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GP > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

Bacteriuria - definition

A

Bacteria in the urine (not in itself a disease) can be symptomatic or asymptomatic

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2
Q

Urinary Tract Infection - definition

A

A diagnosis based on signs and symptoms and assisted by testing for bacteriuria

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3
Q

Urinary Tract Infection - lower vs upper

A

Lower
- involves the bladder and prostate
Upper (a.k.a. pyelonephritis)
- infection of the kidney or renal pelvis

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4
Q

Abacterial Cystitis - definition

A

Diagnosis of exclusion in patients with dyuria amd frequecy

- no demonstrable infection

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5
Q

Urinary Tract Infection - incidence

A

10-20% annual in women

0.3% annual pyelonephritis

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6
Q

Urinary Tract Infection - classifications

A

Uncomplicated - normal renal tract structure and function
Complicated - structural abnormalities of the genito-urinary tract
e.g. obstruction, catheter, stones, neurogenic bladder or renal transplant

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7
Q

Urinary Tract Infection - risk factors

A

Bacterial inoculation
- sex, urinary incontinence, faecal incontinence and constipation
Decreased urine flow
- dehydration, obstructed urinary tract
Bacterial growth
- diabetes, immunosuppression, obstruction, stones, catheter, pregnancy and renal tract malformation

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8
Q

Urinary Tract Infection - clinical features of cystitis

A 
Dysuria
Urgency 
Subrapubic pain
Frequency 
Haematuria (frank or microscopic)
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9
Q

Urinary Tract Infection - clinical features of acute pyelonephritis

A 
Fever
Rigor
Vomiting
Loin pain/tenderness
Sepsis
Costovertebral pain
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10
Q

Urinary Tract Infection - clinical features of prostatitis

A 
Pain - perineum, rectum, scrotum, penis and lower back 
Fever
Malaise 
Nausea
Urinary symptoms (cystitis)
Swollen/enlarged prostate on PR
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11
Q

Urinary Tract Infection - differentials

A

PID - associated with vaginal discharge

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12
Q

Urinary Tract Infection - investigations

A 
Dipstick (not in pregnancy)
- nitrates and leukocytes 
MSU culture (if unsure or failure to respond to treatment)
Bloods (if systemically unwell)
- FBC, U&Es, CRP
Blood cultures (if systemically unwell)
Imaging
- ultrasound
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13
Q

Urinary Tract Infection - indications for USS

A 
Men with pyelonephritis
Failure to respond to treatment
Recurrent UTI (more than 2/year)
Pyelonephritis 
Unusual organisms 
Persistent haematuria
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14
Q

Urinary Tract Infection - common organisms

A 
Anaerobes or gram negative bacteria are common
- from bowel or vagina 
E.Coli (75-95%)
S.Saprophyticus (5-10%)
Proteus mirabilis 
Klebsiella Pneumonia
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15
Q

Sterile pyuria - causes

A 
Defined as increased white cells, but sterile on culture
Infection related  
- TB
- recurrent UTI (recently/poorly treated)
- appendicitis, prostatitis, chlamydia 
Non-infection related 
- polycystic Kidney Disease
- SLE
- steroids 
- calculi 
- renal tract tumour
- papillary necrosis 
- tubulointerstitial nephritis 
- recent catheter 
- pregnancy
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16
Q

Urinary Tract Infection - management in non-pregnancy women

A

Drink lots of water and urinate often to clear the bacteria out of the urine
Lower UTI
- trimethoprim or nitrofurantoin for 3 days
- if this fails, MSU culture and treat as per sensitivities
Pyelonephritis
- MSU culture
- treat empirically as per local guidelines while waiting for sensitivities

17
Q

Urinary Tract Infection - management of recurrent infection

A

Establish whether relapse or reinfection
Relapse
- identify and treat the cause (e.g. stones or scarred kidneys)
- IV antibiotics for 7 days followed by oral antibiotics for 4-6 weeks
- consider long-term therapy is another relapse
Reinfection
- implies poor bladder defence mechanism
- review contraceptive practice (avoid use of spermicidal gels or diaphragms)
- preventative measures and drink lots of water

18
Q

Urinary Tract Infection - management of pregnant women

A

Expert help - UTI associated with increased risk of preterm delivery and IUGR
Antibiotics as per empirical local guidelines
- 1st trimester: avoid trimethoprim and ciprofloxacin
- 3rd trimester: avoid nitrofurantoin
Treat even if asymptomatic bacteriuria
Confirm eradication

19
Q

Urinary Tract Infection - management in men

A

Lower UTI
- trimethoprim or nitrofurantoin for 7 days
Prostatitis
- consider 4 weeks of a fluoroquinolone
- ciprofloxacin (penetrates the prostatic fluid)
Pyelonephritis/recurrent UTI
- refer for urological investigations

20
Q

Urinary Tract Infection - management in catheterised patients

A

All catheterised patients have bacteriuria
Symptomatic
- MSU culture
- change long-term catheter before starting on antibiotic
- prescribe empirically based on local guidelines
- once sensitivities known: narrow spectrum based on culture (best to eliminate recurrence)

21
Q

Urinary Tract Infection - clinical features in catheterised patients

A 
More likely to be atypical or non-specific
Flank pain
Suprapubic pain
Fever
Change in voiding pattern 
Confusion 
Vomiting 
Sepsis

GP (3 decks)

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