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Year 1 NME > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

How common are UTIs in a GP setting?

A
  • very common
  • second only to respiratory problems
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2
Q

Women are much more likley to get a UTI, but what can increase the risk in men?

A
  • enlarged prostate
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3
Q

Bacteriuria is the prescence of bacteria in the urine. What % of patients can be asymptomatic?

A
  • 20% and should not be treated
  • treatment can increase the risk of future UTIs
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4
Q

Nosocomial infections, also called health-care-associated or hospital-acquired infections, are infections that patients get whilst in hospital, that they didnt have on admitance to hospital. What % of nosocomial infection are UTIs, and what % of these are due to indwelling catheters

A
  • 40% of nosocomial infections are UTI
  • 80% of the 40% are due to indwelling catheters
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5
Q

Can catheters increase the risk of UTI?

A
  • yes
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6
Q

How many different classifications of UTI are there?

A
  • 5
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7
Q

According to the European Association of Urological infection Guidelines what are the 5 classificatins of UTIs?

A

1 - Uncomplicated UTIs

2 - Complicated UTIs

3 - Recurrent UTIs

4 - Catheter-associated UTIs

5- Urosepsis

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8
Q

According to the European Association of Urological infection Guidelines there are the 5 classificatins of UTIs. What is the definition of an uncomplicated UTI?

A
  • no known anatomical or functional abnormality that predisposes the patient to a UTI
  • includes non-pregnant women
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9
Q

According to the European Association of Urological infection Guidelines there are the 5 classificatins of UTIs. What is the definition of an complicated UTI?

A
  • physiological or anatomical abnormality that increases risk of UTI
  • pathophysiology that causes complication of renal urinary system
  • all men, pregnant women
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10
Q

According to the European Association of Urological infection Guidelines there are the 5 classificatins of UTIs. What is the definition of an recurrent UTI?

A
  • recurrences of uncomplicated and/or complicated UTIs
  • frequency of at least three UTIs/year or two UTIs in the last six months
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11
Q

According to the European Association of Urological infection Guidelines there are the 5 classificatins of UTIs. What is the definition of an catheter-associated UTI?

A
  • developing a UTI 48 hours following catheter insertion
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12
Q

According to the European Association of Urological infection Guidelines there are the 5 classificatins of UTIs. What is the definition of an urosepsis UTI?

A
  • life threatening organ dysfunction caused by bacteria present in the blood stream from the urinary tract
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13
Q

What is the most common bacteria that causes a UTIs?

A
  • Uropathogenic Escherichia coli (UPEC)
  • strains of E.col that are normally commensal
  • if it migrates from GIT to urinary tract, causes UTIs
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14
Q

Proteus mirabilis is a well known urea splitting bacteria. What is urea splitting and what does this commonly cause?

A
  • splits urea, producing ammonia and increasing the pH
  • increased pH results in cystal formation
  • kidney stones are common with this bacteria
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15
Q

Patients have commensals and pathogenic bacteria, but what 2 things can increase the susceptibility to a UTI?

A

1 - immunosupression (imbalance beween host and pathogens)

2 - increases virulence from bacteria

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16
Q

Uropathogenic Escherichia coli (EPEC) is the leading cause of UTIs. They posses 2 virulence factors related to their structure that help them infect patients, what are they?

A

1 - flagella = allow them to move

2 - pilli = adhere to and invade epithelial cells

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17
Q

Uropathogenic Escherichia coli (EPEC) is the leading cause of UTIs. EPEC posses flagella which allow them to be motile, and pilli which allow them to stick and invade to epithelial cells. What is stage 1 of a UTI?

A
  • contamination of the periurethral area
  • relates to tissue around the urethra
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18
Q

The first stage of a UTI is contamination of the periurethra (area surrounding the urethra). Once contaminated, what is the second stage of a UTI?

