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Week A14 - Nephrology > Urinary Tract Infections (UTIs) > Flashcards

Urinary Tract Infections (UTIs) Flashcards

1
Q

Define the following:

  1. bacteriuria? [1]
  2. what is the common type lower urinary tract infection (LUTI)? [1]
  3. what are the common types of upper urinary traction infection (UUTI)? [2]
  4. uncomplicated UTI? [2]
  5. complicated UTI? [3]
  6. relapse? [1]
  7. recurrent? [1]
  8. urosepsis? [5]
A
  1. bacteria in the urine, which can be asymptomatic or symptomatic
  2. cystitis (in bladder)
  3. pyelonephritis (infection of kidney/renal pelvis) or renal abscess
  4. lower UTI with normal structure & neurology
  5. upper UTI +/- systemic signs and symptoms OR catheter-associated UTI (CAUTI)
  6. infection with the same organism
  7. infection with same or different organism
  8. complicated UTI with sepsis:
    • temp >38°C
    • HR >90/min
    • RR >20/min
    • WBC >15 or <4
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2
Q

Bacteriuria

  1. at risk groups? [5]
  2. management? [2]
A
  1. at risk groups:
    • hospitalised
    • catheterised
    • diabetics
    • anatomical abnormalities
    • pregnant patients
  2. management:
    • treat asymptomatic bacteriuria only in preschool children, pregnancy, patients with renal transplant and immunocompromised patients
    • treatment in other asymptomatic patients not indicated
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3
Q

What are the features of ascending UTI? [4]

  1. where does colonisation occur?
  2. who is more susceptible: males or females?
  3. where does multiplication occur?
  4. what other structure is usually involved?
A
  1. urethral colonisation
  2. female > male
  3. multiplication in bladder
  4. ureteric involvement
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4
Q

What structure is usually involved in descending/haematogenous UTI? [1]

A

renal parenchyma

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5
Q

What are the clinical features of UIT?

  1. general signs & symptoms? [7]
  2. in neonates? [2]
  3. in children? [2]
  4. in elderly? [3]
A
  1. general signs & symptoms:
    • suprapubic discomfort
    • dysuria
    • urgency
    • frequency
    • cloudy, blood stained, smelly urine
    • low-grade fever
    • sepsis
  2. in neonates:
    • failure to thrive
    • jaundice
  3. in children:
    • abdominal pain
    • vomiting
  4. in elderly:
    • nocturia
    • incontinence
    • confusion
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6
Q

What are the common organisms which cause UTIs? [4]

A
  • Gram negative bacilli
    • E.coli
    • Klebsiella sp.
    • Proteus sp.
    • Pesudomonas sp
  • Gram positive bacteria
    • Streptococcus sp.
    • Enterococcus sp.
    • S. agalactiae (Group B streptococcus)
    • Staphylococcus sp. (S.saprophyticus, S.aureus),…
  • Anaerobes
  • (Candida sp.)
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7
Q

Uncomplicated UTI:

  1. how should you investigate non-pregnant women initially? [2]
  2. if the women does respond to treatment, what should you do? [2]
  3. how should you investigate children & men? [2]
A
  1. if 1st presentation, culture not mandatory, just do dipstick and give antibiotics
  2. if no response to treatment, do:
    • urine culture
    • change antibiotic
  3. in children and men, send urine for each and every presentation and treat appropriately
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8
Q

Uncomplicated UTI in pregnancy:

  1. how to investigate? [1]
  2. treatment? [3]
  3. potential complication? [1]
A
  1. send urine sample with each presentation
  2. treat for 7-10 days
    • amoxicillin and cefalexin relatively safe
    • avoid Trimethoprim in 1st trimester
    • avoid Nitrofurantoin near term
  3. can develop into pyelonephritis (30%)
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9
Q

Recurrent UTI

  1. definition? [2]
  2. managment? [2]
A
  1. ≥2 episodes in 6 months or ≥3 episodes/year
  2. prophylactic antibiotics for ideally 6 months
    • trimethoprim
    • nitrofurantoin
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10
Q

What are the types of complicated UTI? [4]

A
  1. catheter-associated UTI (CAUTI)
  2. acute pyleonephritis
  3. perinephric abscess
  4. renal abscess
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11
Q

What are the complications of frequent catheter use? [5]

A
  1. CAUTI
  2. obstruction-hydronephrosis
  3. chronic renal inflammation
  4. urinary tract stones
  5. long term risk of bladder cancer
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12
Q

Catheter Associated UTI (CAUTI):

  1. prevention strategies? [5]
  2. treatment? [3]
A
  1. prevention:
    • catheterise only if necessary
    • remove when no longer needed
    • remove/replace if causing infection
    • catheter care (bundles)
    • hand hygiene
  2. treatment:
    • start empirical antibiotics
    • remove catheter if not needed
    • replace catheter under broad-spectrum antibiotic cover
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13
Q

