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Year 3 > Urinary tract infection (I) > Flashcards

Urinary tract infection (I) Flashcards

1
Q

What is a UTI?

A

Inflammatory reaction of the urinary tract epithelium in response to pathogenic micro-organisms, most commonly bacteria

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2
Q

Describe UTIs in men.

A
  • rarely occurs before 50y
  • associated with abnormal structure/function of urinary tract e.g. prostate, catheters, surgeries, neurogenic
  • also due to altered urinary flow
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3
Q

Describe UTIs in women.

A
  • infectious cystitis is the most common type
  • pyelonephritis is a kidney infection occurring via bacteria ascent
  • urethritis is an infection causing inflammation of urethra
  • colonisation of vagina first, then to urinary tract
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4
Q

Name a common causative agent for UTIs.

A

E. coli (gram -ve bacilli)

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5
Q

What is the difference between lower and upper UTIs?

A
  • bladder & urethra = lower UTIs
  • kidneys & ureters = upper UTIs
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6
Q

Why are females at higher risk of UTIs?

A

Women have shorter urethra (hence shorter distance to bladder from urethral opening) and anal and genital regions that are closer in proximity

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7
Q

What are some different types of UTIs? (4)

A
  • uncomplicated UTI
  • complicated UTI = presence of other factors hindering efficacy of therapy (e.g. structural/functional abnormalities, immunodeficiency, indwelling catheter, infection due to resistance, pregnancy UTIs)
    • men more likely to have complicated UTIs
  • recurrent UTI = due to persistence of infection that is inadequately treated/new infection
    • 2 separate culture-proven episodes of acute UTIs within 6mo. or >3 in 12mo.
  • asymptomatic bacteriuria = presence of bacteria in urine without any symptoms
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8
Q

What are the risk factors for UTIs? (6)

A
  • abnormalities of urinary tract (e.g. benign prostatic hypertrophy, kidney stones)
  • pregnancy
  • postmenopause
  • sexual activity (anal sex increases risk)
  • urinary catheters
  • anything causing urine stasis
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9
Q

What are the diagnostic criteria (AKA signs and symptoms) for UTIs in men?

A
  • presence of risk factors
  • dysuria
  • urgency
  • frequency
  • hesitancy
  • nocturia
  • enlarged prostate
  • tender prostate

UTI: >/=10^2 CFU/ml of a single/predominant organism with symptoms specific to urinary tract

Asymptomatic bacteriuria: >/=10^5 CFU/ml of a single organism by clean catch on one occasion without specific urinary tract symptoms

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10
Q

What are the diagnostic criteria (AKA signs and symptoms) for UTIs in women?

A
  • dysuria
  • new nocturia
  • cloudy-urine
  • presence of risk factors
  • urgency
  • visible haematuria
  • frequency
  • suprapubic pain/tenderness

10^4 to 10^5 CFU/ml indicate UTI

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11
Q

What are the three key symptoms of a UTI in women?

A

Dysuria, new nocturia, cloudy-urine

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12
Q

What are some signs and symptoms of UTIs in men?

A
  • dysuria
  • frequency
  • urgency
  • suprapubic pain (lower tummy)
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13
Q

What are the clinical features of a lower UTI (e.g. urethritis, cystitis)? (5)

A
  • dysuria
  • urinary frequency & urgency
  • malodorous urine
  • haematuria
  • suprapubic tenderness (lower abdominal pain)
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14
Q

What are the clinical features of an upper UTI? (4)

A
  • fever
  • fatigue
  • flank pain
  • nausea and vomiting (may have pyelonephritis)
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15
Q

What are the clinical features of acute pyelonephritis? (5)

A
  • flank (loin) pain
  • fever
  • rigors and vomiting
  • white cell casts in urine
  • may lead to haemodynamic instability

(To distinguish from cystitis: pyrexia, flank pain, abnormal vitals)

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16
Q

What extra features may elderly patients with a UTI have?

A

Delirium / acute confusion

17
Q

What are the first line investigations (and results) for UTIs in men?

A
  • urine dipstick (positive leukocyte esterase and/or nitrate)
  • urine microscopy (WBCs and bacteria)
  • urine culture (>/=10^2 colony forming units, use midstream clean-catch urine)
  • gram stain
18
Q

In an E.coli positive UTI, what does the E.coli appear like on MacConkey agar?

A

Intensely pink –> positive lactose fermentation

19
Q

What imaging investigation modalities are considered for UTIs?

A
  • ultrasound - only if complicated UTI, rule out obstruction
  • CT renal tract - anatomical detail, complicated UTI, rule out obstruction (avoid if pregnant)
  • XR-KUB - complicated UTI, find urinary tract stone/abscess
  • intravenous urogram (IVU) - complicated UTI, rule out obstruction
20
Q

What bloods can be done for UTIs?

