Urinary Tract Infection Flashcards
What is the focus of Part 1 in the urinary tract infections talk?
UTIs: Who, what, why, where?
What does Part 2 of the talk cover?
Clinical presentation & Diagnosis
What is covered in Part 3 of the urinary tract infections talk?
Management
What are some risk factors for acquiring urinary tract infections?
- Females
- Those with previous UTI
- Sexual activity
- Vaginal infection
- Diabetes
- Obesity
- Genetic susceptibility
- Older age
- Oestrogen deficiency
- Cognitive impairment
What are the two types of urinary tract infections?
- Uncomplicated UTI
- Complicated UTI
Who is most likely to get uncomplicated UTIs?
Females and those with previous UTIs
What factors compromise the urinary tract or host defense leading to complicated UTIs?
- Urinary obstruction
- Urinary retention
- Immunosuppression
- Renal failure
- Renal transplantation
- Pregnancy
- Presence of foreign bodies
What is the most common cause of secondary bloodstream infections?
CAUTI (Catheter-Associated Urinary Tract Infections)
What organisms are responsible for causing UTIs?
Uropathogens from the gut
What is the role of Type 1 pili in UTI pathogenesis?
Invades bladder cell wall
What are intracellular bacterial communities (IBC)?
Formed by multiplication of bacteria in the bladder
What are pyelonephritis associated (P) pili used for?
To cause pyelonephritis
What are some bacterial virulence factors?
- Adherence
- Pili
- Adhesins
- Toxin production
- Immune evasion
- Iron acquisition
What are some host factors that contribute to urinary tract infections?
- Antibacterial defences
- Urine osmolality
- Urine pH
- Urine urea concentration
- Urine flow
- Urinary tract mucosa
What are some common locations for urinary tract infections?
- Urethritis
- Prostatitis
- Epididymo-orchitis
- Cystitis
- Pyelonephritis
What is a common source of uropathogens?
Uropathogen from the gut
What is bacteraemia and its relation to pyelonephritis?
Bacteraemia is common in pyelonephritis
Fill in the blank: CAUTI are the ______ common cause of secondary bloodstream infections.
MOST
What is a medical advice to help prevent further UTIs?
Write down 5 pieces of medical advice for patients
What are the clinical presentations of pyelonephritis?
Loin pain/flank tenderness, fever/rigors, sepsis
Pyelonephritis is a type of urinary tract infection that affects the kidneys.
What are the clinical presentations of cystitis?
Dysuria, frequency, urgency, suprapubic tenderness
Cystitis is inflammation of the bladder, often due to infection.
What symptoms may indicate a urinary tract infection in infants under 2 years?
Vomiting, fever
Infants may not exhibit typical urinary symptoms.
What symptoms may indicate a urinary tract infection in the elderly?
Less localized symptoms, confusion, falls
Elderly patients may present atypically, making diagnosis challenging.
What is the diagnosis for a 29-year-old female with a 3-day history of pain on voiding, frequency, and suprapubic tenderness but no fever?
Cystitis
This scenario highlights a typical case of uncomplicated cystitis.
What is the only acceptable use of dipstick testing for UTI diagnosis?
In patients under 65 with clinical UTI symptoms
Dipstick tests are less reliable in other populations.
What does the presence of nitrites in a urine dipstick test indicate?
A possible diagnosis of UTI
Nitrites suggest the presence of bacteria that convert nitrates to nitrites.
What are the types of urine samples used for urine culture?
- Mid-stream urine * Clean catch urine * Catheter sample urine * CSU (from port, not bag) * Other (urostomy/cystocopy/pad)
Different sampling methods may affect the results of urine cultures.
What is considered significant bacteriuria?
Greater than 10^5 CFU/mL
This threshold indicates a likely infection rather than contamination.
What is asymptomatic bacteriuria?
Significant bacteriuria in a patient without symptoms
Typically only treated in pregnant women to prevent complications.
