UTI Flashcards
What is the most common pathogen that causes a UTI?
E.coli
UTIs are uncommon in healthy individuals. True or false?
False
Why are women more prone to UTIs than men?
Because they have a shorter urethra, predisposing to infection with G-ve bacteria from GIT
What are the signs of UTI?
Frequency: visit the toilet more often than usual. Dysuria: pain, stinging, burning sensations. Urgency: feel the need to go to the toilet a lot. Haematuria: blood in urine
What are some risk factors for UTIs?
regular sex, use of spermicides, dehydration as there’s reduced bulk flow of urine, age, pregnancy, indwelling medical device (bacterial colonisation of catheter)
Explain how UPEC works within the host
colonises the bowel in some people causing contamination of the per urethral region with the bacteria and is capable of causing UTI. Will then move to the kidneys to cause pyelonephritis. To colonise the lower regions of urinary tract will use type 1 fimbriae to attach to uroepithelial layers & in the kidneys it overexpresses P fimbriae
Is the urinary tract usually completely sterile?
Yes
What is cystitis?
inflammation of the bladder which is usually as a result of an infection in the bladder
How is cystitis managed in community?
OTC potassium and sodium citrate - alkaline so make urine less painful to pass, OTC analgesia
When should a case of cystitis be referred, in community?
pregnancy, diabetes, men and children, re-current
What is pyelonephritis?
An ascending bacterial infection in UT -> Inflammation of the kidney
What are the symptoms of pyelonephritis?
Initially the same as cystitis then: fever, loin pain, malaise, elevated RBC in urine and WBC casts can be seen
How is a UTI diagnosed?
Symptoms/ Urine dipstick - nitrates and leukocytes (protein and blood even though these are not diagnostic)/ Mid-Stream Sample of Urine - indicates organism responsible
What does a presence of nitrates in urine indicate?
Bacterial infection as nitrates are a breakdown product
Recurrent UTIs carry an increased risk of renal damage. When should a patient be referred?
Refer if patient has had more than 3 episodes in one year or 2 in 6 months
What can recurrent UTIs be associated with?
biofilm formation in the bladder
What is meant by an uncomplicated UTI?
Women (including pregnant), single episode in children
What is meant by a complicated UTI?
Men/ Structural abnormality - indwelling catheter, prostatic hypertrophy etc.
When should a UTI be treated?
If patient is symptomatic AND urine dipstick is positive (i.e. nitrates and leukocytes)
What advice can be given to patients on symptom control and prevention of UTIs?
Drink plenty of fluids, avoid caffeine, empty bladder after sex, empty bladder often and ensure full emptying – wipe front to back
UTIs are uncommon in pregnancy – it is an emergency and needs immediate referral. True or false?
False, very common and often asymptomatic - risk of progression to pyelonephritis
For UTIs in pregnancy, what are women screened for at their first visit?
Bacteriuria
Pregnant women with bacteriuria are not given antibiotics if they are asymptomatic. True or false?
False, given , even if asymptomatic urine culture performed 7 days after AB treatment
When are children treated for UTIs?
When urine dipstick positive
How many days is the treatment for children with cystitis/lower UTI?
3 days
If child has UTI and is at risk of pyelonephritis/upper UTI, how many days is treatment?
10 days
What is first line treatment for UTIs?
Trimethoprim & Nitrofurantoin
What is the treatment for recurrent UTI and what is the duration?
Treat as UTI and also consider prophylaxis with trimethoprim - duration 3-6 months
What drugs are given for acute pyelonephritis?
2nd gen cephalosporins, Quinolones, Gentamicin, For 14 days
What drug are given in pregnancy for asymptomatic bacteriuria?
Amoxicillin for 7 days
Why is nitrofurantoin less effective for upper UTI’s?
due to poor tissue penetration and lack of effective therapeutic concentration in kidney
Explain some resistance issues concerning UTIs
growing UPEC insensitivity to nitrofurantoin and trimethoprim, ESBL production a growing issue, although difficult to accurately monitor in UTIs
