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Urinary system > Urinary tract infections > Flashcards

Urinary tract infections Flashcards

1
Q

Which parts of the urinary tract are affected in a lower UTI?

A
  • Bladder or urethra
  • Cystitis
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2
Q

Which parts of the urinary tract are affected in an upper UTI?

A
  • Kidneys
  • Infection has tracked up ureters
  • Pyelonephritis
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3
Q

Why is the urinary tract normally sterile and resistant to bacterial colonisation?

A
  • Emptying of bladder during micturition washes bacteria out
  • Vesico-uretal valves mean there’s only one direction of urine flow (out of the body)
  • Immunological factors
  • Mucosal barriers
  • Urine acidity
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4
Q

What are the risk factors for UTI?

A
  • Female (short urethra)
  • Obstructive causes - stasis of urine and no wash out of urine
  • Neurological conditions affecting bladder emptying
  • Pregnancy
  • Abnormal renal tract
  • Impaired host defence
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5
Q

What can cause obstruction and lead to UTI?

A
  • Stones
  • Enlarged prostate
  • Retroperitoneal fibrosis
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6
Q

What neurological conditions can result in UTI?

A
  • Multiple sclerosis
  • Stroke
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7
Q

Why does pregnancy put people at risk of UTI?

A
  • Enlarged uterus
  • Hormonal effects on relaxation of musculature
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8
Q

Which abnormal features of the renal tract put people more at risk of developing a UTI?

A
  • Vesico-ureteric reflux in children
  • Indwelling urinary catheter
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9
Q

Which conditions can lead to impaired host defence and result in UTIs?

A
  • Diabetes mellitus
  • Immunosuppression
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10
Q

What are the important differences between male and female anatomy?

A
  • Males have a much longer urethra
  • Male meatus is located far away from the rectum
  • Females have a short urethra
  • Opening of urethra is very close to vagina and rectum
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11
Q

What are common times in life for people to develop UTIs?

A
  • Infancy
  • Preschool
  • Honeymoon cystitis (early 20s)
  • Pregnancy
  • After the age of 60 when prostatism begins
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12
Q

What are the causative agents of UTIs?

A
  • Coliforms
  • Escherichia coli is most common
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13
Q

How do coliforms result in UTIs?

A
  • Flagella - movement
  • Pili - attachment
  • Capsular polysaccharide - colonisation
  • Haemolysin, toxins - damages host membranes and cause renal damage
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14
Q

How does cystitis present?

A
  • Dysuria
  • Cloudy urine
  • Nocturia or frequency
  • Urgency
  • Suprapubic tenderness
  • Haematuria
  • Pyrexia (usually mild)
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15
Q

How does pyelonephritis present?

A
  • High fever +/- rigors
  • Loin pain and tenderness
  • Nausea/vomiting
  • +/- symptoms of cystitis e.g. haematuria
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16
Q

What are some differentials for dysuria?

A
  • Other causes of inflammation
  • STIs
  • Post sexual intercourse
  • Contact with irritants
  • Symptoms of menopause, atrophic vaginitis, vaginal atrophy
17
Q

Define an uncomplicated UTI?

A
  • Infection by a usual organism in a patient with a normal urinary tract and normal urinary function
  • May occur in females of any age
18
Q

What factors may predispose a patient to a complicated UTI?

A
  • Abnormal urinary tract
  • Virulent organism (staph aureus)
  • Impaired host defence (immunosuppression, poorly controlled diabetes)
  • Impaired renal function
  • Suspected pyelonephritis
  • Children
  • Males
  • Pregnant women
19
Q

Define a complicated UTI

A
  • 1 or more factors that predispose to persistent infection, recurrent infection or treatment failure
20
Q

What investigations are done when a patient presents with UTI?

A
  • Urine culture
  • Dipstick
  • Visual inspection
21
Q

How do we investigate healthy non-pregnant women of child bearing age?

A
  • Uncomplicated UTI
  • No need for urine culture
22
Q

How do we take a urine culture in complicated UTI?

A
  • Mid-stream urine - cleansing not required, ideally holding labia apart in women
  • Clean catch in children
  • Culture urine within 4 hours of collection, refrigerate or use boric acid preservative
  • Want to know what the organism is so we can find out which antibiotics to use
23
Q

When is a urine dipstick not useful?

A
  • Patients >65 years old (asymptomatic infection is common)
  • Catheterised patients
24
Q

When is a urine dipstick useful?

A
  • If patient presents with one of the following
  • Dysuria
  • New nocturia
  • Cloudy urine
25
Q

What suggests that Staphylococcus saprophyticus is the causative organism of a UTI?

A
  • Urine dipstick is negative for nitrites but positive for LE
26
Q

When do we image the urinary tract when a patient has a UTI?

A
  • Considered in all children with a UTI
  • Valuable in septic patients to identify renal involvement (pyelonephritis)
  • Start with ultrasound, possible MRI
  • Look at urine flow, reflux, hydronephrosis
27
Q

When do we image the urinary tract when a patient has a UTI?

A
  • Considered in all children with a UTI
  • Valuable in septic patients to identify renal involvement (pyelonephritis)
  • Start with ultrasound, possible MRI
  • Look at urine flow, reflux, hydronephrosis
28
Q

How do we treat a UTI?

A
  • Increase fluid intake to wash out bacteria
  • Regular analgesia
  • Address underlying disorders
  • Antibiotics
29
Q

What antibiotic courses are given for UTI treatment?

A
  • 3 day course for uncomplicated UTI
  • 5-7 day course for complicated lower UTI e.g. pregnant, male, underlying disorders
30
Q

Which antibiotics treat cystitis?

A

Can be treated with:
- Nitrofurantoin
- Trimethoprim
- Pivmecillinam
- Fosfomycin

31
Q

How is uncomplicated cystitis treated?

A
  • 3 day abx course as effective as 5 or 7 days
  • Limiting prescription to 3 days reduces selection pressure for resistance
32
Q

How is complicated UTI treated?

A
  • UTI complicated if pt is pregnant, male, or UTI is catheter associated
  • 5-7 day course of abx
33
Q

How is pyelonephritis treated?

A

7-10 day course of abx
- Use agent with systemic activity (not nitrofurantoin or fosfomycin)
- Possibly IV initially unless good oral absorption and patient is well enough/tolerating orally

34
Q

Which antibiotics are used to treat pyelonephritis/septicaemia?

A
  • Co-amoxiclav
  • Ciprofloxacin
  • Gentamycin (IV only)

Urinary system (22 decks)

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