A
  • colonisation of the urethra and migration to the bladder
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19
Q

Uropathogenic Escherichia coli (EPEC) is the leading cause of UTIs. EPEC posses flagella which allow them to be motile, and pilli which allow them to stick and invade to epithelial cells. Stage 1 of a UTI is when the UPEC contaminates the periurethra (area surrounding the urethra). Once contaminated, the second stage of a UTI is colonisation of the urethra and migration to the bladder. What is the 3rd stage of a UTI?

A
  • UPEC adhere and infiltrate the epithelial of the bladder due to pilli
  • inflammation occurs, specifically neutrophil infiltration
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20
Q

Uropathogenic Escherichia coli (EPEC) is the leading cause of UTIs. EPEC posses flagella which allow them to be motile, and pilli which allow them to stick and invade to epithelial cells. Stage 1 of a UTI is when the UPEC contaminates the periurethra (area surrounding the urethra). Once contaminated, the second stage of a UTI is colonisation of the urethra and migration to the bladder. Once the UPEC adhere and infiltrate the epithelial of the bladder due to pilli inflammation occurs, specifically neutrophil infiltration. What is the UPEC then able to do?

A
  • avoid bodies immune system due to virulence factors
  • multiply and form biofilms
  • release of toxins and protease (degrade proteins)
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21
Q

Uropathogenic Escherichia coli (EPEC) is the leading cause of UTIs. EPEC posses flagella which allow them to be motile, and pilli which allow them to stick and invade to epithelial cells. Stage 1 of a UTI is when the UPEC contaminates the periurethra (area surrounding the urethra). Once contaminated, the second stage of a UTI is colonisation of the urethra and migration to the bladder. Once the UPEC adhere and infiltrate the epithelial of the bladder due to pilli inflammation occurs, specifically neutrophil infiltration. UPEC are then able to avoid bodies immune system due to virulence factors and multiply, forming biofilms (especially in catheters) which allows the UPEC to then release toxins and proteases (degrade proteins), further damaging epithelial. In some instances where can the UPEC then travel to?

A
  • kidneys, where they can colonise
22
Q

What is the term given when a pathogen has infected the urinary tract and travelled to the kidneys and began to colonise?

A
  • pyelonephritis
23
Q

Pyelonephritis is when a pathogen has infected the urinary tract and travelled to the kidneys and began to colonise. What can then occur?

A
  • infection of host tissue and damage by bacterial toxins
  • bacteremia, where the pathogen enters the blood
24
Q

Everyone who has a positive urine dipstick should have a urine culture, except who?

A
  • non-pregnant woman presenting with cystitis
25
Q

What is cystitis?

A
  • inflammation of the bladder, normally caused by an infection
26
Q

Cystitis is inflammation of the bladder, normally caused by an infection. What are some common symptoms they may present with?

A
  • bladder and urethral symptoms
  • overlap with urethritis (inflammation of the urethra)
  • dysuria (painfull when urinating)
  • increased urinary frequency, urgency, suprapubic pain, nocturia (night wee)
  • smelly/cloudy urine/visible blood
  • children, elderly and catheterised can be non-specific
27
Q

What symptoms can patients with pyelonephritis present with?

A
  • fever, rigors, loin pain (below rib cage)
  • renal angle tenderness
  • often lower UTI symptoms in addition (cystitis)
  • if pain radiation from loin to groin - stone? (lower ribs to groin)
  • risk of bacteraemia
28
Q

When performing a urine dipstick which needs to be midstream urinating to assess if a patient has a UTI, what are the 2 main things we are looking for?

A
  • nitrites in urine
  • WBCs
29
Q

When conducting a urine dipstick, why is it important to make sure the patient takes a sample from midlfow of urine?

A
  • if not midflow it could be contaminated from periurethra
30
Q

Why do we look for nitrites in the urine?

A
  • bacteria convert nitrates into nitrites
  • essentially means urea in the urine
31
Q

If a patient has a dipstick, do they have good specificity and sensitivity?

  • specificity = correctly rule out a disease
  • sensitivity = correctly identify those with a disease
A
  • has good sensitivity
  • not very specific
32
Q

The peformance of a urine dipstick is used because it is easy to perform and can be done at a patients bedside and if the patients symptoms are vague. Is it able to diagnose patients alone?

