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PHA332 > UTI > Flashcards

UTI Flashcards

1
Q

Name the 4 parts of the urinary system where infection occurs

A

Urethra, ureters, kidneys, bladder

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2
Q

Where do bacteria enter through

A

Urethra

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3
Q

Which bacteria causes UTI

A

Escherichia Coli (gram negative)

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4
Q

What symptoms occur in bladder (cystitis)

A

Polyuria (peeing more than normal), dysuria (burning when urinating), lower abdominal discomfort

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5
Q

What symptoms occur in urethra (urethritis)

A

Burning on passing urine, discharge

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6
Q

Why can differential diagnosis include STI

A

Due to the proximity of the urethra to the vagina

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7
Q

List risk factors for UTI

A
  • More common in females (shorter urethra, proximity to the anus)
  • Postmenopausal women (decline in circulating oestrogen)
  • Indwelling catheters
  • Recent antibiotic use (disrupts flora)
  • Spermicides (irritation & attachment sites for E coli)
  • Sexual intercourse (bacteria to urinary tract)
  • Pregnancy
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8
Q

List reasons for referral

A
  • Pregnancy (pyelonephritis - kidney infection, premature birth, rupture of membranes and other complications)
  • Men
  • <16 years
  • Symptoms of pyelonephritis (fever, loin pain, nausea/vomiting, flu-like illness)
  • Signs of sepsis (altered behaviour, increased HR, low BP, anuria (lack of urine production)
  • Non-response to first antibiotics
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9
Q

Who not to carry urine dipstick on

A

Over 65 years as asymptomatic bacteria common in this age and therefore unnecessary antibiotics

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10
Q

Which part of urine is tested

A

Mainstream

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11
Q

Why we don’t use urine culture often

A

Results not available straight away therefore uncomplicated infections will have resolved by then

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12
Q

How many days of antibiotics prescribed for non-pregnant uncomplicated lower UTI cases

A

3-day course

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13
Q

When do we prescribe antibiotics for UTI

A

Women under 65 with 2 or more key symptoms and no other causes (STI/sepsis)

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14
Q

When do we not prescribe antibiotics

A

No symptoms unless pregnant

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15
Q

What is urethritis

A

Inflammation post sexual intercourse

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16
Q

How do we differentiate between pyelonephritis and sepsis?

A
  • Pyelonephritis (kidney pain/back pain, flu like illness, nausea/vomiting)
  • Sepsis
    (altered mental state, increased RR/HR, low BP, anuria, mottled skin, rash)
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17
Q

How do we diagnose UTI?

A

Dysuria, new nocturia, cloudy urine

  • 2/3 present (UTI likely & dipstick not needed)
  • 1 present (perform dipstick)
  • 0 present (check urgency, visible haematuria - blood in urine, frequency, suprapubic tenderness)

If yes to other symptoms, perform dipstick, otherwise consider other diagnoses

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18
Q

What if a dipstick is negative for nitrites, leukocytes and RBC?

A

UTI less likely

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19
Q

What if dipstick is negative for nitrites and positive for leukocytes?

A

Could be UTI, send urine culture and consider treatment depending on symptom severity

20
Q

What if a dipstick is positive RBC with positive nitrite or leukocyte?

A

Likely UTI, treat or wait with back up depending on symptom severity

21
Q

What is the key differences between over and under 65?

A
  • No urine dipsticks, new onset dysuria or 2 new symptoms of UTI, always send urine culture, delirium considerations/other diagnostics
22
Q

Who is there seperate guidance for?

A

Children, pregnant women and men

23
Q

What screening do pregnant women receive as part of antenatal care?

A

MSU (mid-stream specimen of urine) screening

24
Q

How are pregnant women treated if suspected UTI?

A
  • Symptomatic relief with paracetamol
  • Prescribe antibiotic (check suitable)
  • Send MSU for culture
  • Amend prescription if needed
  • If a group B streptococcus is isolated, prophylactic antibiotics will be offered during labour and delivery
25
Q

What to consider for antibiotics

A
  • How severe the symptoms are
  • Risk of complications
  • Previous urine culture results & antibiotic use
26
Q

When to use a back up antibiotic?

