Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal and Urology > Urinary tract infection > Flashcards

Urinary tract infection Flashcards

1
Q

definition of a urinary tract infection

A

the presence of micro-organisms in the urinary tract that are causing a clinical infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LOWER UTI

A

infection that is confined to the bladder (cystitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UPPER UTI

A

infection involving the ureters +/- the kidneys (pyelonephritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Urine in the kidneys, ureters and bladder is normally

A

sterile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

the distal urethra is

A

colonised by micro-organisms from the GI tract: coliforms and enterococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

complicated UTI

A

is a UTI complicated by either:

  • systemic symptoms OR
  • urinary structural abnormality/ stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

bacteririuria

A

bacteria present in the urine but does NOT always means infection especially in elderly patients and those with catheters (must determine whether it is symptomatic in order to rule out a UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CYSTITIS

A

INFLAMMATION OF THE BLADDER WHICH AGAIN IS NOT ALWAYS CUASED BY INFECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risk factors for UTI

A
  • Female= have shorter and wider urethra
  • sex
  • pregnancy
  • indwelling catheters
  • abnormalities of the urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 routes of infection for a UTI

A
  • ascending infection

- bacteraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ascending infection

A

is the most common route of infection for a UTI, bacteria from the bowel colonises the peri-anal skin which spreads to the distal urethra and then spreads upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

bacteraemia

A

uncommon route of infection for UTIS, bacteraemia gets seeded in the kidneys resulting in the formation of multiple abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

steps to ascending infection

A
  1. contamination of the peri-urethral skin with a uropathogen from the gut
  2. colonisation of the urethra and migration to the bladder
  3. colonisation and invasion of the bladder mediated by PILI and adhesions causing an inflammatory respsone in the bladder
  4. neutrophil infiltration
  5. bacterial multipiclation and immune system subversion
  6. biofilm formation
  7. epithelial damage by toxins and proteases
  8. Ascension to the kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common pathogen causing UTIS

A

Uropathogenic E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

E.COLI is

A

gram negative air aerobic bacill (ie a coliform)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 SUB-TYPES OF E.COLI

A
  1. EHEC
  2. ETEC
  3. EIEC
  4. EPEC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EHEC

A
  • stands for entero-haemorrhagic E.coli which causes blood diarrhoea and is mostly caused by contaminated red meat
  • Caused by serotype E.coli O157 which produces shiga like toxin (verotoxin) which damages endothelial cells which causes intra-vascular haemolysis (breakdown offered blood cells) which leads to platelet aggregation and fibrin strand deposition mainly in the renal vasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

classic triad in HAEMOLYTIC URAEMIC SYNDROME

A
  1. Microangiopathich haemolytic anaemia
  2. thrombocytopenia
  3. renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

who does haemolytic anaemic syndrome mostly occur in

A

children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

symptoms of haemolytic uraemia syndrome

A
  • bloody diarrhoea
  • abdominal pain
  • AKI
  • haematuria/ proteinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

investigations of E.coli O157

A

stool toxin test, urinalysis and blood which show thrombocytopenia and increased creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ETEC

A

enterotoxigenic E.coli which is also known as travellers diarrhoea it causes a watery diarrhoea which has NO blood in it
- produces enterotoxin which adheres to intestinal mucosa but does not invade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

EIEC

A

invades intestinal mucosa CAUSING DYSENRY BUT DOES NOT PRODUCE A TOXIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EPEC

A
  • common in children

- attaches the the epithelium causing loss of micro-villi causing a mucousy diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

proteus

A

gram negative aerobic bacilli which is large (i.e. coliforms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

struvite renal stones are

A

potentiated by bacterial infection which hydrolyse urea to ammonium which increases the urinary pH to neutral or alkaline values i.e. psuedomona, proteus, klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

pseudomonas aerguinoas

A

gram negative strict aerobic bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pseudomonas aerguinosa is more common in

A

patients with instrumentation and catheters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

pseudomonas aerguinosa is resistant to

A

all orla antibiotics except oral ciprofloxain (one of the C. difficile antibiotics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Ciprofloxacin

A
  • inhibits bacterial DNA gyrase which prevents supercoiling of bacterial DNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ciprofloxacin should not be used in

