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104 theme 3 > urinary tract infections > Flashcards

urinary tract infections Flashcards

1
Q

how common are UTIs

A

2nd only to resp infections
50% women, many recurrent. 3X more common in infant boys than girls and rare in men until old age (prostate enlargement)
20% elderly have asymptomatic bacteria.
Develop from catheters.

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2
Q

consequences of UTIs

A 
societal and individual cost - healthcare, time misused 
freq recurrences 
uncontrolled infection/sepsis
real damage in young children 
preterm birth
antimicrobial resistance and CDI risk
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3
Q

how are UTIS classified

A

uncomplicated- no anatomical or neurological abnormalities of UT
Uncomplicated lower- cystitis, urethritis, prostates, epididmyo-orchitis
uncomplicated upper - acute pyelonephritis

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4
Q

risk factors for UTIs

A 
female, old and young
catheters
immunosuppression 
UT abnormalities 
AB exposure
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5
Q

what is pathogenesis

A

balance between host defences and organism virulence

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6
Q

host factors for Lower UTI

A

obstruction-prostatic hypertrophy, urethral valves/stricture
poor bladder emptying - MS. SCI, bladder diverticula, pelvic floor disorders
catheterisation
sex
vesicle-enteric fistula
diabetes
genetics - non secreters of ABH blood antigen esp premenopausal, variable expression CXCR1 receptor ifor neutrophil activation

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7
Q

host facts for upper UTI

A

may follow from lower UTI
vesicle-ureteric reflex
obstruction (eg calculus, stricture)

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8
Q

pathogenesis of UTIs

A

contamination of the periurethral area with uropathogen from gut
colonisation of urethra, migration and invasion of bladder
mediated by pili and adhesins
neutrophil infilt
bacterial multiply, immune system subversion
biofilm forms
epithelial damage by bad toxins and proteases
colonise kidney
host tissue damage by bacteria toxins
bacteremia

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9
Q

what does bacterial virulence depend on

A

adherence
invasion
evasion

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10
Q

how is adherence involved in UTIs

A

in bladder uropathogenic E.coli (UPEC) express type 1 pili essential for colonisation, invasion and persistence
p-pili confer tropism to kidney
highly adhesive so proficient in retrograde urethral ascent

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11
Q

How invasion involved in UTIs

A

pilus bind to host cell
actin rearrange in host cell to take up bacteria
protected from antibiotics and host defences

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12
Q

how is evasion linked to UTIs

A

escape eviction by going to cytoplasm and multiplying
filamentous morphology so harder to kill
excrete things to aid nutrient acquisition

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13
Q

how is a UTI diagnosed

A

Clinical symptoms
Urine dipstick testing
Urine culture

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14
Q

clinical symptoms of cystitis

A

Cystitis
bladder and urethral symptoms
overlap with urethritis
dysuria, frequency, urgency, suprapubic pain, nocturia
cloudy urine/visible blood
Children, elderly and catheterised can be non-specific, such as delirium, lethargy so consider the diagnosis among other causes.

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15
Q

clinical symptoms of pyelonephritis

A 
fever, rigors, loin pain 
renal angle tenderness
often lower UTI symptoms in addition
if pain radiation to groin - stone?
risk of bacteraemia
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16
Q

when is a dipstick used

A

main use if symptoms vague eg not diagnostic
not useful if >65y or catheter
look for nitrites, leucocytes, RBCs

17
Q

how is a UTI diagnosed in a female <65

A

dysuria, new nocturia, cloudy urine
if only 1 symptom dipstick
if none look for other symptoms and dipstick

18
Q

when should a UTI be diagnosed by sending to a lab for a culture

A

pregnant, children, men, elderly, pyelonephritis, recurrence, failed treatment, abnormal urinary tract, renal impairment

19
Q

principles of a urine culture

A

urine sterile if no UTI
contaminated by bacteria in distal urethra or hands/genitals
mid stream urine avoids this (no initial or end micturition)
rapid transport, boric acid preservative/fridge to avoid growth of contaminants

20
Q

urine specimens

A 
MSU
Suprapubic aspirate
Catheter urine
acute
intermittent self catheterisation
indwelling
21
Q

what does boric acid do in MSU

A

boric acidhelps to maintain the microbiological quality of thespecimen
prevents cell degradation and overgrowth of organisms that can occur if thesampleis not analysed within 4 hours ofcollection.
can cause false
negative culture if urine not filled to correct mark on specimen bottle and can affect urine dipstick tests

22
Q

microscopy of UTIs

A

WCs -inflammation in UT
Automated urine analysers in lab scan for RCs, WCs and organisms
Discard without culturing if scan negative (unless immunosuppressed or neonate)

23
Q

culture and AB sensitivity of UTIs

A

quantitative
>10^5 organisms per ml is “significant bacteriuria” (in MSU only)
ie, probably not contaminants (90% specific)
Mixed growth may represent contamination&raquo_space; true mixed infection

24
Q

what should be considered in treating a UTI

A 
Empiric treatment need to consider:
target organisms
route of administration
target site
side effects
resistance (known or likely)
25
Q

how can a UTI be prevented

A 
Correct any underlying host causes (uncontrolled DM)
Antibiotic prophylaxis (temporary, between 6m and 2y; not evidence based)
Behavioural changes eg high fluid intake (cranberry juice not recommended any more), void after sex, double void
26
Q

what is a catheter associated UTI

A

Bacteria colonise catheter and bladder, 3-5% people/day
Removal of catheter will clear bacteria in most cases
Usually asymptomatic
some develop UTI, and bacteremia, sepsis and death
21% of patients with an E coli bloodstream infection had UC inserted/ removed/ manipulated in prior 7days

27
Q

prevention of catheter associated UTIs

A 
Use for good reason eg
Mx of urine output in acutely unwell
Mx of acute retention/obstruction
Selected surgical procedures
Aseptic insertion
Closed drainage system
Daily review of removal needs
Consider alternatives
28
Q

signs of a CAUTI

A 
Fever
rigors
new onset confusion
lethargy
back pain 
pelvic pain 
acute haematuria
29
Q

how is a CAUTI diagnosed

A

urine dipstick not used - contamination, non visible haematuria, normal findings when usually would = UTI
urine sample pre ABs, post diagnosis as will help guide treatment but won’t diagnose

30
Q

how is asymptomatic bacteriuria treated

A

Best left untreated unless pregnant
Extremely common in elderly patients; organisms often lack virulence factors
Treatment is not benign – adverse effects, financial cost, development of resistant strains and risk of C. difficile infection

31
Q

what is a UTI relapse

A

the same uropathogen causes UTI symptoms within 2 weeks of completing appropriate AB treatment

32
Q

what s a UTI recurrence

A

at least 2 culture-proven episodes in 6 months, or at least 3 in 1 year
beyond the initial 2 weeks
or a different uropathogen

104 theme 3 (15 decks)

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