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Nephro > Urinary Tract Infection Microbiology > Flashcards

Urinary Tract Infection Microbiology Flashcards

1
Q

What is a complication UTI?

A

Upper UTI with or without systemic signs and symptoms

Catheter-associated UTI

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2
Q

What are the criteria for urosepsis?

A

Temperature over 38
Heart rate >90/min
Respiratory rate >20/min
WBC >15 or <4

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3
Q

What are the at risk groups for developing bacteriuria?

A 
Hospitalised
Catheterised 
Diabetics
Anatomical abnormalities 
Pregnant 
Preschool aged children (girls > boys)
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4
Q

In which patients should you treat asymptomatic bacteriuria?

A

Preschool children
Pregnant women
Renal transplant patients
Immunocompromised patients

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5
Q

What are the features of ascending urinary tract infections?

A

Urethral colonisation
Occurs more in women
Multiplication in the bladder
Ureteric involvement

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6
Q

What are the features of descending UTIs?

A

Associated with blood-borne infections

Involves the renal parenchyma

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7
Q

In which situations are UTIs most likely to be caused by multiple organisms (<5%)?

A

Long-term catheters
Recurrent infections
Structural/neurological abnormalities

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8
Q

What are the clinical features of a UTI?

A 
Suprapubic discomfort
Dysuria 
Urgency
Frequency 
Cloudy, blood stained, smelly urine 
Low-grade fever
Sepsis
Failure to thrive, jaundice (neonates)
Abdominal pain and vomiting (children)
Nocturia, incontinence and confusion (elderly)
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9
Q

Name the common causative organisms of UTIs.

A 
Gram negative bacilli
- E.Coli
- Klebsiella
- Proteus 
- Pseudomonas 
Gram positive bacteria 
- Strep (entercoccus)
- Staph
Anaerobes 
Candida
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10
Q

What are the investigations for an uncomplicated UTI?

A

1) Non-pregnant women
On 1st presentation, culture is not mandatory
- dipstick has high false positive rates
- antibiotic for 3-7 days
- culture if there is no response to treatment and change the antibiotic
2) Children and men
- send urine for each and every presentation
- treat

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11
Q

How are UTIs in pregnancy managed?

A

Send urine sample with each presentation
Treat for 7-10 days
- amoxicillin and cefalexin
Hospital admission and IV antibiotics if severe
Can develop into pyelonephritis (30%)

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12
Q

What antibiotics should you not give a pregnant woman for a UTI?

A

Trimethoprim
- not in first trimester
Nitrofurantoin
- not near term

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13
Q

What constitutes a recurrent UTI?

A

Two or more episodes in 6 months

Three or more episodes in a year

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14
Q

How should you manage a recurrent UTI?

A

Send a sample with each episode
Encourage hydration
Encourage urge initiated and post-coital voiding
Cranberry products
Intravaginal/oral oestrogen
Urology investigation
Self administered single dose/short course therapy
Single dose post-coital antibiotics
Prophylactic antibiotics
- if simple measures fail
- 6 months ideally (trimethoprim or nitrofurantoin)

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15
Q

How do catheter associated UTIs occur?

A

Disturbance of the flushing system
Colonisation of the urinary catheter
Biofilm production by bacteria

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16
Q

Name some complications of catheters.

A 
CAUTI
Obstruction-hydronephrosis 
Chronic renal inflammation 
Urinary tract stones
Long term risk of bladder cancer
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17
Q

How are catheter infections prevented?

A 
Catheterise only if necessary
Remove when no longer needed 
Remove and replace if causing an infection
Catheter care
Hand hygiene
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18
Q

How are CAUTIs treated?

A 
Check recent microbiology 
Start empirical antibiotics 
Remove catheter is not needed
Replace catheter under antibiotic cover
- gentamicin and ciprofloxacin 
May need to be more broad spectrum
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19
Q

What is acute pyelonephritis?

A

Upper urinary tract infection (moderate/severe)
Ascending infection involving the pelvis of the kidney
Enlarged kidney
Raised abscesses on the surface of the kidney

20
Q

How is acute pyelonephritis managed?

A 
Check recent microbiology 
Send urine and blood cultures
Image the kidneys
Community
- trimethoprim, ciprofloxacin or co-amoxiclav 
Hospital
- broad spectrum 
No response means further investigation is needed 
Uncomplicated = 7-14 days
Complicated = longer than 2 weeks
21
Q

What causes a renal abscess?

