UTI Flashcards
General predisposing factors for UTI?
Immunosuppresion, steroids, malnutrition, diabetes
Predisposing factors specific to the urinary tract for UTI
Female sex,
Sexual intercourse and poor voiding habits,
Congenital abnormalities (eg duplex kidney)
Stasis of urine
Foreign bodies (eg catheters, stones)
Oestrogen deficiency in postmenopausal women,
Fistula between bladder and bowel
Usually orgaranisms causing a UTI?
E.coli, proteus, klebsiella, enterococcus
Transfer of UTI routes?
Transurethral route, bloodstream, lymphatic
Children clinical features of a UTI?
Diarrhoea, excessive crying, fever, n/v, not eating
Adult clinical features of a UTI?
Flank pain, dysuria, cloudy offfensive urine, urgency, chills, strangury, confusion
Clinical features of acute pyelonephritis?
Pyrexia, poor localisation, loin tenderness, signs of dehydration, turbid urine
Investigations that could be useful in a UTI?
MSSU, urinalysis , microbiology in lab (microscopy and gram staining, ultrasound, IVU, isotope studies (to look for reflux and scarring)
Treatment of UTI?
Fluids,
Antibiotics- amocilllin, cephalosporin, trimethoprim
What is reflux nephropathy?
Kidney damage due to reflux and infection, common in UTIs in children
What are investigations for reflux nephropathy?
Micturating cystogram (radionuclide 99Tc techniques), Assess progresssion by ultrasound scan and biochemistry, Surgery
Advice if someone has recurrent infections?
Fluid intake should be 2l/day,
Should void every 2-3hrs by day,
Void before bedtime and before and after intercourse
What would you expect on isotope studies for chronic pyelonephritis?
Scarring and clubbing
What is bacteriuria?
The presence of bacteria in the urine
What is pyuria?
The presence of pus cells (neutrophil polymorphs) in significant quantities in the urine
What is sterile pyuria?
The clinical scenario in which urine is negative on culture but significant numbers of pus cells are present
Factors which may contribute to chronic pyelonephritis?
Diabetes, vesicoureteric reflux and urinary obstruction
Diagnosis of UTI in women?
3 or more of the following:
Dysuria, frequency, urgency, suprapubic pain, polyuria, haematuria
Or 2 symptoms + a MSSU
What detected in a dipstick test can be a sign of a UTI?
Nitrite, protein, lecucocytes
What is recurrent UTIs in men a sign of?
Prostatitis
What is the commonest cause of prostatitis?
California organisms in older patients,
STI organisms eg chlamydia trachomatis and neisseria gonorrhoeae in younger males
How long should people with acute pyelonephritis be treated with antibiotics?
7 days
What type of UTI to people with catheter-related infections get?
Bacteriuria
What is asymptomatic bacteriuria in pregnancy associated with?
Pyelonephritis and premature delivery
What are some explanations for sterile pyuria?
Undeclared presence of antibiotics,
Renal tuberculosis (3 early morning urines for ZN stain and TB culture should be collected)
Chlamydia,
Trachomatis
What can recurrent sterile pyurias be a sign of?
Non-infective pathology in the bladder or kidneys eg Renal tract stone disease, Interstitial cystitis, Urological disease, Chronic prostatitis
Why is follow up from children with vesico0uretetic reflux important?
As it may lead to renal scarring in later life
Predisposing factors for UTI?
Females- short urethra and proximity to rectum,
Trauma to female urethra- during coitus and childbirth,
Pregnancy- stasis of urine,
Anatomical abnormalities,
Renal cysts,
Pre-existing renal parenchyma damage,
Stones in urinary tract,
Immunosuppression,
Instrumentation of urinary tract,
Presence of foreign body in urinary tract
What are the common organisms of uncomplicated UTI?
E.coli or skin commendable such as staph.saprophyticus
In a MSSU what urine should be discarded?
The first 10-20ml of stream
How should be MSSU be stored?
Refrigerated or
In a special container containing boric acid to prevent bacterial overgrowth or
Dipslide
What urine samples should be used in children?
A clean catch urine sample, urine collection pads, catheter sample or suprapubic aspiration
What organisms cause UTI?
E.coli, proteus sp, enterococcus faecalis, klebsiella sp, pseudomonas sp, staph. Saprophyticus
What strains of e.coli are most common to cause a UTI?
Strains with specialised projections called p fimbriae, they are more adherent to uroepithelium and are more likely to cause upper UTI
What is a common cause of UTI in a sexually active female?
Staph.saprophticus
Why does proteus encourage stone formation?
It produced the enzyme urease which splits urea to release ammonia, thus making urine alkaline and encouraging stone formation
What organisms are more common to be found in hospital UTIs
E.coli, proteus, klebsiella and pseudomonas sp
What organisms are more likely to cause stone formation in the urinary tract?
Proteus or klebsiella
What does the presence of >10 white blood cells/mm3 in uncentrifuged urine represent?
Significant pyruria- marker of infection rather than contamination
What do SIGN guidelines recommend for treatment for non-pregnancy women with symptoms or signs of acute lower UTI
3 days of trimethroprim or nitrofurantoin
Treatment of UTI in men
14 days of a quinolone (eg ciprofloxacin) OR
7 days of nitrofurantoin or trimethoprim if appears uncomplicated
Treatment of acute pyelonephritis?
Antibiotic chosen by sensitivity testing.
7 days of ciprofloxacin
Should be reviewed- checking urine sample in 1-2 weeks after cessation of antibiotic therapy
Treatment of UTI in pregnancy?
Nitrofurantoin is safe during pregnancy but not at term as can cause neonatal haemolysis,
Cephalexin
If a patient with a catheter has a positive culture of UTI should you treat?
No
Only patients with a catheter and symptoms of a UTI should be treated
