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