Acute Pyelonephritis

  1. features? [5]
  2. investigations? [3]
  3. community management? [3]
  4. hospital management? [2]
  5. long-term complication? [1]
A
  1. features:
    • upper UTI
    • ascending infection involving pelvis of kidney
    • results in enlarged kidney and abscesses on the surface of kidney
  2. investigations
    • urine culture
    • +/- blood culture
    • +/- imaging
  3. community management:
    • co-amoxiclav
    • ciprofloxacin
    • trimethoprim
  4. hospital management:
    • broad spectrum antibiotics
    • +/- radiological/surgical intervention
  5. long term complication:
    • renal abscess caused by gram-negative bacilli
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14
Q

Perinephric Abscess:

  1. risk factors? [5]
  2. common causative organisms? [3]
  3. symptoms? [2]
  4. management? [1]
A
  1. risk factors:
    • untreated LUTI
    • anatomical abnormalities
    • renal calculi
    • bacteraemia
    • haematogenous spread
  2. common causative organisms:
    • gram -ve bacilli → E.coli/Proteus sp.
    • gram +ve cocci → S.aureus/Streptococci
    • Candida sp.
  3. symptoms:
    • similar to pyelonephritis
    • localised signs & symptoms
  4. management:
    • treated empirically as complicated UTI but often poor response to antibiotic therapy
    • hence surgical management is indicated
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15
Q

Describe the treatment strategy for:

  1. uncomplicated UTI? [5]
  2. complicated UTI? [5]
A
  1. uncomplicated UTI:
    • PO antibiotics:
      • amoxicillin
      • trimethoprim
      • nitrofurantoin
      • pivemcillinam
      • fosfomycin
  2. complicated UTI:
    • IV antibiotics:
      • amoxicillin/vancomycin
      • gentamicin/azetronam/temocillin
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16
Q

Acute Bacterial Prostatitis:

  1. definition? [1]
  2. symptoms? [4]
  3. signs? [2]
  4. causative organisms? [3]
  5. investigations? [4]
  6. complications? [5]
  7. antibiotic management? [2]
A
  1. localised spontaneous infection that affects the prostate that may follow urethral instrumentation
  2. symptoms:
    • fever
    • perineal/back pain
    • UTI
    • urinary retention
  3. signs:
    • diffuse oedema
    • micro-abscesses
  4. causative organisms:
    • gram -ve bacilli e.g. E.coli, Proteus sp.
    • S. aureus (MSSA/MRSA)
    • N. gonorrhoea (less common)
  5. investigations:
    • urine culture, usually positive
    • blood culture
    • trans-rectal U/S
    • CT/ MRI
  6. complications:
    • prostatic abscess
    • spontaneous rupture of urethra/rectum
    • epididymitis
    • pyelonephritis
    • systemic sepsis
  7. antibiotic management:
    • ciprofloxacin/ofloxacin (no streptococcus cover)
17
Q

Epididymitis:

  1. definition? [1]
  2. causes? [2]
  3. symptoms? [5]
  4. causative organisms? [4]
A
  1. definition:
    • inflammatory reaction of the epididymis
  2. causes:
    • ascending infection from urethra
    • urethral instrumentation
  3. symptoms:
    • pain
    • fever
    • swelling
    • penile discharge
    • symptoms of UTI/urethritis
  4. causative organisms:
    • gram -ve bacilli
    • enterococci
    • staphylococci
    • TB in high risk areas/individuals
18
Q

Orchitis

  1. definition? [1]
  2. symptoms? [5]
  3. causes? [3]
  4. pyogenic bacterial orchitis is a complication of what? [1]
  5. complications of bacterial orchitis? [2]
A
  1. inflammation of one or both testicles
  2. symptoms:
    • testicular pain
    • testicular swelling
    • dysuria
    • fever
    • penile discharge
  3. causes
    • usually viral
      • mumps
    • can be bacterial
  4. pyogenic bacterial orchitis is a complication of epididymitis
  5. complications
    • testicular infarction
    • abscess formation
19
Q

Fournier’s Gangrene

  1. definition? [1]
  2. clinical presentation? [3]
  3. risk factors? [4]
  4. investigations? [3]
  5. management? [2]
A
  1. form of necrotising fasciitis that occurs in patients >50yrs of age
  2. clinical presentation:
    • rapid onset and spreading infection
    • systemic sepsis
  3. risk factors:
    • UTI
    • complications of IBD
    • trauma
    • recent surgery
  4. investigations:
    • blood cultures
    • urine culture
    • tissue/pus
  5. management:
    • 1st line = surgical debridement
    • broad spectrum/combination antibiotics e.g.
      • pip-tazobactam + gentamicin + metronidazole
      • +/- clindamycin

Week A14 - Nephrology (12 decks)

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