A

If no improvement at 48 hours or if symptoms worsen at any time

27
Q

List risk factors for increased resistance

A
  • Care home resident
  • Recurrent UTI (2 in 6 months, ≥ 3 in 12 months)
  • Unresolving urinary symptoms
  • Hospitalisation for > 7d in last 6 months
  • Recent travel to country with increased resistance
  • Previous UTI resistance to trimethoprim, cephalosporins or quinolones
28
Q

What to do if there is a risk of resistance?

A

Always safety net & send for urine culture and susceptibilities

29
Q

What do antibiotics increase the risk of?

A

Clostridium difficile (severe diarrhoea & in worst cases life-threatening damage to the colon)

Risk increased with broad spectrum antibiotics

30
Q

What is the difference between trimethoprim and nitrofurantoin?

A
  • Trimethoprim (narrow spectrum, resistance common)
  • Nitrofurantoin (broad spectrum, resistance rates much lower)
31
Q

What are the first choice of antibiotics?

A
  • Nitrofurantoin MR if eGFR > 45ml/min 100mg BD for 3 days
  • Trimethoprim 200mg BD for 3 days
32
Q

What are the second choice of antibiotics?

A
  • Nitrofurantoin MR if eGFR > 45ml/min and not first choice, same dose
  • Pivmecillinam (penicillin) > 400mg initial then 200mg TDS for 3 days
  • Fosfomycin > 3g single dose sachet
33
Q

What is the MOA of nitrofurantoin?

A

Concentrated in urine (bactericidal) reduced by bacterial flavoproteins to reactive intermediates which inactivate/alter bacterial ribosomal proteins

34
Q

When to avoid nitrofurantoin?

A

If eGFR is <45ml/min/1.73m2

35
Q

Why is nitrofurantoin not effective in renal impairment?

A

Antibacterial efficacy depends on renal secretion of the drug into the urinary tract

36
Q

Why do we take nitrofurantoin with food?

A

To increase bioavailability

37
Q

What does nitrofurantoin do to the urine

A

Darkens urine colour (yellow/brown)

38
Q

What are contraindications of nitrofurantoin?

A
  • eGFR low, GP6D deficiency, acute porphyria (abnormal metabolism of haemoglobin), infants <3 months
39
Q

What are adverse effects of nitrofurantoin?

A
  • GI (minimised by taking with food/milk)
  • Dizzy/tired
  • Itchy rash/allergic reaction/swollen salivary glands
  • Peripheral neuropathy (caution in diabetes patients) discontinue if signs
  • Pulmonary reactions
  • Discontinue treatment if unexplained pulmonary, hepatotoxic, haematological or neurological syndromes occur
40
Q

What is the MOA of Trimethoprim?

A

Inhibits DHFR therefore blocks the reduction of dihydrofolate to tetrahydrofolate, the active form of folic acid by susceptible organisms

Inhibitory activity for most gram-positive aerobic cocci and some gram-negative aerobic bacilli

41
Q

What to do with trimethoprim in renal impairment

A

Dose reductions may be needed if severe renal impairment

42
Q

What does trimethoprim interact with?

A

Methotrexate, Warfarin

Therefore can cause hyperkalaemia so caution with other drugs that increase K+ (e.g. ACEI)

43
Q

What is trimethoprim contraindicated with?

A

Blood dyscrasias (imbalance of body fluids), first trimester pregnancy

44
Q

List adverse effects of trimethoprim

A
  • Mild GI disturbances
  • Pruritus (itching) and skin rash
  • Blood disorders (long term)
45
Q

List some advice for self-care

A
  • Adequate fluid intake
  • Paracetamol for pain (or ibuprofen if appropriate and lower UTI)
  • Cranberry juice or tablets (no good evidence)
  • Hygiene (wipe front to back)
  • Empty bladder soon after sexual intercourse
  • Birth control
  • Avoid potentially irritating female products as these can irritate the urethra
46
Q

What is some future changes?

A
  • Point-of-care tests for UTIs developed which may guide antimicrobial prescribing
  • Faster more accurate results could improve outcomes and reduce resistance risk

PHA332 (14 decks)

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