Urology::UTIs Flashcards
Define pyelonephritis [1]
inflammation of the kidney resulting from bacterial infection. The inflammation affects the kidney tissue (parenchyma) and the renal pelvis (where the ureter joins the kidney).
Why are UTIs more common in women than men? [1]
The urethra is much shorter, making it easier for bacteria to get into the bladder.
What is the difference between complicated and uncomplicated UTIs? [2]
Uncomplicated UTI: if occurring in healthy non-pregnant adult women
Complicated UTI: the presence of factors that increase the risk of treatment failure (e.g diabetes, structural abnormalities, catheter and other devices and all UTIs in men)
UTIs are caused by the organism [] in 75-90% of cases.
UTIs are caused by the organism Escherichia coli in 75-90% of cases.
Escherichia coli (E. coli) is a [] that is a facultative inhabitant of the large intestines.
HINT: type of bacteria
Escherichia coli (E. coli) is a gram-negative bacillus that is a facultative inhabitant of the large intestines.
State the 4 most common causes of UTIs
Escherichia coli (E. coli)
Proteus mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus
Haematogenous spread of UTIs is more often seen with uncommon urinary microorganisms such as [3]
Haematogenous spread is more often seen with uncommon urinary microorganisms such as Staphylococcus aureus, Candida albicans and Mycobacterium tuberculosis.
Name a common vector of infection of UTIs [1]
Why is this clinically significant? [1]
Urinary catheters are a possible source of infection
Catheter-associated urinary tract infections tend to be more serious and challenging to treat.
Name 5 risk factors for development of UTIs [5]
Recent sexual intercourse
Diabetes
History of UTIs
Spermicide use
Catheters
Describe presentation of UTIs [5]
Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
N & V
Urgency
Incontinence
Haematuria
Cloudy or foul-smelling urine
Confusion is commonly the only symptom in older and frail patients
Pyelonephritis has a similar presentation to lower urinary tract infections plus the additional triad of symptoms of which symptoms? [3]
Which sign also indicates pyelonephritis? [1]
Symptoms:
* Fever
* Loin or back pain (bilateral or unilateral)
* Nausea or vomiting
AND
* Renal angle tenderness on examination
Explain which investigations should be given for UTIs? [2]
Urine dipstick:
- Nitrates suggest bacteria in urine (E. coli breaks down nitrates into nitrites)
- Leukocytes
- Haematuria
Midstream urine sample:
- sample sent for microscopy, culture and sensitivity testing will determine the infective organism and the antibiotics that will be effective in treatment.
FYI:
Where only nitrites are present, it is worth treating as a UTI. Where only leukocytes are present, a sample should be sent to the lab for further testing. Antibiotics may be considered where there is clinical evidence of a UTI.
What is the management of lower UTIs causing uncomplicated cystitis: (include length of time)
First line? [2]
Second line? [3]
Length of treatment? [1]
3-5 day course of standard antibiotics to local guidance:
First line:
* Nitrofurantoin
* Trimethoprim
Second line:
* co-amoxiclav
* cephalosporin
* ciprofloxacin
A patient presents with recurring UTIs.
You have investigated using urine dipstick and MSU. What are the next most appopriate steps for investigation? [2]
USS renal tract or CT KUB (kidney, ureter, bladder)
Describe the differing length of treatment time for different patient populations for UTIs [3]
3 days of antibiotics for simple lower urinary tract infections in women
5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter-related UTIs
NICE guidelines (2018) recommend the which first-line antibiotics for 7-10 days when treating pyelonephritis in the community? [5]
Cefalexin
Co-amoxiclav (oral or IV if more serious; if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
IV Gentamicin (if severe)
How long should antibiotic treatment of pyelonephritis be provided for? [1]
7-10 days
Urinary tract infections in pregnancy increase the risk of w which pathologies? [3]
pyelonephritis
premature rupture of membranes
pre-term labour.
Urinary tract infection in pregnancy requires [] days of antibiotics.
All women should have an what additional investigation? [1]
Urinary tract infection in pregnancy requires 7 days of antibiotics.
All women should have an MSU for microscopy, culture and sensitivity testing.
What is the treatment for UTIs of pregnant women? [3]
When should each treatment be avoided? [3]
Nitrofurantoin (avoided in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin (the typical choice)
Why should nitrofurantoin be avoided in the 3rd trimester of pregnancy? [1]
Why should trimethoprim be avoided in the 1st trimester of pregnancy? [1]
Nitrofurantoin:
* should be avoided in the third trimester as there is a risk of neonatal haemolysis
Trimethoprim:
* should be avoided in the first trimester as it works as a folate antagonist. Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.