A

It’s a complication of pyelonephritis (similar symptoms)

Gram negative bacilli (usually)

22
Q

What are the complications of a renal abscess?

A

Can become life-threatening
- emphysematous pyelonephritis (severe infection causes gas accumulation in the tissues)
Poor response to antibiotics

23
Q

What are the risk factors for a perinephric abscess?

A 
Untreated LUTI
Anatomical abnormalities
Renal calculi 
Bacteraemia 
Haematogenous spread
24
Q

What are the common causative organisms of a perinephric abscess?

A 
E.Coli
Proteus 
S.aureus 
Strep
Candida
25
Q

How can you detect a perinephric abscess?

A 
Symptoms
- similar to pyelonephritis
- localised signs and symptoms 
Positive blood cultures 
Pyuria with/without bacterial growth
26
Q

How are perinephric abscesses treated?

A

Empirically as a complicated UTI
(poor response normally)
Surgical removal/drainage

27
Q

How are complicated UTIs managed in all patients?

A 
Bloods - FBC, U&amp;es, CRP
Urine sample
Blood culture - if pyrexic or hypothermic 
Renal US
CT KUB
Antibiotic therapy for 2 weeks or more
28
Q

Describe the interpretation of urine microscopy?

A 
Epithelial cells - contamination 
Bacteria with no WBC - contamination 
Bacteria with WBC and no catheter - infection
Bacterial with WBC and a cather needs to be assessed clinically 
Pyuria with no bacteria
- previous/recent antibiotic 
- tumour
- calculi
- urethritis (chlamydia check)
- TB
29
Q

What are the antibiotic guidelines for a complicated UTI?

A

IV therapy
- amoxicillin/vancomycin
- gentamicin/aztreonam/temocillin
Drug monitoring in gentamicin

30
Q

What is acute bacterial prostatitis?

A

A spontaneous, localised infection of the prostate gland

31
Q

What are the symptoms of acute bacterial prostatits?

A 
Fever
Perineal/back pain
UTI
Urinary retention 
Diffuse oedema 
Micro abscesses
32
Q

What are the likely causative organisms of acute bacterial prostatitis?

A 
Gram negative bacilli
- E.Coli
- Proteus
S.aureus 
N.gonorrhoea
33
Q

What are the investigations for acute bacterial prostatitis?

A

Urine culture
Blood culture
Trans-rectal US
CT/MRI

34
Q

What are the complications of acute bacterial prostatits?

A 
Prostatic abscess
Spontaneous rupture 
- urethra or rectum
Epidiymitis
Pyelonephritis 
Systemic sepsis
35
Q

What is the antibiotic management for acute bacterial prostatitis?

A

Check recent microbiology

Ciprofloxacin or Ofloxacin

36
Q

What are the common symptoms of chronic prostatitis?

A

Perineal discomfort/back pain
Low-grade fever possible
UTI symptoms

37
Q

What is epididymitis?

A

Inflammatory reaction of the epididymis

- from ascending infection of the urethra

38
Q

What are the symptoms of epididymitis

A 
Pain
Fever
Swelling
Penile discharge 
Symptoms of UTI
39
Q

What are the common causative organisms for epididymitis?

A 
GNB
Enterococci
Staph
TB - in high risk groups
Need to rule out urethritis
- Chlamydia
- N.gonorrhoea
40
Q

What is orchitis?

A

Inflammation of one or both testicles

41
Q

What are the symptoms of orchitis?

A

Testicular pain and swelling
Dysuria
Discharge
Penile discharge

42
Q

What is the most common cause of orchitis?

A

Viral (mumps)

43
Q

What are the complications of bacterial orchitis?

A

Testicular infarction

Abscess formation

44
Q

What is Fournier’s gangrene?

A

A form of necrotising fasciitis
- rapid onset and spreading infection
Causes systemic sepsis

45
Q

What are the risk factors for Fournier’s gangrene?

A

UTI
Complications of IBD
Trauma
Recent surgery

46
Q

What are the investigations used in Fournier’s gangrene?

A

Blood cultures
Urine
Tissue/pus

47
Q

How is Fournier’s gangrene treated?

A

Surgical debridement
Broad spectrum/combination antibiotics
- Tazocin and gentamicin and metronidazole and clindamycin

Nephro (10 decks)

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