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Week 12 - Nephrology and urology > UTI > Flashcards

UTI Flashcards

1
Q

Bacteriuria

A

Bacteria in urine, often asymptomatic

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2
Q

Lower urinary tract infection

A

Cystitis (bladder)

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3
Q

Upper urinary tract infection

A

Pyelonephritis, renal abscess

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4
Q

Uncompliated UTI

A

Lower UTI with normal structure and neurology

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5
Q

Complicated UTI

A
  • upper UTI with or without systemic signs and symptoms

* CAUTI (catheter)

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6
Q

Recurrent

A
  • Infection with the same or different organism
  • > /2 episodes in six months or >/3 episodes a year
  • Mostly women
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7
Q

Urosepsis, complicated UTI

A
  • Temperature >38 degrees
  • HR>90/min
  • RR>20/min
  • WBC >15.0 or <4.0
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8
Q

What are the risk factors of bacteriuria?

A
  • Sex: female>male
  • Urinary catheterisation
  • Diabetes
  • Anatomical abnormalities of urinary tract system
  • Pregnancy
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9
Q

When do you treat asymptomatic bacteriuria?

A
  • Preschool children
  • Pregnancy
  • Renal transplant or immunocompromised
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10
Q

Describe a descending UTI

A
  • Haematogenous spread

* Involvement of the renal parenchyma

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11
Q

When are there more likely to be multiple organisms in a UTI?

A
  • Long term catheter
  • Recurrent infection
  • Structural/neurological abnormalities
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12
Q

When are there more likely to be multi drug resistant organisms in a UTI?

A
  • Anatomical/neurological abnormalities
  • Frequent infections
  • Multiple antibiotic courses
  • Prophylactic antibiotic use
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13
Q

What are the common UTI organisms?

A

•Gram negative bacilli:

  • E. coli
  • klebsiella sp.
  • proteus sp.
  • pseudomonas sp.

•gram positive bacilli:

  • streptococcus sp.
  • enterococcus sp.
  • s. agalactiae (group B streptococcus0
  • Staphylococcus sp.
  • Candida
  • Anaerobes
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14
Q

What are the clinical features of UTI?

A
  • Suprapubic discomfort
  • Dysuria
  • Urgency
  • Frequency
  • Cloudy, blood stained, smelly urine
  • Low grade fever
  • sepsis
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15
Q

What are the signs of UTI in neonates?

A
  • Failure to thrive

* Jaundice

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16
Q

What are the clinical features of UTI in children?

A
  • Abdominal pain

* Vomiting

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17
Q

What are the clinical features of UTI in the elderly?

A
  • Nocturia
  • Incontinence
  • Delirium
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18
Q

Explain the management of UTI in pregnant women

A
  • Send urine
  • Check previous sensitivities
  • Amoxicillin and cefalexin are relatively safe but avoid trimethoprim in 1st trimester or nitrofurantoin near term
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19
Q

Describe the management of recurrent UTI

A
  • Send sample from each episode
  • Emphasise the importance of hygiene
  • Encourage hydration
  • Encourage urge initiated and post coital voiding
  • Intravaginal/oral oestrogen
  • Antibiotic therapy as per symptoms: send administered single dose/short course therapy, single dose post coital, prophylactic if simple measures fail
  • 6 months: trimethoprim or nitrofurantoin
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20
Q

What are the prevention strategies of catheter infections?

A
  • Catheterise only if necessary
  • Remove when it is no longer needed
  • Remove/replace if causing infection
  • Infection prevention precautions
  • catheter care - check list to appropriately manage
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21
Q

What is acute pyelonephritis?

A
  • Upper urinary tract infection
  • Moderate to severe infection
  • Flank pain +/- systemic infection
  • enlarged kidney
  • Abscesses in surface of kidney
22
Q

What is the management of acute pyelonephritis?

A
  • Check previous microbiology results
  • Options may be limited
  • Send urine +/- blood culture and imaging
  • If in community: co-amoxiclav/ciprofloxacin/trimethoprim
  • Hospital: IV antibiotics initially
  • If uncomplicated 7-14 days, if complicated then 14 days+ and also consider radiological or surgical intervention (drainage)
23
Q

What are renal abscesses a complication of?