Which conditions should trimethoprim be avoided in? [1]
Renal impairment
Those with HLA-[] blood group antigen - tend to have recurrent UTIs
Those with HLA-A3 blood group antigen - tend to have recurrent UTIs
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What is the difference in organs implicated between lower UTI and upper UTIs? [3]
Lower: cystitis; prostatitis
Upper: pyelonephritis (kidney / renal pelvis)
What is abacterial cystitis / urethral syndrome? [1]
A diagnosis of exclusion with dysuria and frequency, without demonstrable infection
What is the difference between complicated and uncomplicated UTI? [2]
Complicated UTI: structural/functional abnormality of genitourinary tract (e.g. stone / catheter / neurogenic bladder)
Uncomplicated UTI: normal renal structure and function
State 4 categoriesand examples of risk factors for UTIs
Increase in bacterial innoculation:
* sexual activity
* urinary incontinence
* faecal incontinence
Increased binding of uropathogenic bacteria:
- spermicide use
- decreased oestrogen
- menopause
Decreased urine flow
Increased bacterial growth:
- DM
- I/S
- Stones
- Obstruction
- Pregnancy
Lower urinary tract infections present with which symptoms? [6]
Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul-smelling urine
Confusion is commonly the only symptom in older and frail patients
Pyelonephritis has a similar presentation to lower urinary tract infections plus the additional triad of symptoms [3]
Fever
Loin or back pain (bilateral or unilateral)
Nausea or vomiting
Renal angle tenderness on examination
If vaginal discharge is present, what is your most likely differential? [1]
PID
Which pathogen is the most common cause of UTI? [1]
Name two other causes
E. coli
Staph. saprophyticus
Klebsiella pneumoniae
How do you manage UTIs in non-pregnant women? [2]
If 3+ symptoms of cystitis and no vaginal discharge:
- 3 day course of trimethoprim or nitrofurantoin
- If fails, take a MSU and send for culture
How do you manage UTIs in pregnant women? [1]
Which drugs should be avoided [3] and in which semesters? [3]
Get expert help: associated with pre-term babies
Avoid:
* trimethoprim & ciprofloxacin in trimester 1
* nitrofurantoin in 3rd trimester
How do you manage UTIs in men:
- If lower UTI [2]
- If suspected prostatic involvement [1]
If lower UTI:
* 7 day course of trimethoprim or nitrofurantoin
If suspected prostatic involvement:
- Ciprofloxacin
- Cefalexin (the typical choice)
The typical duration of antibiotics is:
[] days of antibiotics for simple lower urinary tract infections in women
[] days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
[] days of antibiotics for men, pregnant women or catheter-related UTIs
The typical duration of antibiotics is:
3 days of antibiotics for simple lower urinary tract infections in women
5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter-related UTIs
What risk does giving nitrofurantoin in 3rd trimester risk? [1]
Nitrofurantoin should be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).
What risk does giving trimethoprim in 1st trimester risk? [1]
Trimethoprim should be avoided in the first trimester as it works as a folate antagonist.
Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are? [2]
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are:
Renal abscess
Kidney stone obstructing the ureter, causing pyelonephritis
NICE guidelines (2018) recommend which first-line antibiotics for 7-10 days when treating pyelonephritis in the community? [4]
Cefalexin
Co-amoxiclav (if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
State the 4 most common causes of UTIs
Escherichia coli (E. coli)
Proteus mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus
Haematogenous spread of UTIs is more often seen with uncommon urinary microorganisms such as [3]
Haematogenous spread is more often seen with uncommon urinary microorganisms such as Staphylococcus aureus, Candida albicans and Mycobacterium tuberculosis.
Pyelonephritis has a similar presentation to lower urinary tract infections plus the additional triad of symptoms of which symptoms? [3]
Which sign also indicates pyelonephritis? [1]
Symptoms:
* Fever
* Loin or back pain (bilateral or unilateral)
* Nausea or vomiting
AND
* Renal angle tenderness on examination
Explain which investigations should be given for UTIs? [2]
Urine dipstick:
- Nitrates suggest bacteria in urine (E. coli breaks down nitrates into nitrites)
- Leukocytes
- Haematuria
Midstream urine sample:
- sample sent for microscopy, culture and sensitivity testing will determine the infective organism and the antibiotics that will be effective in treatment.
