelonephritis

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17
Q

What are upper UTIs?

A
  1. Kidneys

2. Pyelonephritis

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18
Q

What is the aeitology of upper UTIs?

A

Ascending faecal bacteria
OR
Descending bacteremia

19
Q

What is the presentation of an upper UTI?

A
  1. Costo-vertebral angle tenderness
  2. Flank pain
  3. Fever
  4. N&V
  5. Urinary Sx
  6. Acute confusion: elderly
20
Q

What is a lower UTI?

A
  1. Bladder (cystitis)

2. Urethra (urethritis)

21
Q

What is the aeitology of lower UTIs?

A

faecal bacteria

E.Choli, Klebsiella Pneumoniae, Proteus mirabilis

22
Q

What is the presentation of a lower UTI?

A
  1. Urgency
  2. Dysuria
  3. Frequency
  4. Suprapubic pain
  5. Foul smelling urine
23
Q

What are Ix for cystitis?

A
  • If young woman with typical symptoms clinical Dx
  • Clean catch
  • Suprapubic aspiration
24
Q

What is clean catch?

A
  1. Midstream urine sample

2. Avoids contamination with bacteria from outer meatus

25
Q

When is suprapubic aspiration indicated?

A

in patients with indwelling catheter (urine in bladder should have no bacteria)

26
Q

What bloods are done in pyelonephritis?

A
  1. FBC (Leukocytosis w/ neutrophilia)
  2. Renal function tests
  3. Urinalysis (WBC casts on microscopy)
  4. Urine culture
27
Q

What imaging is done in pyelonephritis?

A
  1. Renal USS (Hypoechoic mass)

2. Abdominal CT (Localised hypodense symptoms, signs of obstruction)

28
Q

What is abdo uss done?

A

exclude urinary tract obstruction or renal stones

29
Q

What are most causative organisms?

A
  1. Gram-negative enteric organisms produce urinary nitrite and represent the most common uropathogens
  2. Enterococcus, a less common uropathogen, does not produce nitrite and has a unique antibiotic resistance pattern.
30
Q

What makes a UTI complicated?

A
  1. Men
  2. pregnant women
  3. indwelling catheters
  4. uncontrolled diabetes mellitus
  5. urethral strictures
  6. recent urological procedures
  7. immuno compromised
31
Q

What is the 1st line treatment for uncomplicated lower UTI?

A

1st line: Nitrofurantoin:
50mg x4/day for 3 days
Trimethoprim:
200mg x2/day for 3 days

32
Q

What is important to remeber with Trimethoprim?

A

tetarogenic

33
Q

What is 2nd line for lower uncomplicated UTI?

A
  • if no improvement in symptoms
    1. Pivmecillinam
    2. Fosfomycin
34
Q

What is the 1st line treatment for lower complicated UTI (men)?

A

Nitrofurantoin:
50mg x4/day for 7days
Trimethoprim:
200mg x2/day for 7 days

35
Q

What is the 1st line treatment for lower complicated UTI (pregnant women)?

A

1st line:
Nitrofurantoin:
50mg x4/day for 7days

36
Q

What is the 2nd line treatment for lower complicated UTI (pregnant)?

A
  1. amoxicillin

2. cefalexin

37
Q

How do you check if complicated UTI?

A
  1. structural or functional condition of genitourinary tract
    OR
  2. underlying disease
38
Q

For upper UTIs how do you administer medication?

A

IV if unable to take oral antibiotics or severely unwell (i.e:. Sepsis concern)

39
Q

What is the 1st line oral treatment for uncomplicated upper UTI or complicated upper UTI (men)?

A
  1. Cefalexin
  2. Co-amoxiclav
  3. Trimethoprim
  4. Ciprofloxacin
40
Q

What is the 1st line IV treatment for uncomplicated upper UTI or complicated upper UTI (men)?

A
  1. Co-amoxiclav
  2. Cefuroxime
  3. Ceftriaxone
  4. Ciprofloxacin
  5. Gentamicin
41
Q

What is the 1st line oral treatment for complicated upper UTI (pregnant)?

42
Q

What is the 1st line IV treatment for complicated upper UTI (pregnant)?

A

Cefuroxime

43
Q

What are the key antibiotics for UTI?

A
  • Trimethoprim (avoid in pregnancy) / Nitrofurantoin

- Pyelonephritis – Cefalexin 1st line

Z Year3 Urology (18 decks)

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