A

Pyelonephritis (or due to haematongenous spread)

24
Q

What are the most common causative organisms in renal abscess?

A
  • Gram negative bacilli

* If haematogenous spread then staphylococci

25
Q

What is a complication of renal abscess

A

Emphysematous pyelonephritis: requires urgent urology review

26
Q

Explain perinephric abcess

A

•Uncommon
•Often from haematogenous spread
•Common organisms:
- gram negative bacilli: E.coli, Proteus sp.
- gram positive cocci: s.aureus, streptococci
- candida

27
Q

What are the symptoms of perinephric abscess?

A
  • Flank pain, may have systemic symptoms

* Swollen - localised signs and symptoms

28
Q

Describe the management of perinephric abscess

A
  • Send urine and blood culture (usually positive blood cultures)
  • Pyuria (white cells in urine)
  • Treat empirically as complicated UTI
  • Surgical management
29
Q

What are the antibiotic guidelines for complicated UTI?

A
  • Usually IV therapy
  • Amoxicillin/vancomycin
  • Gentamicin/aztreonam/temocillin
30
Q

What does amoxicillin cover?

A
  • Some gram negatives

* Streptococci

31
Q

What does co-amoxiclav cover?

A
  • some gram negative cover
  • Streptococci
  • Anaerobes
32
Q

What does pivemecillinam cover?

A

Gram negative but not pseudomonas

33
Q

What does ciprofloxacin cover?

A
  • Gram negatives including pseudomonas

* Poor gram positive cover

34
Q

What are the signs/symptoms of acute bacterial prostatitis?

A
  • Diffuse oedema
  • Micro abscesses
  • Perineal/back pain
  • UTI symptoms
  • Urinary retention
  • Pyrexia
35
Q

What is essential in suspected acute bacterial prostatitis?

A

Urology referral

36
Q

What are the complications of acute bacterial prostatitis?

A
  • Prostatic abscess
  • Spontaneous rupture
  • Epididymitis
  • Ascending infection
  • Systemic sepsis
37
Q

What investigations should be carried out in suspected acute bacterial prostatitis?

A
  • Urine culture
  • Blood culture
  • Trans-rectal Ultrasound
  • CT/MRI
38
Q

What are the likely organisms causing acute bacterial prostatitis?

A
  • Gram negative bacilli
  • S.aureus
  • N.gonorrhoea
39
Q

What is the empirical antibiotic management of acute bacterial prostatitis?

A

•Ciprofloxacin/ofloxacin

40
Q

What may chronic prostatitis follow?

A

Chlamydia urethritis

41
Q

What are the common organisms causing chronic prostatitis?

A
  • Gram negative bacilli: E. coli, proteus sp.
  • Enterococcus sp.
  • S. aureus
42
Q

What is the aetiology of epididymitits?

A
  • Ascending infection from the urethra

* Urethral instrumentation

43
Q

What are the symptoms of epididymitits?

A
  • Pain
  • Fever
  • Swelling
  • Penile discharge
44
Q

What are the common organisms causing epididymitis?

A

•Gram neg

45
Q

What are the symptoms of orchitis?

A
  • Inflammation of one or both of the testicles
  • Testicular pain and swelling
  • Dysuria
  • Fever
  • Penile discharge
46
Q

What is the aetiology of orchitis?

A
  • usually viral
  • Mumps
  • Bacterial
47
Q

What are the risk factors of Fournier’s gangrene?

A
  • UTI
  • complication of IBD
  • Trauma
  • Recent surgery
48
Q

What investigations should you carry out in Fournier’s gangrene

A
  • Blood cultures
  • Urine
  • Tissue/pus
49
Q

What is the 1st line management of spurner’s gangrene?

A

•Surgical debridement

50
Q

What are the antibiotics initially for Fournier’s gangrene?

A

•Pip-tazobactam
•Gentamicin
•Metronidazole
+/- clindamycin

Week 12 - Nephrology and urology (14 decks)

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