Urinary tract infection Flashcards
What is classed as the UPPER urinary tract?
above the bladder - kidneys and ureters
What is classed as the LOWER urinary tract?
bladder and below - bladder, urethra, prostate (men)
What parts of the urinary tract are sterile?
kidneys
ureters
bladder
What part of the urinary tract normal contains flora and of what type?
urethra
perineal flora - skin/lower GI tract flora
What does skin flora predominantly contain?
coagulase negative staphylcocci
What does lower GI flora contain?
anaerobic bacteria
aerobic bacteria - enterobacteriaceae i.e. enteric gram negative nacilli, coliforms
gram positove cocci - enterococcus spp
What are the symptoms of cystitis?
Dysuria - painful or difficult urination urinary frequency urgency surpr-pubic pain/tenderness polyuria nocturia haematuria - if severe
What infections are classed as LOWER urinary tract infections?
cystitis
urethral syndrome
What are the symptoms of pyelonephritis?
symptoms of the lower UTI loin/abdominal pain & tenderness fever rigors nausea vomiting diarrhoea
What infections are classed as UPPER urinary tract infections?
Pyelonephritis
What is urethral syndrome?
abacterial cystitis
frequency-dysuria syndome
mostly affects 30-50 year old women
symptoms of lower UTI without infection e.g. allergy, hormones
What is classed as ‘significant’ bacteriuria?
10(5) cfu/mL
signifies infection
What are the limitations of ‘significant’ bacteria?
Bacterial count is on a normal curve (see next slide)
Many symptomatic females have bacterial counts of less than 10(5)
Males significant bacteria is around 10(3)
Not applicable in catheter urine/sterile aspiration
What is asymptomatic bacteriuria?
significant bacteria count but no symptoms of UTI
What is sterile pyuria and what can it signify?
pus cells in urine (high numbers of WBC) but no organisms grown in cultures
can signify: inflammation, trauma, polycystic kidney disease
What are the risk factors for acquiring a UTI?
female urinary stasis e.g. Pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine instrumentation e.g. cystoscopy sexual intercourse fistulae congenital abnormalities
What are potential sources of infection?
perineum - movement of bacteria along the lumen
fistulae - bacteria from genital/GI to urinary tract
haematogenous - seeding of infection from the blood (rare)
What is the main organism to cause a UTI?
E. coli
What are the causes of sterile pyuria?
inhibition of bacterial growth i.e. unprescribed antibiotics
fastidious (hard to grow) organisms
urinary tract inflammation
Explain how a catheter can cause a UTI
long term causes bacteria in the urine
need to distinguish between colonisation and infection
catheter removal can also cause bacteria in the urine
antibiotic prophylaxis may be used
What investigations can be performed for a suspected UTI?
dipstick test
blood tests
microbiology
imaging
What are the important things to look for on the dipstick for suspected UTI’s?
Blood
Protein
Nitrite
White blood cells
In what circumstance does dipstick testing have no diagnostic value?
in patients with indwelling urinary catheters unless these have been placed very recently
When should you do a blood test for a UTI?
Suspected pyelonephritis
Describe what and how the urine sample should be taken for susupected UTI?
mid stream - transported in boric acid to preserve
clean catch
Otherwise: catheter urine, surpa-pubic aspirate
What test should be performed for suspected urinary TB?
early morning urine
3 samples
whole content of the bladder
What are the 2 main antibiotics given for UTI’s?
nitrofurantoin
Trimethoprim
What antibiotics are used to treat pyleonephritis and what is its duration?
both given IV
cefuroxime
ciprofloxacin
7-14 days
what groups of people do you treat that have asymptomatic bacteriuria?
pregnant
infant
prior to urological procedures