FYI:
Where only nitrites are present, it is worth treating as a UTI. Where only leukocytes are present, a sample should be sent to the lab for further testing. Antibiotics may be considered where there is clinical evidence of a UTI.
What is the management of lower UTIs causing uncomplicated cystitis: (include length of time)
First line? [2]
Second line? [3]
Length of treatment? [1]
3-5 day course of standard antibiotics to local guidance:
First line:
* Nitrofurantoin
* Trimethoprim
Second line:
* co-amoxiclav
* cephalosporin
* ciprofloxacin
A patient presents with recurring UTIs.
You have investigated using urine dipstick and MSU. What are the next most appopriate steps for investigation? [2]
USS renal tract or CT KUB (kidney, ureter, bladder)
Describe the differing length of treatment time for different patient populations for UTIs [3]
3 days of antibiotics for simple lower urinary tract infections in women
5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter-related UTIs
NICE guidelines (2018) recommend the which first-line antibiotics for 7-10 days when treating pyelonephritis in the community? [5]
Cefalexin
Co-amoxiclav (oral or IV if more serious; if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
IV Gentamicin (if severe)
How long should antibiotic treatment of pyelonephritis be provided for? [1]
7-10 days
Urinary tract infections in pregnancy increase the risk of w which pathologies? [3]
pyelonephritis
premature rupture of membranes
pre-term labour.
Urinary tract infection in pregnancy requires [] days of antibiotics.
All women should have an what additional investigation? [1]
Urinary tract infection in pregnancy requires 7 days of antibiotics.
All women should have an MSU for microscopy, culture and sensitivity testing.
Why should nitrofurantoin be avoided in the 3rd trimester of pregnancy? [1]
Why should trimethoprim be avoided in the 1st trimester of pregnancy? [1]
Nitrofurantoin:
* should be avoided in the third trimester as there is a risk of neonatal haemolysis
Trimethoprim:
* should be avoided in the first trimester as it works as a folate antagonist. Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.
Which conditions should trimethoprim be avoided in? [1]
Renal impairment
Those with HLA-[] blood group antigen - tend to have recurrent UTIs
Those with HLA-A3 blood group antigen - tend to have recurrent UTIs
State 4 categoriesand examples of risk factors for UTIs
Increase in bacterial innoculation:
* sexual activity
* urinary incontinence
* faecal incontinence
Increased binding of uropathogenic bacteria:
- spermicide use
- decreased oestrogen
- menopause
Decreased urine flow
Increased bacterial growth:
- DM
- I/S
- Stones
- Obstruction
- Pregnancy
If vaginal discharge is present, what is your most likely differential? [1]
PID
Which pathogen is the most common cause of UTI? [1]
Name two other causes
E. coli
Staph. saprophyticus
Klebsiella pneumoniae
How do you manage UTIs in non-pregnant women? [2]
If 3+ symptoms of cystitis and no vaginal discharge:
- 3 day course of trimethoprim or nitrofurantoin
- If fails, take a MSU and send for culture
How do you manage UTIs in pregnant women? [1]
Which drugs should be avoided [3] and in which semesters? [3]
Get expert help: associated with pre-term babies
Avoid:
* trimethoprim & ciprofloxacin in trimester 1
* nitrofurantoin in 3rd trimester
How do you manage UTIs in men:
- If lower UTI [2]
- If suspected prostatic involvement [1]
If lower UTI:
* 7 day course of trimethoprim or nitrofurantoin
If suspected prostatic involvement:
- Ciprofloxacin
- Cefalexin (the typical choice)
The typical duration of antibiotics is:
[] days of antibiotics for simple lower urinary tract infections in women
[] days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
[] days of antibiotics for men, pregnant women or catheter-related UTIs
The typical duration of antibiotics is:
3 days of antibiotics for simple lower urinary tract infections in women
5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
7 days of antibiotics for men, pregnant women or catheter-related UTIs
What risk does giving nitrofurantoin in 3rd trimester risk? [1]
Nitrofurantoin should be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).
What risk does giving trimethoprim in 1st trimester risk? [1]
Trimethoprim should be avoided in the first trimester as it works as a folate antagonist.
Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are? [2]
Two things to keep in mind with patients that have significant symptoms or do not respond well to treatment are:
Renal abscess
Kidney stone obstructing the ureter, causing pyelonephritis
NICE guidelines (2018) recommend which first-line antibiotics for 7-10 days when treating pyelonephritis in the community? [4]
Cefalexin
Co-amoxiclav (if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
