UTI Flashcards

1
Q

Define UTI

A

Infection of the kidneys, bladder or urethra

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2
Q

Most common UTI

A

Infectious cystitis

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3
Q

Infection of the kidney

A

Pyelonephritis

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4
Q

Inflammation of the urethra

A

Urethritis

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5
Q

Epidemiology UTI

A
  • 10% of females >18 annually
  • 20-40% of women have recurrent UTI
  • M < F
  • Most common bacterial infection
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6
Q

Most common cause of UTI

A

Escherichia coli - 70-95% uncomplicated

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7
Q

Second most common cause of UTI

A

Staphylococcus saprophyticus (5-20%)

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8
Q

Common causes of uncomplicated UTI

A
  • Enterobacteriaceae = Proteusmirabilis, Klebsiella
  • Enterococci
  • Group B strep
  • P.aeruginosa
  • Citrobacter
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9
Q

Bacteria causing complicated UTIs

A

Most resistance to antibiotics

  • P.aeruginosa
  • Enterobacter
  • S.aureus
  • Enterococci
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10
Q

MRSA is a rare cause of …

A

Uncomplicated cystitis and pyelonephritis

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11
Q

2 things that are considered complicated UTIs

A
  • Pregnancy

- Kidney involvement

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12
Q

Complicated UTIs

A
  • Increased colonisation
  • Decreased efficacy of treatment
  • Anatomical or functionally abnormal urinary tract
  • Immunocompromised host
  • Multi-drug resistant bacteria
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13
Q

Uncomplicated UTI

A
  • Infection in a health person

- Anatomically and functionally normal urinary tract

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14
Q

Upper UTI structures

A
  • Ureters and kidneys
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15
Q

Lower UTI structures

A
  • Bladder and urethra
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16
Q

Upper compared to lower UTI

A
  • Upper more rare than lower

- Upper generally more severe than lower

17
Q

Most common route of infection (UTI)

A

Ascending pathway (colonise vagina then ascend)

18
Q

Bladder stasis and UTI

A
  • Impaired defence - no emptying
19
Q

Define recurrent UTI

A

> 3 UTIs in 12 months

20
Q

Signs and symptoms of UTIs

A
  • Dysuria
  • Urinary frequency
  • Back pain
  • Gross haematuria

UPPER

  • Urgency
  • Supra-pubic pain
  • Fever
  • Costovertebral tenderness
21
Q

First diagnostic test in UTIs

A

Dipstick test
- Postive nitrates and leukocytes

Even if dipstick test is negative, if clinical picture fits, diagnosis is likely

22
Q

Other tests for UTIs

A
  • MCS - midstream urine - test if symptoms atypical
  • Imaging - if treatment failed or persistent symptoms
  • Renal US
  • Abdominal pelvic CT
  • Cystoscopy - rule out lower tract abnormalities
  • Post-void residual
23
Q

Post-void residual and UTIs

A
  • PVR >100mL - not emptying bladder to completion

- Promote infection

24
Q

UTI DDx

A
  • Over-active bladder
  • Urothelial carcinoma - upper UT or bladder
  • Non-infectious urethritis
  • Foreign body in bladder
  • Vaginitis
  • STI
  • Interstitial cystitis
  • Urethral diverticulum
25
Q

Risk factors for UTIs

A
  • Sexual activity
  • Spermicide use
  • Post-menopause
  • Positive family history
  • History of recurrent infections
  • Presence of foreign body
  • Insulin treated diabetes
  • Many previous UTIs
  • Recent AB use
  • Poor bladder emptying
  • Older age
26
Q

Management of acute, uncomplicated UTI

A
  • Oral antibiotics - Nitrofurantoin, Trimethoprim
27
Q

Management acute UTI - with resistance

A
  • Ciprofloxacin
  • Levofloxacin
    (Quinolones)
28
Q

Management of acute, complicated UTI

A
  • Pregnant = Cefalexin
  • Not-pregnant = Ciprofloxacin

Longer treatment for complicated

29
Q

Management for recurrent UTI - pre-menopause

A
  • Nitrofurantoin
30
Q

Management for recurrent UTI - menopause

A
  • Intra-vaginal oestrogen therapy
31
Q

Uncomplicated UTI treatment

A

Short course AB - 3-5 days

32
Q

Why is Nitrofurantoin in no recommended as treatment for UTI in pregnancy

A
  • Baby-haemolytic anaemia
33
Q

Complications UTI

A
  • Renal and peri-renal abscess
  • Emphysematous polynephritis
  • Xanthogranulomatous pyelonephritis