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uti Flashcards

1
Q

Types and classifications of UTI

A
  1. asymptomatic bacteriuria (self limiting)
  2. cystitis (bladder)
  3. pyelonephritis (kidney)
  4. UTI with bacteremia, sepsis or death
  5. UTI in pregnancy
  6. catheter-associated UTI
  7. nosocomial/healthcare-associated pyelonephritis
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2
Q

what is sepsis

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

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3
Q

3 classification of UTI

A
  1. upper UTI
  2. Lower UTI
  3. Catheter associated UTI
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4
Q

types of upper UTI

A

pyelonephritis (kidneys)

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5
Q

types of lower UTI

A

cystitis (bladder)
urethritis (urethra)
prostatitis (prostate)
epididymitis (epididymis)

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6
Q

route of UTI infection

A
  1. ascending

2. hematogenous (descending)

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7
Q

ascending route of infection

A
  • colonic/fecal flora colonise periurethra area, ascend to bladder and kidney
  • higher risk in females due to shorter urethra
  • eg organism: E.coli, Kleb, Proteus
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8
Q

Hematogenous (Descending) route of infection

A
  • organism at distant primary site (eg. heart or bones), into bloodstream (bacteremia), urinary tract causing UTI
  • eg organisms: staph aureus, TB
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9
Q

factors determining development of UTI

A
  1. competency of natural host defense mechanisms
  2. size of inoculum (amount of bacteria present)
  3. virulence/pathogenicity of microorganisms (how resistant)
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10
Q

Host defences against UTI

A
  1. micturition stimulated by bladder with increase diuresis to empty bladder
  2. antibacterial properties of urine and prostatic secretion
  3. adherence mechanism of bladder (prevent bacterial attachment to bladder)
  4. inflammatory responses withy polymorphonuclear leukocytes (PMNs); phagocytosis, to prevent and control spread
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11
Q

risk factors of UTI

A
  1. Female>male
  2. sex
  3. abnormalities in urinary tract
  4. neurological dysfunctions
  5. anticholinergic drugs
  6. catheterization and other mechanical instruments
  7. DM
  8. pregnancy
  9. use of diaphragms/ spermicides
  10. genetic association / positive family history
  11. previous UTI
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12
Q

healthcare associated risk factor

A
  1. hospitalisation last 90d
  2. current hospitalisation >=2d
  3. residence in nursing home
  4. antimicrobial use last 90d
  5. home infusion therapy
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13
Q

complicated UTI definition

A

associated with conditions that increase potential for serious outcomes, risk for therapy failure. present with complicating factors like functional/structural abnormalities of urinary tract, genitourinary instrumentation, DM, immunocompromised host

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14
Q

uncomplicated UTI

A

usually in healthy premenopausal, non-pregnant women with no history suggestive of abnormal urinary tract

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15
Q

clinical spectrum of uncomplicated UTI

A

mild cystitis to severe pyelonephritis

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16
Q

diagnosis of uncomplicated UTI

A

infection suspected on basis of typical symptoms, urinalysis and urine culture but not routinely needed for suspected cystitis but recommended for pyelonephritis

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17
Q

diagnosis for complicated UTI

A

typical symptoms or symptoms that are atypical and subtle (owing to catheterisation, impaired sensation, or altered mental status, urinalysis and urine culture indicated

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18
Q

subjective diagnosis of lower urinary tract infection (Cystitis)

A

dysuria, uregency, frequency, nocturia, suprapubic heaviness or pain, gross hematuria (blood in urine)

19
Q

subjective diagnosis of upper urinary tract infection (pyelonephritis)

A

fever, rigors, headache, N&V, malaise (discomfort), flank pain, costovertebral tenderness- do the renal punch to test), abdominal pain

20
Q

objective diagnosis of UTI

A

urine sent for urinalysis (UFEME- urine formed elements and microscopic examination) and culture

21
Q

types of urine collection

A
  1. midstream clean catch
  2. catheterisation
  3. suprapubic bladder aspiration
22
Q

things to look out for during microscopic urinalysis

A
  1. WBC
  2. RBC
  3. microorganisms: identify bacteria/yeast using gram-stain
  4. WBC casts
23
Q

what to look out for in WBC count

A

> 10WBC/mm3 suggest pyuria, showing signs of inflammation which may or may not be from infection, not having pyuria rules out UTI

24
Q

what to look out for in RBC count

A

microscopic >5/HPF or gross suggest hematuria, blood can also be due to menses/ trauma

25
Q

what does WBC cast cell suggest

A

they are masses of cells and proteins that form in renal tubules in kidney, indicating upper tract infection/disease (in the kidney)

26
Q

what does presence of nitrite means

A

presence of nitrite: (>10^5 bacterial/ml; presence of gram neg; false neg due to presence of gram pos (P. aeruginosa, low urinary pH, dilute urine)

