UTI Flashcards
Differentials for burning discomfort.
Pyelonephritis - SYSTEMIC symptoms
Urethritis
Gonorrhoea
Chlamydia
Cystitis
Where does chlamydia and gonorrhoea commonly occur in males
Urethra - urethritis (therefore if woman presented with burning, unlikely to be urethritis)
Where does chlamydia and gonorrhoea commonly occur in females
Cervix - cervicitis and further up
Where do UTI’s occur?
Kidney, ureter, bladder, urethra.
What further questions do you ask when presented with burning discomfort with urine passing?
Frequency - Indicates cystitis
Urgency - Indicates cystitis
Supra pubic pain/Cramping - Indicates cystitis (inflamed bladder)
How common is cystitis in males to females? Why?
More common in females - anatomy, longer ureter in males.
What is a mid stream urine?
Collecting specimen half way through urination to clear any bacteria colonising urethra - use for cystitis
What is a first void urine?
Collecting urine from beginning of stream to collect sample from urethra - For urethritis (gonorrhoea and chlamydia)
What is the most useful first step in management for dysuria? Why?
HISTORY! We can figure out if it is urethritis or cystitis which will affect subsequent investigations and treatment.
What are hallmark symptoms of gonorrhoea?
Dysuria and discharge!
Is obtaining a MSU for culture better or for a dipstick?
Dipstick - Cheaper, on the spot and can check for white blood cells!
Culture/microscopy takes a lot longer (2-3 days), would’ve treated by now, and more expensive.
Should we treat all patients with AB’s?
Yes, all patients will get better with cystitis but not until a month. That’s a long time to have pain and discomfort.
Main causative organisms of cystitis?
E.coli - colonised urethra and made its way up to bladder. Fimbriae have attached to urothelium wall and releases toxins that damage the urothelium, which is the point of infection. (Cytokines released from damaged urothelium - inflammation)
Can E.coli in cystitis go on to cause pyelonephritis?
No, different E.Coli (uro-pathogenic E.coli) which have different types of fimbriae which allow it to attach to kidney tissue and would cause pyelonephritis at the same time as cystitis. So don’t worry about E.coli if present in urine.
Risk factors contributing to cystitis in females and males.
…
Why is cystitis more common in older women then younger?
Post-menopausal. Low oestrogen which is known to help in host defence against e.coli colonies around urethral opening.
When should you prescribe AB’s for a patient with delirium and fevers and E.coli present in urine?
When there is no other known cause of the fever etc. Worth a go.
What properties should and antibioitc used to treat cystitis have?
Cleared by kidneys Narrow range Safe Cheap Works!
What are the options for anti-microbial treatment for cystitis?
Trimethprim - Folate antagonist (inhibits DNA synthesis) therefore contraindicated in pregnancy
Nitrofuratoin
Benefits and disadvantages between Nitrofuratoin and Trimethprim
Nitrofuratoin is 99% effective but has to be taken 3 times a day (USED IN HOSPITALS WHERE NURSES BRING YOU AB’S SO NO WORRY ABOUT COMPLIANCE)
Trimethprim is 80% effective but is taken at night as pee less so stays in bladder longer. (GP’s usually prescribe this for better compliance)
What type of AB’s are the ones used for cystitis?
Bacteriostatic
Broad spectrum
