Urinary Tract Infections Flashcards
Commensal flora in the kidneys/ureter
Considered sterile
Commensal flora in the bladder
Almost always sterile
Commensal flora in the urethra
Perineal flora (skin/lower GI tract flora)
What organisms make up the perineal flora?
Skin flora-coagulase -ve staphylococci
Lower GI flora-anaerobic bacteria,aerobic bacteria (enterobacteriaeceae), gram +ve cocci-enterococcus
Lower UTI
Cystitis
Symptoms of cystitis
Dysuria Urinary frequency Urgency Supra-pubic pain/tenderness Polyuria,nocturia, haematuria
Upper UTI- infection of kidney and/or pelvis
Pyelonephritis
What additional symptoms do you get in pyelonephritis?
Fever or other evidence of systemic infection
Abacterial cystitis- symptoms of UTI without infection
Urethral syndrome
Who typically gets urethral syndrome?
30-50yrs women.
What are the possible causes of urethral syndrome?
Hypersensitivity reactions, hormone imbalances etc.
Who defined ‘significant bacteriuria’ and what level is classes as significant?
Kass criteria
10(5)cfu/ml
what does cfu stand for?
colony forming units
Significant bacteriuria with a single organism but no symptoms of UTI
Asymptomatic bacteriuria
Pus cells in urine, no organisms grown
Sterile pyruria
Predisposing factors for UTI
Female
Urinary stasis-pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
Instrumentation
Sexual intercourse
Fistulae-recto-vesical, vesico-vaginal
Congenital abnormalities e.g. vesico-ureteric reflux
Sources of UTI infection
Perineum
Fistulae-genital/GI tract to urinary tract
Haematogenous
3 causes of sterile pyruia
Inhibition of bacterial growth e.g. unprescribed antibiotics
Fastidious (hard to grow) organisms
Urinary tract inflammation
4 types of investigations for someone with a UTI
Urinanalysis
Blood tests
Microbiological
Imaging
Name 5 types of urine samples
Mid stream Catheter urine 'clean catch' supra-pubic aspirate early morning urine (whole contents of bladder_
When would you carry out an early morning urine test?
Suspected urinary TB
When would you carry out a blood test?
suspected pyelonephritis
Name 4 UTI antibiotics
Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin
When woudl you treat asymptomatic bacteriuria
Pregnant women, infants or prior to urological procedures
How does the course of antibiotics for cystitis vary between men and women?
Longer course for men (7 days compared to 3)
Treatment for pyelonephritis
Cefuoroxime
Ciprofloxacin
Piperacillin-tazobactam if >65 yrs
