Urinary Tract Infection (UTI) Flashcards
Definitions:
What is bacteriuria?
Where is affected in a lower UTI?
Where is affected in an upper UTI?
What urethral syndrome?
Bacteria in the urine - may be asymptomatic
Bladder (cystitis)
Prostate
Pyelonephritis (infection of the kidney and renal pelvis)
The patient has dysuria and frequency, with NO infection
DIagnosis of exclusion is made - common in women
What is uncomplicated UTI?
What is meant by a complicated UTI?
Normal renal tract structure and function
UTI in the presence of certain risk factors:
- Renal or urinary tract abnormality
- Voiding difficulty
- Reduced kidney function
- Indwelling catheter
- Immunosuppression
- Virulent organism
Recurrent UTI:
How long after recovery does a relapse usually happen via the same organism?
How many UTI’s per yr would it be classed as recurrent?
2 wks
2-3 per yr
Risk factors:
Why are women at increased risk of UTI?
What can cause increased pathogen exposure? - 3
What can cause stagnant flow? - 3
What are some infection-prone states? - 2
Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include: Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
Sexual activity
Urinary incontinence
Faecal incontinence
Constipation
Urine and faeces aren’t moving to allow bacteria to grow!
Dehydration
Obstruction
Retention
DM
Immunosuppression
Risk factors:
Why is UTI common in pregnancy?
During pregnancy, the compression of your expanding uterus — plus the muscle-relaxing properties of the hormones flooding your body and the challenge of keeping your perineal area clean due to your expanding baby belly — make it even easier for the intestinal bacteria that live quietly on your skin and in your gastrointestinal tract to enter your urinary tract, leading to UTIs.
Symptoms - Cystitis:
What are the 4 main symptoms of cystitis (lower UTI)?
What may they notice in the urine?
Where may they feel pain?
What is the 2 symptoms does URETHRITIS cause?
Dysuria +
Frequency - frequent, small amounts of urine
Urgency
Nocturia
D FUN
Blood - haematuria
Suprapubic region
Urethritis typically causes pain while urinating and an increased urge to urinate. The primary cause of urethritis is usually infection by bacteria. Urethritis is not the same as a urinary tract infection (UTI). Urethritis is an inflammation of the urethra, while a UTI is an infection of the urinary tract.
SO BASICALLY DYSURIA AND FREQUENCY
Symptoms - Prostatitis:
Where do they feel pain?
What other symptoms do they have?
Perineum Rectum Scrotum Penis Bladder Lower back
Fever Rigors Malaise N&V Urinary symptoms Swollen/tender prostate
Symptoms - Acute pyelonephritis:
What are the symptoms of AP?
Where do they experience pain?
What is the sepsis caused by this called?
Fever
Rigors
Vomiting
Loin/flank pain and tenderness
Urosepsis
Signs:
They might have a fever.
Where will they have tenderness?
What 2 things would you notice about the urine?
What may be causing discharge?
Suprapubic or loin tenderness
Cloudy or smelly urine
STI urethritis
Investigations:
Urine dipstick:
- What 2 things are seen?
- What other type of test can be used for MC+S? - remember the urine needs to not be contaminated!!
- Who is this unreliable in?
Nitrites*** and leukocytes
MSU
Pregnant women
Investigations:
MSU MC+S:
- What does it show?
- How would you know the sample is contaminated?
Further investigations for pyelonephritis?
What endocrine disease needs to be ruled out?
What imaging can be used to look for obstruction hydronephrosis?
What is a CT KUB and what is it used for?
Leukocytes and bacteria
Many different organisms --- FBC U&E CRP Blood cultures CT scan
DM
Kidney US
Post-void bladder US
A CT KUB (CT of the kidneys, ureters and bladder) is the investigation of choice for acute renal colic. This is a study without intravenous or oral contrast, relatively low dose (in CT terms), and has a very high sensitivity for the detection of renal and ureteric stones.
What is vesicoureteric reflux?
What does it lead to?
Urine flows retrograde/backwards into the ureter/kidneys
Hydronephrosis
Management - general approach?
Antibiotics if symptomatic
Paracetamol +/or NSAIDs for symptom releif
Remove catheter if present
Management - Lower UTI - Women:
What 2 antibiotics are used?
For how long?
What if these antibiotics fail?
How long should the antibiotics be used if it’s complicated UTI?
Nitrofurantoin
Trimethoprim
3 days
Culture and treat to AB sensitivity
7 days
Management - Lower UTI - Women:
Pregnancy:
- Why is it risky to have a UTI during pregnancy?
- What should be checked when prescribing AB’s?
THEY ARE TREATED EVEN IF THEY ARE ASYMPTOMATIC
Preterm delivery and IGUR
Local guidelines