27
Q

what does leukocyte esterase (LE) refer to

A

correlates with significant pyuria (>10WBC/mm3)

28
Q

when to obtain urine culture

A
  1. pre-treatment for pregnant women
  2. pre-treatment for recurrent UTI (within 2w)
  3. pre-treatment for pyelonephritis
  4. pre-treatment for catheter associated UTI
  5. pre-treatment for all men with UTI
  6. not needed in uncomplicated cystitis
29
Q

common pathogen for complicated / healthcare associated UTI

A
  1. E.coli
  2. enterococci
  3. Proteus spp
  4. klebsiella spp
  5. enterobacter spp
  6. p. aeruginosa
30
Q

common pathogen for uncomplicated or community acquired UTI

A
  1. E.coli
  2. Staphylococcus saprophyticus
  3. Enterococcus faecalis
  4. klebsiella pneumoniae
  5. Proteus spp
31
Q

other pathogen for uti

A
  1. S. aureus (bacteremia- consider other primary site of infection)
  2. yeast/candida (possible contaminant- consider other site of infection)
32
Q

should treatment be started on pregnant women with UTI, and why?

A

treatment reduces development of pyelonephritis and risk of preterm labour and low birth weight infant

33
Q

what should be done to pt going for invasive urologic procedures with mucosal trauma (like TURP, cystoscopy with biopsy)

A

antibiotics given as prophylaxis, to prevent postoperative bacteremia and sepsis; obtain culture then start antibiotics based on culture and sensitivity 12-24h before procedure

34
Q

first line empiric antibiotics for uncomplicated cystits in women

A
  1. PO cotrimoxazole 800/160mg BD x3d or
  2. PO nitrofurantoin 50mg QID x 5d or
  3. PO fosfomycin 3g single dose (inferior)
35
Q

alternative empiric antibiotics for uncomplicated cystitis in women

A
  1. PO beta-lactams x3-7d (inferior)
    a: PO cefuroxime 250mg BD
    b: PO cephalexin 500mg BD
    c: PO amoxi-clav 625mg BD
  2. PO fluoroquinolones x3d: (good but care res.)
    a: PO ciprofloxacin 250mg BD
    b: levofloxacin 250mg OD
36
Q

duration of empiric antibiotic for complicated cystitis

A

longer duration 7-14d of the uncomplicated treatment

37
Q

empiric antibiotics for community acquired pyelonephritis in women

A
  1. PO ciprofloxacin 500mg BD x7d or
  2. PO levofloxacin 750mg OD x5d or
  3. PO cotrimoxazole 160/800mg BD x14d
  4. PO cephalexin 500mg BD 10-14d
  5. PO amoxi-clav 625mg TDS 10-14d
  6. IV cipro 400mg BD
  7. IV cefazolin 1g q8h
  8. IV amoxi-clav 1.2g q8h
  9. IV/IM genta 5mg/kg
38
Q

empiric antibiotic for community acquired UTI in men

A
  1. PO ciprofloxacin 500mg BD or
  2. PO cotrimoxazole 800/160mg BD
    for 10-14d
39
Q

empiric antibiotics for nosocomial (onset >48h)/healthcare related pyelonephritis

A
  1. IV cefepime 2g q12h +/- amikacin 15mg/kg/d or
  2. IV imipenem 500mg q6h or
  3. IV meropenem 1g q8h or
  4. PO levofloxacin 750mg (less sick) or
  5. PO ciprofloxacin 500mg BD (less sick)
    for 7-14d
40
Q

empiric antibiotic for catheter-associated UTI

A
  1. IV imipenem 500mg q6h
  2. IV meropenem 1g q8h
  3. PO/IV levofloxacin 750mg x5d (mild CA-UTI)
  4. PO cotrimoxazole 960mg BD x3d (<65yo [F] with CA-UTI)
41
Q

catheter association UTI prevention

A
  1. avoid unnecessary use of catheter
  2. minimal duration of catheter
  3. long term indwelling catheters changed before blockage is likely to occur
  4. use closed system
  5. aseptic insertion techique
  6. prophylactic & chronic suppressive & topical antiseptic/antibiotics not rec.
42
Q

Antibiotics to avoid in pregnant UTI

A
  1. ciprofloxacin (fetal cartilage damage, arthropathies)
  2. cotrimoxazole in first and third trimester (G6PD)
  3. nitrofuratoin at term: 38-42w (G6PD)
  4. AG (8th cranial nerve toxicity)
43
Q

treatment in pregnant UTI pt

A
  1. beta-lactams (first line)
  2. asymptomatic bacteriuria or cystitis- 7d
  3. pyelonephritis- 14d

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