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CLINICAL PATHOLOGY > Urinary tract infections > Flashcards

Urinary tract infections Flashcards

1
Q

What differentiates upper urinary tract from lower urinary tract?

A

Above bladder = upper urinary tract

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2
Q

What flora is found within the urinary tract (kidneys/ureter, bladder and urethra)?

A 
Kidneys/ureters = sterile
Bladder = usually considered sterile but may not be the case
Urethra = Perineal flora (skin/lower GI tract flora)
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3
Q

What is the predominant skin flora making up the perineal flora?

A

Coagulase negative staphylococci

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4
Q

What lower GI tract flora can make up part of the perineal flora? 3

A

1) Anaerobic bacteria
2) Aerobic bacteria - enterbacertiacae
3) Gram-positive cocci - enterococcus spp.

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5
Q

What is cystitis?

A

Lower urinary tract infection

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6
Q

What 5 components make up the syndrome of cystitis?

A

1) Dysuria
2) Urinary frequency
3) Urgency
4) Supra-pubic tenderness/ pain
5) Polyuria, nocturia, haematuria

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7
Q

What is pyelonephritis?

A

Upper urinary tract infection - infection of kidney and or renal pelvis

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8
Q

What are the 3 main symptoms of pyelonephritis?

A

1) Loin/abdominal pain/ tenderness
2) Fever
3) Other evidence of systemic infection eg. rigors, nausea, fever, diarrhoea, elevated CRP and WBC

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9
Q

What is urethral syndrome?

A

Also called abacterial cystitis or frequency-dysuria syndrome - symptoms of lower UTI without demonstratable infection

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10
Q

Which group does urethral syndrome commonly affect?

A

Women - 30-50 years of age

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11
Q

How is significant bacteriuria classified, what does that indicate?

A

10^5 cfu/ml (colony forming units)

Indicated likely UTI

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12
Q

What levels of bacteria indicate probable UTI?

A

10^4-10^5 cfu/ml

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13
Q

What are the 4 main limitations of defining significant bacteriuria and using this as an indicator of UTI?

A

1) Bacterial count is on a normal curve
2) Many symptomatic females have bacterial counts less than that considered significant bacteriuria
3) Lower counts 10^3cfu/ml are considered significant in males
4) Not relevant to catheter urine or sterile-aspirate urine

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14
Q

What is asymptomatic bacteriuria?

A

Significant bacteriuria with a single organism

With no symptoms of urinary tract infection

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15
Q

What is sterile pyruria?

A

Pus cells in urine

No organisms grown

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16
Q

Give 6 predisposing factors for UTI?

A

1) Female sex - 10:1
2) Urinary stasis (pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine)
3) Instrumentation - eg. cystoscopy
4) Sexual intercourse
5) Fistuale - recto-vesical, vesico-vaginal
6) Congenital abnormalities - vesico-ureteric reflex

17
Q

Give 3 sources of infection in UTI?

A

1) Perineum - movement of bacteria along a lumen
2) Fistulae - Movement of bacteria from genital/GI tract to urinary tract
3) Haematogenous (rare) - seeding of infection from the blood

18
Q

What is the most common bacteria to cause UTI both in general practise and in hospital?

A

E coli

19
Q

What is the second most common bacterial cause of UTI in general practise?

A

Staphylococcus saprophyticus

20
Q

What is the second most common bacterial cause of UTI in hospitals?

A

Enterococcus spp.

21
Q

What are the 3 causes of sterile pyuria?

A

1) Inhibition of bacterial growth - unprescribed abx, specimen contaminated with antiseptic
2) Fastidious (hard to grow) organisms - eg. mycobacterium TB, haemophilus spp., Neisseria gonorrhoeae and anaerobes
3) Urinary tract inflammation - renal or bladder stones, other renal disease

22
Q

What is a catheter UTI?

A

Long-term indwelling catheterization results in bacteriuria

23
Q

What 2 things is it important to distinguish between in catheter UTI, how are the distinguished?

A

Need to distinguish between colonisation and infection

Do so through looking at clinical features

24
Q

How many catheter UTI lead to bacteraemia, how can this be avoided?

A

Manipulation or catheter removal may result in bacteraemia - prophylactic Abx may be used to prevent this in people with a hx of this problem, purulent discharge at site or colonisation of catheter exit site with staph aureus

25
Q

Which 4 investigations can be carried out in someone with suspected UTI?

A

1) Dipstick testing (urinalysis)
2) Blood tests
3) Microbiology
4) Imaging

26
Q

When is dipstick testing of no clinical value in suspected UTI?

A

In people with indwelling catheters unless these have been changed very recently

27
Q

What 4 things does urine dipstick testing identify?

A

1) Blood
2) Protein
3) Nitrite
4) White blood cells (leucocyte esterase)

28
Q

What 2 samples can be used for microbiological testing in suspected UTI?

A

1) Blood

2) Urine

29
Q

What are the 4 types of urine sample?

A

1) Mid stream - MSU
2) Catheter urine - CU
3) Clean catch
4) Supra-pubic aspirate - SPA

30
Q

Give one special test which may be used in suspected urinary tuberculosis?

A

Early morning urine (EMU) x 3
Whole contents of bladder
Used in suspected urinary tuberculosis

31
Q

Give 4 indications for further investigations including renal tract USS and specialised tests in UTI?

A

1) Recurrent UTI
2) Any UTI in male patient
3) Any UTI in childhood
4) Pyelonephritis

32
Q

What are the 5 requirements of Abx used to treat UTI?

A

1) Present in urine
2) Minimally toxic
3) Effective against likely organisms
4) Easily administered
5) Cheap

33
Q

Give 4 examples of Abx used to treat UTI?

A

1) Nitrofurantoin
2) Pivmecillinam
3) Trimethoprim
4) Fosfomycin

34
Q

What is the treatment for cystitis in women?

A

Treatment pre-empts microbiology results

Short course of Abx - 3 days

35
Q

What is the treatment for cystitis in women with recurrence of symptoms or in males?

A

Longer course of Abx - 7 days

36
Q

What are the 2 stages of treatment for pyelonephritis?

A

1) Empiric therapy - cefuroxime, ciprofloxacin, piperacillin-tazobactam (if >65)
2) Targeted therapy based on sensitivity reports for 7-14 days depending on Abx used

37
Q

What 3 groups of people are treated for asymptomatic bacteriuria and why?

A

1) Pregnant - association with upper UTI, pre-term delivery and low birth weight babies
2) Infant - prevention of pyelonephritis and renal damage
3) Prior to urological procedures - prevention of UTI/bacteraemia

38
Q

Do the elderly and catheterised require Abx for asymptomatic bacteriuria?

A

No, they do not require Abx

39
Q

What type of urine sample is required is suspected UTI?

A

Mid stream

CLINICAL PATHOLOGY (56 decks)

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