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urinary tract infections Flashcards

1
Q

what is an UTI?

A

an infection of any part of your urinary system

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2
Q

what is an infection?

A

an infection is the invasion of body tissues by a pathogenic organism

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3
Q

what are the predisposing factors to UTIs?

A

o female sex

o urinary stasis

  • pregnancy
  • prostatic hypertrophy
  • stones
  • strictures
  • neoplasia
  • residual urine

o urological instrumentation (including catheters)

o sexual intercourse

o Fistulae

o congenital abnormalities
- vesicle-uteric reflux VUR

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4
Q

what are the normal bacteria in the urinary tract?

A

the ureter and kidney is sterile.

the urethra is colonised, perineal flora is found there.

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5
Q

what makes up the perineal flora?

A

skin flora
- mainly coagulase negative staphylococci

Lower GI tract flora

  • colonising bacteria are often found on the skin around the relevant oriface
  • anaerobic bacteria
  • aerobic bacteria

Enterobacterales (aka coliforms, enteric Gram negative bacilli)

Gram positive Cocci
-enterococcus spp.

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6
Q

where do the invading bacteria come from?

A

Endogenous
- most infections are caused by gut bacteria
+ Perineum
- movement of bacteria along a lumen
+ Fistulae
- Movement of bacteria from the Genital/GI tract to the urinary tract

Haematogenous Spread
- seeding of bacteria to the urinary tract via the blood

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7
Q

so, what are the organisms that cause UTIs?

A

E.coli - 70/80% general practice, 50% hospital

CNS - 10/15% general practice

enterococcus spp. 10/20% hospital

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8
Q

where does cystitis occur?

A

lower UTI

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9
Q

what are the signs and symptoms of Cystitis?

A 
Dysuria
Frequency
Urgency
Supra-pubic pain or tenderness
polyuria, nocturne, haematuria
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10
Q

what is pyelonephritis?

A

infection of the kidney/or renal pelvis

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11
Q

what are the signs and symptoms of pyelonephritis?

A

symptoms of lower UTI
loin/abdominal pain or tenderness
fever

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12
Q

what is catheter associated UTI?

A

indwelling catheterisation results in bacteriuria

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13
Q

what are the signs and symptoms for Urosepsis?

A
  • fever
  • rigors
  • nausea, vomiting, diarrhoea
  • +/- haemodynamic compromise
  • raised inflammatory markers
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14
Q

what is prostatitis?

A

inflammation of prostate

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15
Q

what are the signs and symptoms of acute bacterial prostatitis?

A

lower urinary tract symptoms
fever
tender tense prostate
acute retention

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16
Q

what are the typical pathogens of acute bacterial prostatitis?

A

typically the normal urinary pathogens e.g. E.coli

S. aureus

17
Q

what are the risk factors of prostatitis?

A

procedures involving the prostate
- TURP
- TRUS biopsy
Indwelling urinary catheter

18
Q

what are the signs and symptoms of chronic prostatitis?

A
  • 90% due to chronic pelvic pain syndrome
  • pain in and around the perineum and genitalia
  • lower urinary tract symptoms (LUTS)
  • enlarged or tender prostate on examination
19
Q

what is sterile pyuria?

A 
pus cells (raised WCC) in the urine
no organisms grown
20
Q

why does sterile pyuria occur?

A
  • inhibition of bacterial growth
  • fastidious organisms
  • urinary tract inflammation
  • urethritis
21
Q

what is the non-antimicrobial management?

A
  • fluid intake
  • anti-inflammatories
  • device removal
  • drainage if obstruction
  • recurrent UTIs
22
Q

what makes a good UTI antibiotic?

A
  • gets into the urine
  • minimally toxic
  • effective against likely organisms
  • easily administered
  • cheap
23
Q

how to treat female cystitis?

A
  • treatment often pre-empts microbiology results

- short course of antibiotics. 3days

24
Q

how to treat male cystitis?

A

-longer course, 7 days

25
Q

how to treat pyelonephritis?

A

empiric therapy

  • broad action required
  • need to be systemically active

Directed therapy

  • based on sensitivity results
  • not all oral agents are suitable for PO step-down

Duration
- 7-14 days depending on antibiotic used

26
Q

how to treat prostatitis?

A
  • need to be active against likely pathogens
  • need to penetrate the prostate
  • empirical options
  • piperacillin-tazobactam (IV)
  • ciprofloxacin (IV/PO)

duration 2,4 weeks

27
Q

do we treat asymptomatic bacteriuria?

A

treat only specific groups

  • pregnant
  • infant
  • prior to urological procedures

CP (14 decks)

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