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Urology > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

Which sex are UTI’s most common in?

A

Females

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2
Q

What is the definition 0of bacteriuria?

A

Bacteria in the urine - may be symptomatic/asymptomatic

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3
Q

What is a UTI?

A

A diagnosis based on symptoms and signs. Tests which prove bacteria in the urine may provide additional information

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4
Q

What parts of the urinary tract fall under the classification of lower urinary tract infection?

A
  • Bladder (cystitis)
  • Prostate (prostatitis)
  • Urethra (Urethritis)
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5
Q

What parts of the urinary tract are involved in upper UTI?

A

Kidney/renal pelvis (pyelonephritis)

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6
Q

What is the definition of an uncomplicated UTI?

A

Normal renal tract structure and function

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7
Q

What is the definition of a complicated UTI?

A

Structural/functional abnormality of the GU tract e.g. obstruction, catheter, stones, neurogenic bladder, renal transplant

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8
Q

What are groups of risk factors for the development of a UTI?

A
  • Increased bacterial inoculation
  • Increased binding of uropathogenic bacteria
  • Decreased urine flow
  • Increased bacterial growth
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9
Q

What are causes of increased bacterial inoculation?

A
  • Sexual activity
  • Urinary incontinence
  • Faecal incontinence
  • Constipation
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10
Q

What are causes of decreased urinary flow which can lead to the development of UTI?

A
  • Dehydration
  • Obstructed urinary tract
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11
Q

What conditions can increase bacterial growth in the urinary tract?

A
  • DM
  • Immunosuppression
  • Obstruction
  • Stones
  • Catheter
  • Renal tract malformation
  • Pregnancy
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12
Q

What are symptoms of cystitis?

A

Complex of:

  • Frequency
  • Dysuria
  • Urgency
  • Suprapubic pain

Plus:

  • Polyuria
  • Haematuria
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13
Q

What are symptoms of acute pyelonephritis?

A
  • Fever
  • Rigors
  • Vomiting
  • Loin pain/tenderness
  • Costovertebral pain
  • Associated cystitic symptoms
  • Septic shock
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14
Q

What are the most commonly implicated organisms which cause UTIs?

A
  • E.Coli
  • Proteus spp
  • Klebsiella aerogenes
  • Enterococcus faecalis
  • Staph epidermidis
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15
Q

What organism is most commonly implicated in UTI?

A

E. Coli

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16
Q

What are symptoms of prostatis?

A
  • Pain - perineum, rectum, scrotum, penis, bladder, lower back
  • Fever
  • Malaise
  • Nausea
  • Urinary symptoms
  • Swollen tender prostate on examination
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17
Q

What are signs of a UTI?

A
  • Fever
  • Abdo/loin pain
  • Distended bladder
  • Enlarged prostate
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18
Q

If you suspected someone had a UTI, what investigtions might you do?

A
  • Urine dipstick
  • MSU culture/microscopy
  • Bloods - FBC, U+E’s, CRP, Blood culture

Consider

  • Fasting glucose
  • Imaging - consider US, urodynamics, cystoscopy, CT urogram/Abdo/pelvis
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19
Q

When would you consider treating a UTI without investigation?

A

Non-Pregnant women with >/= 3 symptoms of cystitis, and no vaginal discharge

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20
Q

What does a negative diptick reduce the probability of a UTI to?

A

<20%

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21
Q

What organisms reduce nitrates to nitrites?

A

Gram-negative organisms

22
Q

What organism can be responsible for a sterile pyuria?

A

TB

23
Q

What are infectious causes of a sterile pyuria?

A
  • TB
  • Recently treated UTI
  • Inadequately treated UTI
  • Appendicitis
  • Prostatitis
  • Chlamydia
24
Q

What are non-infectious causes of sterile pyuria?

A
  • Calculi
  • Renal tract tumour
  • Papillary necrosis
  • Tubulointerstitial nephritis
  • Chemical cystitis
  • PKD
  • Recent catheter
  • PRegnancy
  • SLE
  • Drugs - e.g. steroids
25
Q

What properties of urine reduce bacterial survival?

A
  • Osmolality > 800 mOsm/Kg
  • Low/high pH
26
Q

How does urine flow reduce risk of UTI?

A

Flow washes out bacteria

27
Q

What might indicate infection on urine diptick?

A
  • Positive Leucocytes
  • Positive nitrites
  • Mixture of the two - most sensitive
28
Q

What is diagnostic of a UTI on urine culture in men?

A

Culture demonstrates ≥10^2 CFU/mL of a single or predominant organism in a patient plus symptoms specific to the urinary tract

29
Q

What is diagnostic of asympotmatic bacteruria in a man?

