UTI Flashcards
1
Q
Bacteriuria
A
Bacteria in urine, often asymptomatic
2
Q
Lower urinary tract infection
A
Cystitis (bladder)
3
Q
Upper urinary tract infection
A
Pyelonephritis, renal abscess
4
Q
Uncompliated UTI
A
Lower UTI with normal structure and neurology
5
Q
Complicated UTI
A
- upper UTI with or without systemic signs and symptoms
* CAUTI (catheter)
6
Q
Recurrent
A
- Infection with the same or different organism
- > /2 episodes in six months or >/3 episodes a year
- Mostly women
7
Q
Urosepsis, complicated UTI
A
- Temperature >38 degrees
- HR>90/min
- RR>20/min
- WBC >15.0 or <4.0
8
Q
What are the risk factors of bacteriuria?
A
- Sex: female>male
- Urinary catheterisation
- Diabetes
- Anatomical abnormalities of urinary tract system
- Pregnancy
9
Q
When do you treat asymptomatic bacteriuria?
A
- Preschool children
- Pregnancy
- Renal transplant or immunocompromised
10
Q
Describe a descending UTI
A
- Haematogenous spread
* Involvement of the renal parenchyma
11
Q
When are there more likely to be multiple organisms in a UTI?
A
- Long term catheter
- Recurrent infection
- Structural/neurological abnormalities
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
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
14
Q
What are the clinical features of UTI?
A
- Suprapubic discomfort
- Dysuria
- Urgency
- Frequency
- Cloudy, blood stained, smelly urine
- Low grade fever
- sepsis
15
Q
What are the signs of UTI in neonates?
A
- Failure to thrive
* Jaundice
16
Q
What are the clinical features of UTI in children?
A
- Abdominal pain
* Vomiting
17
Q
What are the clinical features of UTI in the elderly?
A
- Nocturia
- Incontinence
- Delirium
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
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
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
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
What is a complication of renal abscess
Emphysematous pyelonephritis: requires urgent urology review
26
Explain perinephric abcess
• Uncommon
• Often from haematogenous spread
• Common organisms:
- gram negative bacilli: E.coli, Proteus sp.
- gram positive cocci: s.aureus, streptococci
- candida
27
What are the symptoms of perinephric abscess?
* Flank pain, may have systemic symptoms
| * Swollen - localised signs and symptoms
28
Describe the management of perinephric abscess
* Send urine and blood culture (usually positive blood cultures)
* Pyuria (white cells in urine)
* Treat empirically as complicated UTI
* Surgical management
29
What are the antibiotic guidelines for complicated UTI?
* Usually IV therapy
* Amoxicillin/vancomycin
* Gentamicin/aztreonam/temocillin
30
What does amoxicillin cover?
* Some gram negatives
| * Streptococci
31
What does co-amoxiclav cover?
* some gram negative cover
* Streptococci
* Anaerobes
32
What does pivemecillinam cover?
Gram negative but not pseudomonas
33
What does ciprofloxacin cover?
* Gram negatives including pseudomonas
| * Poor gram positive cover
34
What are the signs/symptoms of acute bacterial prostatitis?
* Diffuse oedema
* Micro abscesses
* Perineal/back pain
* UTI symptoms
* Urinary retention
* Pyrexia
35
What is essential in suspected acute bacterial prostatitis?
Urology referral
36
What are the complications of acute bacterial prostatitis?
* Prostatic abscess
* Spontaneous rupture
* Epididymitis
* Ascending infection
* Systemic sepsis
37
What investigations should be carried out in suspected acute bacterial prostatitis?
* Urine culture
* Blood culture
* Trans-rectal Ultrasound
* CT/MRI
38
What are the likely organisms causing acute bacterial prostatitis?
* Gram negative bacilli
* S.aureus
* N.gonorrhoea
39
What is the empirical antibiotic management of acute bacterial prostatitis?
• Ciprofloxacin/ofloxacin
40
What may chronic prostatitis follow?
Chlamydia urethritis
41
What are the common organisms causing chronic prostatitis?
* Gram negative bacilli: E. coli, proteus sp.
* Enterococcus sp.
* S. aureus
42
What is the aetiology of epididymitits?
* Ascending infection from the urethra
| * Urethral instrumentation
43
What are the symptoms of epididymitits?
* Pain
* Fever
* Swelling
* Penile discharge
44
What are the common organisms causing epididymitis?
• Gram neg
45
What are the symptoms of orchitis?
* Inflammation of one or both of the testicles
* Testicular pain and swelling
* Dysuria
* Fever
* Penile discharge
46
What is the aetiology of orchitis?
* usually viral
* Mumps
* Bacterial
47
What are the risk factors of Fournier's gangrene?
* UTI
* complication of IBD
* Trauma
* Recent surgery
48
What investigations should you carry out in Fournier's gangrene
* Blood cultures
* Urine
* Tissue/pus
49
What is the 1st line management of spurner's gangrene?
• Surgical debridement
50
What are the antibiotics initially for Fournier's gangrene?
• Pip-tazobactam
• Gentamicin
• Metronidazole
+/- clindamycin
