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PathY5 > UTI > Flashcards

UTI Flashcards

1
Q

What is the definition of bacteriuria?

A

The presence of bacteria in the urine.

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2
Q

What is the definition of cystitis?

A

Inflammation of the bladder, often caused by infection.

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3
Q

What is the difference between uncomplicated and complicated UTI?

A

Uncomplicated urinary tract infection refers to infection in a structurally and neurologically normal urinary tract.

Complicated urinary tract infection refers to infection in a urinary tract with functional or structural abnormalities (including indwelling catheters and calculi).

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4
Q

Who is more likely to get complicated UTIs?

A
  • men
  • pregnant women
  • children
  • patients who are hospitalised or in health care–associated settings
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5
Q

What is the incidence of bacteriuria and UTI?

A

The prevalence of bacteriuria in young nonpregnant women is about 1% to 3%

Up to 40% to 50% of the female population will experience a symptomatic urinary tract infection at some time during their life.

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6
Q

Which is the most common bacteria in a UTI?

A

E Coli

Serogroups O1, O2, O4, O6, O7, O8, O75, O150, and O18ab, cause a high proportion of infections

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7
Q

What are the less common urinary tract organisms?

A

Proteus mirabilis
Klebsiella aerogenes
Enterococcus faecalis
Staphylococcus saprophyticus
Staphylococcus epidermis

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8
Q

What is the pathogenesis of a UTI?

A

In recurrent urinary tract infections, especially in the presence of structural abnormalities of the urinary tract, the relative frequency of infection caused by Proteus, Pseudomonas, Klebsiella, and Enterobacter species and by enterococci and staphylococci increases greatly

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9
Q

What are the host defences against UTI?

A

Urine (osmolality, pH, organic acids)

Urine flow and micturition

Urinary tract mucosa (bactericidal activity, cytokines)

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10
Q

What is an ascending UTI?

A

The urethra is usually colonized with bacteria

The female urethra is short and is in proximity to the warm moist vulvar and perianal areas, making contamination likely

It has been shown that the organisms that cause urinary tract infection in women colonize the vaginal introitus and the periurethral area before urinary infection results

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11
Q

Why should women pee after sex?

A

Massage of the urethra in women and sexual intercourse can force bacteria into the female bladder

Once within the bladder, bacteria may multiply and then pass up the ureters, especially if vesicoureteral reflux is present, to the renal pelvis and parenchyma

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12
Q

What are important renal tract abnormalities?

A

Several abnormalities of the urinary tract interfere with its natural resistance to infection

Obstruction inhibits the normal flow of urine, and the resulting stasis is important in increasing susceptibility to infection

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13
Q

What mechanical obstructions may occur in the renal tract?

A

Mechanical reasons
Extrarenal: valves, stenosis, or bands; calculi; extrinsic ureteral compression from a variety of causes; and benign prostatic hypertrophy
Intrarenal: nephrocalcinosis, uric acid nephropathy, analgesic nephropathy, polycystic kidney disease, hypokalemic nephropathy, and the renal lesions of sickle cell trait or disease

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14
Q

What neurogenic obstructions may occur?

A
  • poliomyelitis,
  • tabes dorsalis,
  • diabetic neuropathy,
  • spinal cord injuries
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15
Q

What is reflux in the kidney?

A

Vesicoureteral reflux tends to perpetuate infection by maintaining a residual pool of infected urine in the bladder after voiding

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16
Q

How does haematogenous spread occur in the kidney?

A

The kidney is frequently the site of abscesses in patients with Staphylococcus aureus bacteremia or endocarditis, or both

It appears that in humans, infection of the kidney with gram-negative bacilli rarely occurs by the hematogenous route

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17
Q

What are the symptoms of UTI in <2yrs?

A

Symptoms in neonates and children younger than 2 years are nonspecific

Failure to thrive
vomiting
fever

18
Q

What are the symptoms of UTI in >2yrs?

A

more likely to display localized symptoms such as:

frequency
dysuria
abdominal or flank pain

19
Q

What are lower UTI symptoms?

A

The lower tract symptoms result from bacteria producing irritation of urethral and vesical mucosa, causing frequent and painful urination of small amounts of turbid urine.
Patients sometimes complain of suprapubic heaviness or pain.
Occasionally, the urine is grossly bloody or shows a bloody tinge at the end of micturition.
Fever tends to be absent in infection limited to the lower tract.

20
Q

What are upper UTI symptoms?