A

FBC, U&Es (renal function, CRP, blood cultures)

21
Q

What is the first line investigation for UTIs in women?

A
  • urine dipstick (+ve nitrates/leukocytes/RBCs)
  • perform when 1/3 symptoms are present OR other severe symptoms
  • if 2/3 key symptoms OR positive dipstick OR risk of antibiotic resistance –> urine culture + sensitivity
  • mid-stream, clean-catch urine specimen before giving antibiotics
22
Q

What is seen in MC&S in pyelonephritis?

A

White cell casts

23
Q

What are some differential diagnoses for UTIs in men?

A
  • benign prostatic hypertrophy (BPH) - high PSA + enlarged prostate
  • prostatitis - rectal pain, tender boggy prostate
  • pyelonephritis - unilateral costovertebral angle pain, WBC casts on urinalysis
  • urinary tract stones - loin to groin pain, IVU and CT confirm
  • gonococcal/chlamydia urethritis
  • bladder cancer - haematuria
  • prostate cancer - obstructed flow
  • renal cancer - haematuria
  • epididymitis - lack of dysuria, urgency, frequency
  • reactive arthritis - sterile urine culture
  • Behcet’s Syndrome - sterile urine culture
24
Q

What are some differential diagnoses for UTIs in women?

A
  • overactive bladder - urgency, frequency
  • non-infectious urethritis
  • foreign body in bladder
  • vaginitis, bacterial vaginosis and cervicitis
  • interstitial cystitis
  • urethral diverticulum
  • pelvic organ prolapse
  • urethral cancer
  • asymptomatic bacteriuria
  • radiation cystitis
25
Q

What antibiotics are prescribed 1st line for uncomplicated lower UTI?

A
  • nitrofurantoin OR trimethoprim
  • course: 3 day (women) / 7 day (men)
  • AVOID trimethoprim if pregnant in T1 (folate antagonist)
  • AVOID nitrofurantoin near end of pregnancy (risk of haemolytic anaemia in baby)
26
Q

What antibiotics are prescribed 2nd line for uncomplicated lower UTI?

A

Beta-lactams (amoxicillin) OR cefalexin

27
Q

How is asymptomatic bacteriuria managed in pregnant women?

A

Still treat with nitrofurantoin (avoid near end term) or amoxicillin to avoid risk of progression to pyelonephritis

28
Q

How is asymptomatic bacteriuria managed in catheterised patients?

A

Do not treat (could be colonisation of catheter)
If symptomatic - 7 day Abx course and change catheter

29
Q

How could acute pyelonephritis be managed?

A
  • hospital admission
  • broad spectrum cephalosporin (e.g. ceftriaxone/cefuroxime) or quinolone (e.g. levofloxacin/ciprofloxacin) for 10-14 days
30
Q

How do we treat initial asymptomatic bacteriuria before urological procedure in men?

A
  • trimethoprim/sulfamethoxazole 160/800mg PO BD 1-2d
  • OR nitrofurantoin 100mg PO QD 1-2d
  • OR amoxicillin/clavulanate 500mg PO TD 1-2d
  • OR cefalexin 500mg PO QD 1-2d
  • OR levofloxacin 500mg PO OD 1-2d
  • OR ciprofloxacin 500mg PO BD 1-2d
31
Q

How do we treat acute but not severe and tolerating oral therapy UTI in men?

A
  • trimethoprim/sulfamethoxazole 160/800mg PO BD 7-14d
  • OR nitrofurantoin 100mg PO QD 7-14d
  • OR amoxicillin/clavulanate 500mg PO TD 7-14d
  • OR cefalexin 500mg PO QD 7-14d
  • OR levofloxacin 500mg PO OD 7-14d
  • OR ciprofloxacin 500mg PO BD 7-14d
32
Q

How do we treat acute and severe / not tolerating oral therapy UTI in men?

A

Hospitalisation plus IV antibiotic therapy for 7-14 days

33
Q

What is the treatment algorithm for women with UTIs?

A

Immediate empirical antibiotics or prescription for backup antibiotics

  • 1st line: nitrofurantoin 100mg PO BD/50mg PO QD if eGFR>45 / trimethoprim 200mg PO BD if low risk of resistance and eGFR low
  • 2nd line (no improvement in lower UTI Sx after 48h/not suitable): nitrofurantoin, pivmecillinam, fosfomycin
  • NICE recommends 3 day course
34
Q

Name some complications of UTIs.

A
  • pyelonephritis
  • prostatitis
  • renal function impairment
  • sepsis due to bacteraemia
  • acute kidney injury

Year 3 (22 decks)

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