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MBChB3 > UTI > Flashcards

UTI Flashcards

1
Q

What are complicated and uncomplicated UTIs?

A
  • complicated: UURTI +/- systemic signs or catheter-associated UTI
  • uncomplicated: lower UTI, normal structure and neurology
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2
Q

Define relapse and recurrent

A
  • relapse = infection with the same organism
  • recurrent = infection with same or different organism, 2+ episodes in 6 months or 3+ in a year
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3
Q

What are the risk factors of bacteriuria?

A
  • female
  • urinary catheterisation
  • diabetes
  • anatomical abnormalities of urinary tract
  • pregnancy
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4
Q

What patients are treated for bacteriuria?

A
  • preschool children
  • pregnancy
  • renal transplant
  • immunocompromised
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5
Q

Describe ascending UTIs

A
  • urethral colonisation
  • female >male
  • multiplication in bladder
  • ureteric involvement
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6
Q

Describe descending/haemotgenous UTIs

A
  • haematogenous spread
  • involvement of renal parenchyma
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7
Q

What patients are at risk of poly-microbial or multi-drug resistant UTIs?

A
  • multiple organisms: long-term catheters, recurrent infection, structural/neurological abnormalities
  • multi-drug resistant: anatomical/neurological abnormalities, frequent infections, multiple antibiotic courses, prophylactic antibiotic use
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8
Q

What are the common organisms that cause UTIs?

A
  • gram-negative bacilli: E.coli, klebsiella, proteus, pseudomonas
  • gram-positive: strep, enterococcus, s. agalactiae, staph
  • candida
  • anaerobes (associated with bladder malignancies)
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9
Q

Describe the clinical features of UTI

A
  • suprapubic discomfort
  • dysuria
  • frequency
  • cloudy, blood stained, smelly urine
  • low-grade fever
  • sepsis
  • failure to thrive, jaundice in neonates
  • abdo pain and vomiting in children
  • nocturne, incontinence and delirium in elderly
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10
Q

When is a culture indicated for suspected UTI?

A

Non-pregnant women:
- if no response to empirical treatment
- change to targeted treatment

Children and men: always

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11
Q

Describe the management of a UTI in pregnancy

A
  • send urine for culture and treat each episode
  • amoxicillin and cefalexin safe
  • avoid trimethoprim in 1st trimester
  • avoid nitrofurantoin near term
  • hospital admission if severe
  • risk of pyelonephritis
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12
Q

How would you manage recurrent UTIs?

A
  • send sample from each episode
  • emphasise importance of hygiene
  • encourage hydration
  • encourage urge initiated and post-coital voiding
  • urology investigation
  • intravaginal/oral oestrogen
  • antibiotic therapy as per symptoms
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13
Q

How would you manage CAUTIs?

A
  • send urine samples
  • start empirical antibiotic therapy (look at previous microbiology)
  • remove/replace catheter
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14
Q

What is pyelonephritis and describe the clinical presentation

A
  • upper UTI
  • moderate to severe infection
  • flank pain +/- systemic infection
  • enlarged kidney
  • abscess on surface of kidney
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15
Q

Describe the management of acute pyelonephritis

A
  • check previous microbiology results
  • send urine and blood for culture
  • imaging
  • community: co-amoxiclav, ciprofloxacin, trimethoprim
  • hospital: initial IV antibiotics
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16
Q

Describe renal abscesses

A
  • complication of pyelonephritis (similar symptoms)
  • positive urine and blood culture
  • gram negative bacilli usually
  • can become life threatening (eg. emphysematous pyelonephritis)
  • poor response to antibiotics alone, surgical intervention needed
17
Q

Describe perinephric abscess

A
  • haemtogenous spread of infection (rare)
  • common causes: gram negative bacilli (E.coli), gram-positive cocci (strep), candida spp.
18
Q

What are the symptoms and management of perinephric abscesses?

A
  • symptoms similar to pyelonephritis
  • localised signs and symptoms
  • local invasion
  • urine and bloods sent for culture (pyuria and bacterial growth)
  • treat empirically as complicated UTI
  • poor response to antibiotic therapy and requires surgical management
19
Q

What drugs are used for complicated UTI and any contraindications?

A
  • amoxicillin, vancomycin
  • contraindicated in renal failure
20
Q

Describe acute bacterial prostatitis and its clinical presentation

A
  • usually spontaneous but can follow urethral instrumentation
  • causes diffuse oedema and microabscesses
  • causes perineal/back pain, UTI symptom, urinary retention, pyrexia
  • urology referral necessary
21
Q

What are the complications of acute bacterial prostatitis?

A
  • prostatic abscess
  • spontaneous rupture (urethra, rectum)
  • epididymitis
  • ascending infection
  • systemic sepsis
22
Q

What investigations would you want to carry out if suspecting acute bacterial prostatitis?

A
  • urine and blood cultures
  • trans-rectal US
  • CT/MRI
  • no prostatic secretions
23
Q

What are the likely causes and treatment for acute bacterial prostatitis?

A
  • causes: gram-neg bacilli, S. aureus, n. gonorrhoea
  • treatment: antibiotic management - empirical (ciprofloxacin/ofloxacin), check previous microbiology
24
Q

Describe chronic prostatitis and common causative organisms

A
  • rarely associated with acute prostatitis
  • can follow chlamydia urethritis
  • causes recurrent UTI symptoms, back pain, low grade fever
  • relapse common
  • causes: gram-neg bacilli, enterococcus, s. aureus
25
Q

Describe epididymitis and the clinical features of it

A
  • inflammatory reaction to epididymis
  • caused by ascending infection from urethra or urethral instrumentation
  • symptoms: UTI/urethritis symptoms, pain fever, swelling, penile discharge
26
Q

Describe orchitis and the clinical features of it

A
  • inflammation of 1 or both testicles
  • testicular pain and swelling
  • dysuria
  • fever
  • penile discharge
  • can be associated with viral causes (mumps) and bacterial infections
27
Q

Describe the complications of bacterial orchitis

A
  • pyogenic infection: severe and requires urological review, IV antibiotics (as per complicated UTI)
  • testicular infarction
  • abscess formation
28
Q

Describe Fournier’s gangrene

A
  • form of necrotising fasciitis
  • > 50y
  • rapid onset and spread
  • systemic sepsis
29
Q

What are the risk factors for Fournier’s gangrene?

A
  • UTI
  • complications of IBD
  • truma
  • recent surgery
30
Q

What are the causes and management of Fournier’s gangrene?

A
  • causes: mixed, mainly gram-neg bacilli and anaerobes
  • blood and urine cultures
  • tissue/pus sample
  • surgical debridement (1st line)
  • broad spectrum antibiotics (pip-tazobactam + gentamicin + metronidazole +/- clindamycin)

MBChB3 (100 decks)

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