What is symptomatic bacteriuria?
Bacteriuria associated with UTI symptoms
This indicates an active infection requiring treatment.
What is the purpose of point-of-care tests like Flexicult?
Rapid detection of UTI by culture at the bedside in 24 hours
These tests facilitate quicker diagnosis and treatment decisions.
What are the three key aspects of rapid detection using molecular markers for UTI?
- Presence of bacteria * Presence of inflammation * Presence of antimicrobial resistance genes
These markers can guide treatment and management strategies.
What urgent clinical need is identified for the elderly regarding urinary infections?
Indicator of active inflammation specifically in the urinary tract
This need arises due to the high prevalence of asymptomatic bacteriuria in this population.
True or False: Culture results support clinical diagnosis of UTI.
True
Culture results confirm the presence of infection and guide treatment.
Fill in the blank: The sensitivity of dipstick tests for diagnosing UTI is as low as ______.
75%
This indicates that negative results do not rule out a UTI.
What does the O’Neill AMR report highlight regarding antimicrobial prescriptions?
By 2020, all antimicrobial prescriptions to be prescribed with diagnostic support
This aims to reduce the misuse of antibiotics and combat resistance.
What is the primary purpose of antibiotics for cystitis?
Amelioration and shortening of symptom duration in cystitis
Randomized controlled trials (RCT) indicate that trimethoprim decreases symptom duration by 4 days.
What percentage of patients with culture-negative UTI experience the same symptom burden as culture-positive patients?
25%
This indicates that a significant number of culture-negative cases still present similar symptoms.
What is the effect of antimicrobial use on recurrent UTI?
Increases risk of recurrent UTI
Antimicrobial use is also associated with increased antimicrobial resistance.
What antibiotic is recommended for cystitis only?
Nitrofurantoin
This antibiotic is specifically indicated for uncomplicated cystitis.
What is the resistance risk for E. coli with amoxicillin?
30%
This demonstrates the concerning levels of antibiotic resistance in common pathogens.
In which situation would IV antibiotics be required?
Signs of SIRS or sepsis
Some multi-drug resistant (MDR) organisms may only have intravenous options available.
What is a key management consideration for UTIs in men?
Prostate involvement may require longer treatment and specific antibiotics
This highlights the complexity of managing UTIs in male patients.
What should be avoided in pregnant women when treating UTIs?
Contraindicated antibiotics
Certain antibiotics can pose risks during pregnancy.
What is the recommended fluid intake for preventing recurrent UTI?
2-2.5L per day
Encouraging adequate hydration is crucial for prevention.
What hygiene practice is recommended to prevent UTIs?
Wipe front to back
This practice helps prevent the introduction of bacteria into the urinary tract.
What is the occurrence rate of recurrent UTI in women?
1 in 4 women
This statistic emphasizes the prevalence of recurrent UTIs.
What is a common risk factor for recurrent UTIs?
Antimicrobial exposure
This factor contributes significantly to the recurrence of infections.
What is the management approach for children with confirmed UTI?
Investigation and consideration of vesico-ureteric reflux
This is important to prevent future complications.
What lifestyle change can help reduce the risk of recurrent UTI?
Smoking cessation
Smoking can contribute to various health issues, including UTIs.
What treatment is recommended for asymptomatic bacteriuria in pregnant women?
Historically thought to decrease risk of pyelonephritis
Treating bacteriuria can help prevent serious complications during pregnancy.
What is the significance of identifying subgroups that do not require antibiotics?
Vital to prevent unnecessary antimicrobials and decrease AMR
This approach is essential in managing antibiotic resistance.
What is the recommended advice for sexual activity to prevent UTIs?
Lubrication, pre and post-coital voiding, personal hygiene
Proper practices can help reduce friction and bacterial introduction.
What is the role of research and development in UTI management?
Improving diagnosis vital to prevent unnecessary antimicrobials
Effective diagnosis reduces the overuse of antibiotics.
