Urinary Tract Infections Flashcards
What is the most common cause of UTIs?
Bacterial
What is pyuria?
Increased WBCs in urine
Inflammation which may or may not be associated with infection
What is the most common route of infection?
Ascending
What are most uropathogens derived from?
Faecal flora - coliforms
What is the most common bacterial isolate in dogs and cats with UTIs?
E. Coli
What is the most common bacterial isolate in cows and horses?
Corynebacterium sp
What is the most important bacterial isolate in UTIs in pigs?
Uropathogenic MDR E. coli
How can uropathogenic bacteria exist in the urinary tract?
Planktonic - free in urine
Biofilm - polysaccaride and water matrix
Intracellular communities - can invade cells
What are some risk factors for UTI development?
Female Older Anatomical/physiological LUT abnormality Incontinence Urolithiasis CKD Iatrogenic Immunosuppression Antibiotics Inflammation
What clinical signs are associated with LUTI?
Pollakiuria Stanguria/dysuria Haematuria Inappropriate urination Overgrooming genitalia esp. cats
What clinical signs are associated with UUTI?
Renal/lumbar pain
PU/PD
Haematuria
Fever/sepsis
How can you definitively diagnose a UTI ?
Urinalysis
Quantitative culture of urine
How should you collect urine for bacteriology?
CYSTO
No antibiotics 5-7 days before sampling
What are the facets of urinalysis?
Sediment examination
SG
Dipstick
What information can be obtained from quantitative culture?
Number of colony forming units determined
What is the fastest way of determining bacterial load in urine?
Point of care tests
What do you determine from antimicrobial susceptibility testing?
Minimum inhibitory concentration of antimicrobial
Clinical breakpoint
How can you classify the different types of bacterial UTI?
Sporadic bacterial cystitis Recurrent bacterial cystitis Upper UTIs Bacterial prostatitis Subclinical bacteriuria
Compare the incidence of sporadic bacterial cystitis in dogs and cats.
Common in dogs, rarer in cats
What clinical presentation is associated with sporadic bacterial cystitis?
No more than 3 episodes per year
Patient otherwise healthy
(NOT entire male dog)
How would you treat sporadic bacterial cystitis?
NSAIDs to reduce inflammation
Empirical - Amoxy clavulante
Change post sensitivity
— if results available within 24h, wait until sens to treat
3-5d antibiotics based on sensitivity
What is the difference between sporadic and recurrent bacterial cystitis?
Recurrent - more than three episodes per year or more than two in 6 months
How would you approach work up for recurrent Bacterial cystitis?
Find underlying cause
Further diagnostics
- urine c+s
US, Rads, cystoscopy
Review previous Abs
How should you treat recurrent bacterial cystitis?
As for sporadic
Address causal factors
FOLLOW UP CULTURE 5-7d post Abs
What comorbidities are associated with recurrent bacterial cystitis?
Endocrinopathies Renal disease Obesity Abnormal vulvar conformation Congenital UT abnormalities Urinary retention Urinary incontinence Prostatic dz Polyploid cystitis Urolithiasis Immunosuppressive therapy Rectal fistula
What would you consider in an entire male with a UTI?
Bacterial prostatitis
What drug can penetrate the drug prostate barrier?
Fluoroquinolones
Is antibiotic therapy indicated in subclinical bacteriuria
NO
How do most diuretics act?
Inhibit sodium chloride reabsorption to increase salt and water excretion
Name a loop diuretic
FUROSEMIDE
Why might IV Furosemide be good for acute pulmonary oedema?
Has a pulmonary venodilator action when given IV
How does Furosemide reach the loop of Henle?
PCT secretion
Where do thiazides diuretics act?
Early DCT
Name a potassium sparing diuretic
Spironolactone
- competitive antagonist of aldosterone
- prevents potassium excretion
What is a potential adverse effect associated with spironolactone?
Hyperkalaemia
Less of a risk because competitive with aldoserone
Hyponatraemia
What is and adverse effect associated with Furosemide ?
Hypokalaemia
Hypochloraemic metabolic acidosis
Hyponatraemia
What adverse effect is associated with thiazides?
Hypomagnesaemia
Hypochloraemic metabolic acidosis
Hyponatraemia
What drugs are diuretics synergistic with?
Vasodilators
— need to reduce dose once congestion resolves
What is the effect of NSAIDs on salts?
Exacerbate salt and water retention as PGs are natriuretic (salt losing)
Describe the course of action of loop diuretics
Most effective but short acting