A

pregnancy or young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

gram positive causes of UTIS

A
  • enterococcus
  • staphylococcus sacrophyticus
  • staphylococcus aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

enterococcus

A

gram positive cocci in chains which is gamma haemolytic and lives in the GI tract there are different types:

  • enterococcus faecalus seen in UTIS
  • enterococcus faecium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

enteroccous causino a UTI is most common in

A

hospital acquired UTIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

staphylococcus sacrophyticus is

A

a type of coagulase negative staphylococcus which usually affects females of child bearing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

staphylococcus aureus causing UTI

A

is uncommon and is usually seen in bacteramiea cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

symptoms and signs of UTI

A
  • dysuria
  • frequency of urination
  • nocturia
  • haematuria
  • fever
  • loin pain
  • rigors
38
Q

loin pain rigors and fever are more

A

specific to pyelonephritis rather than cystitis

39
Q

risk factors for cystitis

A

female, history of UTIS, sex, vagunal infection, diabetes, obesity, genetic susceptibility

40
Q

symptoms of cystitis

A

dysuria, frequency, urgency, nocturia, haematuria, supra-pubic pain

41
Q

risk factors for pyelonephritis

A

diabets, HIV/AIDS. iatrogenic immunosuppression, congenital or acquired urodynamic abnormalities

42
Q

symptoms of pyelonephritis

A

back and or flank pain, fever, riggers, malaise, nausea, vomiting anorexia and the symptoms of cystitis

43
Q

organisms cases CYSTITIS AND PYELONEPHRITIS

A

UPEC, KLEBSILLE, STAPH SACROPHYTICUS (CYSTITIS)< STAPH AUREUA (PYELONEPHRITIS), ENTEROCOCCUS FAECALUS, PROTEUS (PYELONEPHRITIS

44
Q

specimen collection

A
  • first urine passed likely to be contaminated with urethral colonisers so mid stream urine is used instead
  • wash perineum with sterile saline first
45
Q

container used for specimen

A

boron container contains boric acid which preserves urine for 24 hours, sterile universal container must reach lab within 2 hours

46
Q

bag urine

A

used in babies but commonly contaminated with the bowel flora

47
Q

what other specimens can be used

A

catheter specimen of urine or supra-pubic aspiration of urine

48
Q

urinalysis

A

dipstick urine may indicate infection in selected patients

49
Q

DO NOT DIPSTICK URINE OF

A

The elderly or people with catheters

50
Q

leukocyte esterase

A

indicates the presence of leukocytes (white blood cells) in the urine

51
Q

nitrites

A

nitrites indicate the presence of bacteria in the urine however some bacteria reduce the conversion of nitrates to nitrite so nitrites can be negative in enterococcus staphylococci and pseudomonas even though there is an infection present

52
Q

urine microscopy

A

only used for selected cases and is not routinely carried out

53
Q

Culture of urine

A

looks for signs of significant baceiruria using Kass criteria
> 10^5 organisms/ml= significant and probable infection
<10^3 organisms/ml= not significant bacteirurua
10^4= repeat specimen

54
Q

kass criteria used with

A

caution as it is for females of child bearing age, in men counts may be lower even if an infection is present because of prostatic anti-bacterial factor

55
Q

pure growth vs mixed growth

A

a genuine UTI in a non-catheterised patient is usually caused by a single organism (>10^5 organism/ml of pure growth) mixed growth (2 or more organisms) even if more than 10^5 organisms/ ml is not significatn

56
Q

exception to the pure vs mixed growth rule

A

this rule does not apply to catheterised or patients with abnormalities of the urinary tract

57
Q

Treatment of an uncomplicated lower UTI the ideal antibiotic

A

should be excreted in high concentration into the urine, oral and have few side affects

58
Q

abacterial cystitis/ urethral syndrome

A

patient has symptoms of UTI, pus cell in there urine but no significant growth on culture

59
Q

abacterial/ urethral syndrome may be caused by

A
  • early phase of a UTI
  • honeymoon cystitis caused by urethral trauma during sex
  • urethritis caused by gonorrhoea/ chlamydia
60
Q

treatment of bacterial cystitis/ urethral syndrome

A

antibiotics are Not USED alkalinising the urine amy relieve symptoms

61
Q

asymptomatic bacteriuria

A

more than 10^5 organisms/ ml on culture but ht patient is ASYMPTOMATIC therefore, the condition is detected incidentally