A

Urine culture demonstrates ≥10^5 CFU/mL of a single organism obtained by clean catch on one occasion from a man without specific urinary tract symptoms

30
Q

What might you consider as a differential diagnosis for a UTI in a man?

A
  • BPH
  • Prostatis
  • Prostate cancer
  • Pyelonephritis
  • Urinary calculi
  • Gonococcal/chalmydia urethritis
  • Bladder cancer
  • Renal cancer
  • Epididymitis
  • Reactive arthritis
31
Q

What is the primary cause of UTIs ini women?

A

Sexual intercourse

32
Q

Why might you consider doing a CT abdo/pelvis?

A

Used to rule out renal or peri-renal abscess if symptoms do not respond to antimicrobial therapy after >7 days’ duration.

33
Q

Why might you do cystoscopy in someone with recurrent UTI?

A

Rule out lower tract abnormalities. Indicated only in patients in whom conventional treatment has failed or who have unusually severe or persistent symptoms. May find:

  • Tumour
  • Bladder stone
  • Foreign body
  • Diverticulum
34
Q

When would you consider performing a renal ultrasound in someone with a UTI?

A

Only in patients in whom conventional treatment has failed or who have unusually severe or peristent symptoms. Looking for:

  • Kidney stones
  • Hydronephrosis
  • Renal abscess
  • Renal scarring
35
Q

If on urine culture there were <10^5 CFU/mL, but pyuria was present (>20 WBC/mm^3), would this be considered a UTI?

A

Yes

36
Q

If the dipstick result is negative but the symptoms suggest a UTI, what are the chances of a UTI being present?

A

Still relatively high

37
Q

When would you consider doing imaging in someone with symptoms of a UTI?

A
  • Men with upper UTI
  • Failure to respond to treatment
  • Recurrent UTI
  • Pyelonephritis
  • Unusual organism
  • Persitent haematuria
38
Q

How would you manage a lower UTI in a non-pregnant woman?

A

If >/=3 symptoms of cystitis, no vaginal discharge:

  • Trimethoprim - 3 days, or
  • Nitrofurantoin - 3 days
39
Q

When would you avoid giving nitrofurantoin?

A

If eGFR <30

40
Q

How would you approach managing a UTI if first line treatment failed in a non-pregnant women?

A

Culture urine and treat according to resistance

41
Q

How would you manage a pyelonephritis?

A
  • Gentamicin + Amoxicillin - 7 days (or 10-14 if complicated)
  • If allergic - ciprofloxacin
42
Q

How would you treat an uncomplicated lower UTI in a men?

A
  • Trimethoprim - 3 days

OR

  • Nitrofuratoin (eGFR>30) - 3 days
43
Q

How would you manage a complicated UTI?

A

Treat for 7-14 days

  • Co-amoxiclav - 8 hrly

OR

  • Co-trimoxazole - 8 hrly

If allergic - ciprofloxacin

44
Q

How would you manage a UTI in pregnancy?

A

Get expert advice. Consider the following advice:

  • Don’t use trimethoprim 1st trimester - don’t use at all really
  • Don’t use nitrofurantoin in 3rd trimester
  • Avoid ciprofloxacin
  • Consider cefalexin
45
Q

What can UTIs during pregnancy cause?

A
  • Preterm delivery
  • Intrauterine growth restriction
46
Q

If a man is showing signs of prostatitis, how would you manage it?

A

Consider ciprofloxacin for long course (4 weeks) - penetrate prostate fluid better

47
Q

If a catheterised patient developed a UTI, how would you manage it?

A
  • Change catheter
  • Culture urine
  • Antibiotics not indicated unless systemic infection -> if likely, treat as for complicated UTI or pyelonephritis
48
Q

What neurological symptom may indicate a UTI in an elderly individual?

A

Confusion

49
Q

What are features of urinary tract TB?

A
  • Sterile pyuria
  • Dysuria
  • Frequency
  • Suprapubic pain
  • Malaise
  • Fever
  • Night sweats
  • Weight loss
  • Back/flank pain
  • Visible haematuria
50
Q

What is reflux nephropathy?

A

Nephropathy caused by vesicoureteric reflux due to dysfunctional vesicoureteric valve, and infection acquired in infancy or early childhood. Typically, there is papillary damage, tubulointerstitial nephritis and cortical scarring - leading to clubbed calyces

51
Q

Why is nitrofurantoin not recommended in pregnancy in 3rd trimester?

A

Can cause haemolytic anaemia in the baby

52
Q

What is the definition of a recurrent UTI?

A

3 or more episodes in a 12-month period

Urology (11 decks)

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