A

fever (sometimes with rigors)
flank pain
and frequently lower tract symptoms (e.g., frequency, urgency, and dysuria)
at times, the lower tract symptoms antedate the appearance of fever and upper tract symptoms by 1 or 2 days
the symptoms described, although classic, may vary greatly

21
Q

What are UTI symptoms in older patients?

A

The vast majority of older adult patients with urinary infection are asymptomatic
Symptoms, when present, are often not diagnostic, because noninfected older adults often experience frequency, dysuria, hesitancy, and incontinence
Symptoms of upper tract infection are often atypical e.g., abdominal pain, change in mental status

22
Q

What are the Ix of UTI?

A

Uncomplicated UTI/pyelonephritis:
- Urine dipstick
- MSU for urine microscopy, culture and
sensitivities
- Bloods – FBC, UE, CRP (inflammatory markers and renal function)

Further investigation of complicated UTI:

  • Renal USS
  • Intravenous urography
23
Q

What is HPA guidance?

A

Lol f that- please finish this in the lecture

24
Q

What lab tests do you do?

A

Microscopy

Culture

Sensitivities

25
Q

How do you sample in a UTI?

A

Urine in the bladder is normally sterile. Because the urethra and periurethral areas are very difficult to sterilise, even the most carefully collected specimens (including those obtained by catheterisation) are frequently contaminated.

Midstream clean catch (MSU) preferred for the routine collection of urine for culture.

Catheterisation

Suprapubic aspiration

26
Q

What might you see on microscopy?

A
27
Q

What is sterile pyuria?

A
  • Prior treatment with antibiotics
  • Calculi
  • Catheterisation
  • Bladder neoplasm
  • TB
  • Sexually Transmitted Disease
28
Q

How is culture useful?

A
  • By quantitating bacteria in midstream, clean-voided urine, it is possible statistically to separate contamination from urinary tract infection.
  • Patients with infection usually have at least 105 cfu/mL in urine in the bladder, and therefore voided urine usually contains at least 105 cfu/mL.
  • Patients without infection have sterile bladder urine, and with proper collection, voided urine usually contains less than 104 cfu/mL.
  • It is likely that a significant proportion of patients with both symptomatic and asymptomatic infection have fewer than 105 bacteria/mL of urine
29
Q

What is the treatment of UTI?

A
  • Empirical Therapy
  • Community lower UTI

Local Guidance

30
Q

What is imperials local guidance of UTI?

A
31
Q

What is Imperials local guidance on catheter associated UTIs?

A
32
Q

What is the length of treatment for UTI?

A
  • 3 days of therapy with standard doses for treatment of uncomplicated lower tract infection in women
  • Short-course therapy is not appropriate for women who have a history of previous urinary infection caused by antibiotic-resistant organisms or more than 7 days of symptoms. In these patients (who have an increased likelihood of upper tract infection) and in men, 7 days of therapy are recommended
33
Q

How do you treat fungal UTIs?

A
  • Most Candida urinary tract infections occur in patients with indwelling catheters.
  • Removal of the catheter may result in cure
  • oral fluconazole is no more effective than no therapy
  • Exceptions include renal transplant patients and patients who are to undergo elective urinary tract surgery.
  • In these instances, attempts should be made to eliminate or at least suppress the candiduria
34
Q

What is pyelonephritis?

A
  • Infection of the Kidney
  • The greater the number of organisms delivered to the kidneys, the greater is the chance of producing infection.
  • The kidney itself is not uniformly susceptible to infection—very few organisms are needed to infect the medulla, whereas 10,000 times as many are needed to infect the cortex
35
Q

How do you manage pyelonephritis?

A
  • Commonly associated with sepsis and septicaemia
  • Requires more aggressive treatment
  • Broad spectrum antibiotics
  • Co-amoxiclav +/- gentamicin
  • Imaging

–Calculi

–Structural cause

36
Q

What are the complications of pyelonephritis?

A
  • Perinephric abscess
  • Chronic pyelonephritis

–scarring

–chronic renal impairment

  • Septic shock
  • Acute papillary necrosis
37
Q

Presence of which cells on microscopy suggest a poorly taken sample?

A

Squamous epithelial cell

38
Q

What are these cells?

A

Squamous epithelial cells (fried eggs)

39
Q

Which of the following dipstick parameters is a product of nitrate reductase and suggestive of a UTI.

Blood

Protein

Leucocytes

Nitrites

A

Nitrites

40
Q
A

PathY5 (98 decks)

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