62
Q

in asymptomatic bacteirura there are no

A

pus cells in the urine

63
Q

management of asymptomatic bacteririuria

A

ANTIBIOTICS ARE NOT REQUIRED EXCEPT IN PREGNANCY WHERE IT IS ALWAYS TREATED:
- all woman are screen at there first ante-natal visit at 3 months if untreated 20-30% of people develop pyelonephritis and it can cause intra-uterine growth retardation and premature labour

64
Q

catheter related UTI is

A

one of the commonest hospital acquired infections however, the loner a catheter is in situ the more likely it is to become colonised with bacteria so catheterised patients with > 10^5 Organisms/ml should only be given antibiotics if they are symptomatic because necessary antibiotics cause the catheter to become colonised with increasingly resistant micro-organisms

65
Q

antibiotics used for a female lower UTI (uncomplicated cystitis)

A

oral trimethoprim or nitrofurantoin for 3 days

66
Q

recurrent UTI

A

2 or more in 6 months or 3 or more in one year

67
Q

prophylaxis for recurrent UTIS

A

trimethoprim or nitrofurantoin at night and review after 6-12 months

68
Q

uncatheterised male UTI (uncomplicated UTI)

A

should always be cultured: oral trimethoprim or nitrofurantoin for 7 days

69
Q

complicated UTI or pyelonephritis managed in general practise

A

oral co-amoxicla or oral co-trimoxazole for 14 dya

70
Q

complicated UTI or pyelonephritis managed in hospital

A

IV amoxicillin and gentamicin for 3 dyas (co-trimoxazoel and gentamicin if penicillin allergic)

71
Q

amoxicillin and co-trimoxazole cover

A

enterococci 40% of coliforms

72
Q

gentamicin covers

A

coliforms

73
Q

trimethoprim covers

A

the lower urinary tract

74
Q

gentamicin can only be give

A

IV

75
Q

gentamicin should not be used in

A

pregnancy

76
Q

gentamicin has

A

a very narrow therapeutic window and is nephrotoxic and ototoxic

77
Q

UTI AND ESBL PRODUCING BACTERIA

A

Bacteria is resistant to all cephalosporins and all almost all penicillin

78
Q

ESBL is carried on a

A

plasmid which often carried genes for restiqtn to other antibiotics i.e. gentamicin and ciprofloxacin

79
Q

antibiotics that may be useful in ESBL

A

nitrofurantoin, meropene, fosftomycin

80
Q

carbapenemase producen enterobaceriace

A

gram negatice (coliform) bacilli wchih are resistant to meropenem and all current antibiotics

81
Q

2nd line antibiotics for coliforms

A

aztreonam and pivmecillinam

82
Q

2nd line antibiotics for enterococcus

A

vancomycin

83
Q

trimethoprim (oral)

A

inhibits folic acid synthesis so DO NOT USE IN FIRST TRIMESTER OF PREGNANCY

84
Q

Trimethoprim covers

A

coliforms, staph aureus, MRSA but NOT pseudomonas aerguinosa

85
Q

nitrofurantoin is only useful for

A

lower uncomplicated UTIS as it only reaches effective concentrations in the bladder urine

86
Q

do not use nitrofurantoin

A

late in pregnancy as there is risk of neonatal haemolysis, do not use in breastfeeding or children under 3 months old

87
Q

nitrofurantoin covers

A

most coliforms, enterococci, staph aura including MRSA but NOT proteus or pseudomonas

88
Q

amoxicillin

A
  • high concentrations reached in urine can be given oral or IV
  • SAFE IN PREGNANCY
  • COVERS ENTEROCCOCUS AND SOME COLIFORMS BUT MORE THAN 50% OF E.COLI ARE NOW RESISTANT
89
Q

Pivmecillinam (oral)

A

useful for treatment of lower uncomplicated uTI and has activity against ESBL but no activity against staph strep enterccoi or pseudomonas

90
Q

temocillin

A

useful in treating complicated UTIS who’s renal function is too poor to tolerate Gentamicin

91
Q

carbapenems

A

active against ESBLS

Renal and Urology (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions