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Year 3 - Met3b > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

What does the upper urinary tract comprise of

A

o Kidney
o Renal pelvis
o Ureter

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2
Q

What does the lower urinary tract comprise of

A

o Bladder

o Urethra

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3
Q

What does the urothelium lining consist of

A

o Transitional epithelium in the upper tract and bladder

o Pseudostratified columnar in membranous and spongy urethra

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4
Q

What is urinary tract infection

A

o Inflammatory response of urothelium to bacterial invasion

o Inflammatory response causes symptoms

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5
Q

How do urinary tracts become infected

A

o Ascending: retrograde ascent of bacteria up urethra
- Bacteria from large bowel colonise perineum and ascend to bladder
- May ascend from bladder to kidney via ureter = Increased risk: vesicoureteric reflux/impaired ureteric peristalsis e.g. in
patients with renal stones

Haematogenous

Lymphatics

  • inflammatory bowel disease
  • retroperitoneal abscess
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6
Q

What are the risk factors of urinary tract infections

A

 Previous UTI
 Female gender
 Congenital abnormality / reflux nephropathy
 Renal calculi
 Bladder catheterisation / Intermittent self catheterisation for neurogenic bladder
 Diabetes
 Drugs – Sodium Glucose Transporter-2 antagonists (Gliflozins) used in diabetes
 Bladder Cancer

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7
Q

What is the history of urinary tract infections

A

 Previous UTIs
 Sexual history
 Renal tract problems – eg stones, congenital abnormalities
 Any symptoms of bladder cancer

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8
Q

What are the investigations of urinary tract infections

A

 Urine dipstick – leucocytes, nitrites, protein. May be false positive in elderly o Nitrite in urine – 90% sensitive, but 35-85% specific for UTI

 Mid stream urine (MSU) for MC&S – common bacteria are gram –ve such as E.Coli, Pseudomonas, Klebsiella, Proteus. Gram +ve such as strep faecalis or staph aureus are less common

 Recurrent UTI – USS renal tract or CT KUB (kidney, ureter, bladder)

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9
Q

How do you manage pyelonephritis

A

 May require intravenous therapy with co-amoxiclav

 If patient stable, out-patient antibiotic therapy (OPAT) is a possibility

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10
Q

How do you manage recurrent UTI

A

 Consideration given to rotating antibiotics, post coital antibiotics

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11
Q

how do UITs come from the ascending route

A
  • bacterial from large bowel colonise the perineum and ascend to the bladder
  • may ascend from bladder to kidney via the ureter
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12
Q

what are the risk factors for a UTI coming from the bladder to the kidney

A
  • veiscouretic reflux
  • impaired ureteric peristalsis
  • stones
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13
Q

What is bacteriuria

A

= presence of bacteria in urine

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14
Q

What is pyuria

A

= presence of white blood cells in the urine

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15
Q

if you have bacteriuria but no pyuria what does this suggest

A
  • suggest that you have colonisation of bacteria rather than active infection
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16
Q

What does pyuria imply

A
  • implies an inflammatory response of urothelium in response to bacterial infection
17
Q

If you have pyuria but not bacteruria what does this suggest

A
  • carcinoma in situ
  • TB infection
  • bladder stone
18
Q

what is an uncomplicated UTI

A
  • uncomplicated - normal urinary tract structure and function
19
Q

describe how you treat an uncomplicated UTI

A
  • mainly women

- respond quickly to a short course of antibiotics

20
Q

what organisms cause a UTI

A

E.coli = 85% community acquired cases, 50% hospital acquired cases

  • Others = staphylococcus saprophytic, streptococcus faecalis, proteus, klebsiella
21
Q

What is an complicated UTI

A
  • underlying anatomical/functional abnormality
22
Q

describe a complicated UTI

A
  • take longer to respond to antibiotics and often reoccur
  • E.coli: 50% of cases
  • Others - streptococcus faecalis, staphylococcus aureus, Staphylococcus epidermis, Pseudomonas
23
Q

Name 3 categories of UTI

A
  • isolated
  • recurrent
  • unresolved
24
Q

What is an isolated UTI

A
  • at least 6 months between infections
25
Q

What is a recurrent UTI

A

> 2 infections in 6 months or 3 within 12 months

  • reinfection - infection by different organisms
  • persistence - infection by same organism from a focus in the urinary tract e.g. calculi, chronic prostatitis
26
Q

What is an unresolved UTI due to

A
  • inadequate therapy

- may be due to bacterial resistance

27
Q

What is a lower UTI called

A
  • cystitis
28
Q

What is an upper UTI called

A
  • pyelonephritis
29
Q

What is the symptoms of of cystitis (lower UTI)

A
  • frequent small volume voids
  • urgency
  • suprapubic discomfort
  • dysuria
  • haematuria
30
Q

What are the investigations used in cystitis

A

Dipstick of midstream urine (MSU)

  • Presence of leucocytes (pyuria) - 75-90% sensitivity for UTI
  • presence of nitrates (bacteriuria) - >90% specificity, 35-85% sensitivity

Urine MC&S - if dipstick negative

Further

  • KUB x ray
  • renal USS
  • IV/CT urogram
31
Q

What is the management of cystitis

A
  • uncomplicated - short course of antibiotics e.g. trimethoprim
  • Complicated - 7-10 day course of antibiotics e.g. augmenting
  • male - 2 week course of quinolone e.g. ciprofloxacin
  • if persists: prostatitis
32
Q

What is the presentation of pyelonephritis

A
  • flank/loin pain
  • nausea and vomiting
  • fever and rigors
  • LUTs
33
Q

What are the investigations that you use for pyelonephritis

A
  • dipstick MSU
  • urine MC&S = microbiology - 80% E.coli: less common: Enterococci, klebsiella, proteus, pseudomonas
  • blood - FBC, U&Es, culture, CRP
  • KUB X ray, renal USS, CT urogram
34
Q

hat is the management of pyelonephritis

A
  • not systemically unwell - consider outpatient Mx: 10-day oral antibiotics
  • systemically unwell - admit for IV antibiotics
35
Q

what are the complications for pyelonephritis

A
  • Perinephric abscess - abscess in Gerota’s fascia when infection extends outside parenchyma
  • Risk factors - diabetes, obstructing calculus
  • Microbiology - S.aureus, E.coli, Proteus
36
Q

how do you treat perinephric abscess

A
  • drainage

- antibiotics until resolution of infection

37
Q

When do you refer for further investigation

A
  • Child
  • male
  • failure to respond to treatment
  • recurrent UTI
  • Pyelonephritis
  • unusual organisms
  • persistent haematuria
38
Q

What is prophylactic management for UTI

A
  • continuous or post-coital antibiotics for women with many UTIs to reduce the rate of recurrence
39
Q

What is the management of UTI in general

A

Management
Non-pregnant women
- If three or more symptoms of cystitis and no vaginal discharge treat with 3 day course of trimethoprim or nitrofurantoin
- If upper UTI take a urine culture and treat initially with a broad-spectrum antibiotic such as co-amoxiclav
Pregnant women
- UTI in pregnancy associated with preterm delivery and IUGR \
- Treat with antibiotics – but get help
Men
- Treat lower UTI with 7 day course of trimethoprim or nitrofurantoin

Year 3 - Met3b (26 decks)

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