A
33
Q

The peformance of a urine dipstick is used because it is easy to perform and can be done at a patients bedside and if the patients symptoms are vague. It cannot be used to diagnose patients alone. If a patient has a negative dipstick, what does that mean?

A
  • virtually excludes a UTI
34
Q

The peformance of a urine dipstick is used because it is easy to perform and can be done at a patients bedside and if the patients symptoms are vague. It cannot be used to diagnose patients alone. If a patient has a negative dipstick, this virtually excludes a UTI. If the patient has a positive result for nitrites and has symptoms suggestive of cystitis, what would the clinician then do?

A
  • treat with antibiotics
35
Q

If a patient has a positive urine dipstick, they can have automated microscopy. What is this?

A
  • automated urine analysers in lab (more sensitive than dipstick)
  • it is able to scan for red cells, white cells and organisms
36
Q

If a patient has a positive urine dipstick, they can have automated microscopy. If this then comes back negative, what does that mean?

A
  • discard without culture
37
Q

If a patient has a positive urine dipstick, and a positive automated microscopy, what would be then next test to diagnose the patient?

A
  • urine culture and antibiotic sensitivity test
  • provides a quantitative measure
38
Q

If a patient has a positive urine dipstick, and a positive automated microscopy, a urine culture and antibiotic sensitivity test can provide a quantitative measure. Is this a test with good sensitivy or specificity?

A
  • specificity
  • able to correctly rule out 90% of people with infection
39
Q

How long does a urine culture and antibiotic sensitivity test normally take, and what can be done for the patient in the meantime?

A
  • 48-72 hours
  • treat with empirical antibiotics
40
Q

What is empirical treatment/therapy?

A
  • treating a patient based on experience
  • no specific diagnosis or knowledge of specific pathogen
41
Q

When performaing empirical treatment/therapy, what things need to be considered?

A
  • target organisms (resistant to specific bacteria and patients history of UTI)
  • route of administation
  • side effects
  • resistance
42
Q

When performing empirical therapy what informaiton can be used from the site where the clinician is working?

A
  • local guidelines on UTIs
  • they provides, 1st, 2nd or even 3rd line treatment options
43
Q

In a patient with an uncomplicated UTI, generally how long do they need to be treated for?

A
  • 5 days
44
Q

The image below denotes an antibiotic sensitivity test. What does those labelled A and B mean?

A
  • A = antibiotic sensitive and can be used as treatment
  • B = antibiotic resistant, not used for treatment
45
Q

What is asymptomatic bacteriuria?

A
  • an individual without urinary tract infection symptoms
  • BUT has mid stream sample showing bacterial growth ≥ 105 cfu/mL
  • NEED 2 consecutive samples in women, and 1 sample in men
46
Q

Asymptomatic bacteriuria is when an individual doesnt have urinary tract infection symptoms, BUT has mid stream sample showing bacterial growth ≥ 105 cfu/mL. In women this needs to be 2 consecutive samples ans 1 in single men. Why is NOT treating patients with asymptomatic bacteriuria important?

A
  • if you treat asymptomatic bacteriuria for one specific organism, but then the patient has a 2nd UTI the bacteria may become resistant to the same treatment
47
Q

If a patient presents with asymptomatic bacteriuria they are generally not treated, however, what are the 2 occasison when they should be treated?

A
  • pregnant women - ALWAYS COMPLICATED!!
  • when patient needs urological surgery
48
Q

What are some approaches for reducing UTIs?

A
  • correct underlying causes (uncontrolled diabetes)
  • antibiotic prophylaxis (switching between different antibiotics - 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
  • estrogen pessary for post menopausal women
49
Q

How does a bladder catheter remain in the bladder?

A
  • contains a small balloon
  • sits at base of the bladder (internal urethra sphincter)
50
Q

What is a Catheter Associated UTI?

A
  • infection caused by a urinary catheter
51
Q

What is a closed loop drainage system in bladder catheters, and why is this important?

A
  • aseptic techniques used
  • connected to a collection bag

Year 1 NME (61 decks)

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