urinary tract infections Flashcards
define a upper urinary tract infection,
kidney till above the bladder
define a lower urinary tract infection.
bladder to the end of the urethra.
Is the bladder sterile or a non-sterile site.
sterile
Are the kidneys and ureters a sterol or non sterol site.
sterile
Is the urethra a sterile or non sterile site.
not sterile
perineal flora from the skin or bowel.
what flora does perineal flora consist of
skin flora- predominantly coagulase (negative staphylococci)
Lower GI tract flora- anaerobic bacteria, aerobic bacteria (Enterobacteriaceae), gram +ve cocci
Is cystitis a lower or upper tract infection.
lower urinary tract infection
symptoms does cystitis present with
dysuria- pain when passing urine urinary frequency urgency supra pubic pain polyuria, nocturia, haematuria.
is pyelonephritis a upper or lower urinary tract infection
upper urinary tract infection
symptoms of of pyelonephritis
loin, abdominal pain and tenderness, fever, rigours, nausea, committing, diarrhoea,
what 2 measures will be elevated in pyelonephritis
elevated CRP and WBC.
what age group does urethral syndrome typically effect
30-50 year olds
what are the causes of urethral syndrome
symptoms of a upper urinary tract infection without infection
hormonal imbalance
inflammation of Skene glands and the paraurethral glands.
foods
environmental chemicals (bubble batch, condoms, gel)
Hypersensitivity following urinary tract infection
traumatic sexual intercourse.
what criteria determines where there is significant bacteria
Kass
what does significant bacteria indicate
upper respiratory tract infection.
what number is class as significant bacteria
10 ^5 cfu(colony forming units)/mL
limitations of using a figure to determine whether a patient has or doesn’t have significant bacteruria.
o Many symptomatic females have bacterial counts of
define asymptomatic bcteriuria
more than 10^5 cfu/ml, but no symptoms are present.
most common cause os asymptomatic bacteruria in elderly
catherisation.
define sterile pyuria
pus cells in urine (WBC).
no organism grown in culture.
what are the predisposing factors for developing a UTI
female
urinary stasis-pregnancy and prostatic hypertrophy.
Instrumentation
sexual intercourse
fistulae
congenital abnormalities- most commonly vesico-ureteric reflux (VUR)
3 most common sources of infection
perineum instrumentation
fistulae
haematogenus
which organism most commonly causes UTI’s
E.coli
which is the second most common organ to cause UTI
staphylococcus saprophyticus
3 causes of sterile pyuria
inhibition of bacterial growth
fastidious (hard to grow) organisms
Urinary tract inflammation (stones)
prevention of bacteracemia form cauterisation.
antibiotic prophylaxis
what is the difference between the colonisation of bacteria do to catheter and infection
colonisation- bacteria present but no symptoms
infection- bacteria and symptoms are present.
what investigations are carried out when determining as UUTI or LURI
dipstick, blood test, microbiological and imaging.
what does a dipstick test
Blood, Protein, Nitrite, White blood cells (leucocyte esterase
dipstick testing not diagnostic for a patient using what form of equipment.
for a patient with indwelling urinary catheter.
what microbiological investigations are undertaken
URINE • Mid-stream (MSU) • Catheter urine (CSU)- from the bag. • “Clean catch”- common in children. • Supra-pubic aspirate (SPA)- invasive, needle into bladder, because they cannot wee due to swollen prostate. BLOODS pyelonephritis.
further investigations other than microbial investigations
– Renal tract ultrasound scan- congenital abnormalities, kidney stones.
– Specialised tests
• Isotope scans (DMSA, DTPA, MAG3), micturating cystourethrogram
what treatment is provided to treat urinary tract infections.
Antibiotics
what are the requirements of antibiotics used to treat a urinary tract infection.
present in urine
minimally toxic
effective
easily administered cheap
examples of commonly used antibiotics in UTI’s
– Nitrofurantoin- typically used
– Pivmecillinam- new
– Trimethoprim- typically used
– Fosfomycin- new.
treatment for pyelonephritis
cefuroxime and ciprofloxacin
7-14 dyas
define cystitis
inflammation of the bladder
which groups of patients are treated for asymptomatic bacteurinia
pregnant
infant- prevent pyelonephritis and renal damage
prior to a urological procedure-• prevention of UTI/bacteraemia
what is used to determine what antibiotic is used to treat a patient
sensitivities.
when are further investigations carried out (nor just microbiology)
– Recurrent UTI
– Any UTI in male patient
– Any UTI in childhood
– Pyelonephritis
