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Renal and Urology > Urinary Tract Infection COPY > Flashcards

Urinary Tract Infection COPY 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?

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
What properties of urine reduce bacterial survival?
* **Osmolality \> 800 mOsm/Kg** * **Low/high pH**
26
How does urine flow reduce risk of UTI?
Flow washes out bacteria
27
What might indicate infection on urine diptick?
* **Positive Leucocytes** * **Positive nitrites** * **Mixture of the two** - most sensitive
28
What is diagnostic of a UTI on urine culture in men?
Culture demonstrates **≥10^2** CFU/mL of a single or predominant organism in a patient ***_plus_*** symptoms specific to the urinary tract
29
What is diagnostic of asympotmatic bacteruria in a man?
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
What might you consider as a differential diagnosis for a UTI in a man?
* **BPH** * **Prostatis** * **Prostate cancer** * **Pyelonephritis** * **Urinary calculi** * **Gonococcal/chalmydia urethritis** * **Bladder cancer** * **Renal cancer** * **Epididymitis** * **Reactive arthritis**
31
What is the primary cause of UTIs ini women?
Sexual intercourse
32
Why might you consider doing a CT abdo/pelvis?
Used to rule out renal or peri-renal abscess if symptoms do not respond to antimicrobial therapy after \>7 days' duration.
33
Why might you do cystoscopy in someone with recurrent UTI?
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
When would you consider performing a renal ultrasound in someone with a UTI?
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
If on urine culture there were \<10^5 CFU/mL, but pyuria was present (\>20 WBC/mm^3), would this be considered a UTI?
Yes
36
If the dipstick result is negative but the symptoms suggest a UTI, what are the chances of a UTI being present?
Still relatively high
37
When would you consider doing imaging in someone with symptoms of a UTI?
* **Men with upper UTI** * **Failure to respond to treatment** * **Recurrent UTI** * **Pyelonephritis** * **Unusual organism** * **Persitent haematuria**
38
How would you manage a lower UTI in a non-pregnant woman?
If \>/=3 symptoms of cystitis, no vaginal discharge: * **Trimethoprim** - 3 days, or * **Nitrofurantoin** - 3 days
39
When would you avoid giving nitrofurantoin?
If eGFR \<30
40
How would you approach managing a UTI if first line treatment failed in a non-pregnant women?
Culture urine and treat according to resistance
41
How would you manage a pyelonephritis?
* **Gentamicin + Amoxicillin** - 7 days (or 10-14 if complicated) * **If allergic** - ciprofloxacin
42
How would you treat an uncomplicated lower UTI in a men?
* **Trimethoprim** - 3 days OR * **Nitrofuratoin (eGFR\>30)** - 3 days
43
How would you manage a complicated UTI?
Treat for 7-14 days * **Co-amoxiclav** - 8 hrly OR * **Co-trimoxazole** - 8 hrly **If allergic** - ciprofloxacin
44
How would you manage a UTI in pregnancy?
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
What can UTIs during pregnancy cause?
* **Preterm delivery** * **Intrauterine growth restriction**
46
If a man is showing signs of prostatitis, how would you manage it?
Consider ciprofloxacin for long course (4 weeks) - penetrate prostate fluid better
47
If a catheterised patient developed a UTI, how would you manage it?
* **Change catheter** * **Culture urine** * **Antibiotics not indicated unless systemic infection** -\> if likely, treat as for complicated UTI or pyelonephritis
48
What neurological symptom may indicate a UTI in an elderly individual?
Confusion
49
What are features of urinary tract TB?
* **Sterile pyuria** * **Dysuria** * **Frequency** * **Suprapubic pain** * **Malaise** * **Fever** * **Night sweats** * **Weight loss** * **Back/flank pain** * **Visible haematuria**
50
What is reflux nephropathy?
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
Why is nitrofurantoin not recommended in pregnancy in 3rd trimester?
Can cause haemolytic anaemia in the baby
52
What is the definition of a recurrent UTI?
3 or more episodes in a 12-month period

Renal and Urology (51 decks)

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