UTI 2 Flashcards
Define Pyuria [1]
What is sterile pyuria [1]
Pus cells present in the urine
Sterile pyuria = pus cells but -ve on urine cultures
What can cause chronic pyelonephritis? [3]
Recurrent UTIs but also:
- DM
- Vesico-uretic reflux
- Urinary Obstruction
Whats the difference between a complicated and uncomplicated UTI? [4]
Functionally normal urinary tract [1]- unlikely to result in serious kidney damage. [1] Usually in young women with clear correlation to sexual activity
Complicated UTI - abnormal urinary tracts or poor defense mechanisms[1] that result in severe kidney damage [1]
When do you we treat women with UTIs in the following scenarios: [3]
They have 3 or more symptoms
They have all 3 dispstick components
They only have 2 symptoms
IF they have 3 or more symptoms from:
Dysuria/frequency/urgency/suprapubic pain/polyuria/haematuria
Then you start on empirical Abx
If all 3 dipstick components (nitrites/protein/leucocytes) are +ve -> Empirical Ab
If they only have 2 symptoms do an MSSU
What mostly causes UTIs in men? [2]
Recurrent UTIs tend to be a sign of prostatitis in older men or STIs in younger men (chlamydia/gonorrhoea)
Whats the sequelae of UTI in pregnancy? [2]
Pyelonephritis & Premature delivery
How do you approach pregnant women re UTIs: Symptomatic [3]
Asymptomatic bacteriuria
if the pregnant woman is symptomatic:
a urine culture should be sent in all cases
first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin
Asymptomatic bacteriuria:
Immediate antibiotic, nitro or amoxicillin 7d course
a further urine culture should be sent following completion of treatment as a test of cure
How does pyelonephritis [4] present vs lower UTI [6]?
Lower UTIs:
- Suprapubic Pain
- Dysuria
- Frequency
- Urgency
- Polyuria
- Haematuria
Pyelonephritis:
- Loin Pain
- Fever
- ~systemic unwellness
- Severe cases have bacteraemia (rigors, N&V etc)
How do you manage pyelonephritis? [3]
Urine culture
Empircal Abx: broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
Blood cultures if systemically unwell
What extra investigation would you do for a patient with a proteus or Klebsiella UTI? [1]
Non-contrast CT for stones as they produce a lot of stones
What are the important parts of the dipstick test for a UTI? [4]
Nitrites (produced by bacteria)
Protein (inflammation or renal pathology)
Leucocytes
Also blood
What are the indications for a MSSU?
Presentations in which there are severe sequelae [3]
Atypical presentations [4]
Presentations in which there are severe sequelae:
1) Women in which the dipstick is inconclusive
2) Acute pyelonephritis
3) Pregnant (screening & Symptomatic)
Atypical presentations:
1) Men
2) Failed Abx or persistant symptoms
3) Recurrent UTIs
4) Children
How do you take a MSSU? [3]
How would you obtain a catheter specimen? [1]
1) Discard the first 10-20ml of stream
2) Early morning urines are more likely to be +ve
3) Boric Acid container prevents overgrowth
If its a catheter specimen take it from the sampling port not the bag
How do you take a urine sample from a child? [4]
Most kids can't give a decent MSSU. So a clean catch urine sample is preferable. [1] IF that fails: - Urine collection Pad - Catheter Sample - Suprapubic Aspiration
How do we detect pyuria? [1]
What is deemed significant pyuria? [1]
With microscopy
Significant pyuria = >10WBC/mm^3
How do we tell if its contamination or infection on a urine culture? [1]
What does mixed organisms indicate on a urine culture? [1]
10^4 organisms/ml indicates infection > contamination
(10^5 in asymptomatic bacteriuria)
Mixed organisms usually means contamination
Its almost inevitable that patients with indwelling catheters get bacteriuria, how do you approach Catheter-related infections?
Dont do culture or treatment if they’re not symptomatic.
If they are do a urine culture and empirical Abx, the catheter should be changed immediately prior to treatment.
Asymptomatic Bacteriuria is quite common in adult women and men with BPH, in which cases would we culture and treat? [3]
We’d only do a urine culture and treat such patients if they’re:
- Pregnant
- Undergoing urological surgery
- Undergoing surgery involving prosthesis
What can cause sterile pyuria? [3]
- Abx in blood preventing bacterial growth
- Renal Tuberculosis
- Genito-urinary infections
How do we rule out renal TB in sterile pyuria? [2]
Collect 3 early morning MSSUs [1] for ZN stains & TB cultures [1]
Uncomplicated UTIs can be started on empirical therapy after dipstick testing.
How do you investigate a complicated UTI? [4]
- US or CT-KUB
- Cystoscopy
- Post-void bladder scan
- Urinary Flow study
What treatments can be used for a UTI? [3]
Fluids
Alkalinizing agents (over the counter)
Antibiotic regimen
Describe the Abx course you use for uncomplicated UTIs? [3]
3-5 day course of trimethoprim 200mg OR nitrofurantoin 50mg OR Co-trimoxazole
What abx must be avoided in pregnancy? [1]
Trimethoprim -Teratogenic
