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Renal > UTI > Flashcards

UTI Flashcards

1
Q

What is a lower UTI infection?

A

Infection confined to the bladder (cystitis)

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2
Q

What is an upper UTI infection?

A

Infection involving the ureters +/- kidneys (pyelonephritis)

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3
Q

What bacteria colonise the distal urethra?

A

Coliforms

Enterococci

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4
Q

What is a complicated UTI?

A

UTI with
Systemic symptoms OR
Urinary structural abnormality/ stones

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5
Q

What is bacteriuria?

A

Bacteria present in urine

Only UTI if symptoms present

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6
Q

What is cystitis?

A

Inflammation of the bladder - not necessarily infection

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7
Q

Why do women get more UTIs than me?

A

Short, wide urethra
Proximity of urethra to anus
Increased risk with sexual activity, pregnancy

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8
Q

What are the routes of infection in an UTI?

A

Ascending infection: bacteria from bowel, perineal skin, lower end of urethra
Bloodstream: bacteraemia, seeding into kidneys

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9
Q

What coliforms commonly cause UTI?

A

E.COLI
Klebsiella
Enterobacter
Proteus

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10
Q

What bacteria, that is not a coliform, will cause UTIs?

A

Pseudomonas aeruginosa

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11
Q

What will a proteus UTI cause?

A

Struvite stones (triple phosphate stones) - staghorn calculus

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12
Q

How does proteus cause struvite stones?

A

Produces urease which breaks down urea to form ammonia, increasing urinary pH

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13
Q

What is the only oral antibiotic active against pseudomonas aeruginosa?

A

Ciprofloxacin

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14
Q

What is the mechanism of action of quinolones?

A

Inhibits bacterial DNA gyrase, preventing supercoiling of bacterial DNA

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15
Q

What enterococcus commonly causes UTI?

A

Enterococcus faecalis

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16
Q

What is the most common gram positive organism to cause UTI?

A

Staphylococcus saprophyticus - coag neg staph

Affects women of child bearing age

17
Q

What are the symptoms and signs of a UTI?

A

Dysuria
Frequency of urination
Nocturia
Haematuria

18
Q

What are the symptoms of pyelonephritis?

A

Fever
Loin pain
Rigors

19
Q

What is the ideal urine sample for culture?

A

MSU as first passed urine is most likely to be contaminated with commensals

20
Q

Should you dipstick urine in the elderly and those with catheters?

A

NO

21
Q

What do nitrites signify on dipstick?

A

Presence of bacteria in the urine
Coliforms can reduce nitrates to nitrites HOWEVER, enterococcus, staphylococcus and pseudomonas do NOT so will have a negative teet

22
Q

What level of bacteria in the urine is associated with infection?

A

> 10^5

23
Q

What is abacterial cystitis?

A

Symptoms of UTI but no significant growth on culture

24
Q

Should you treat an UTI if there are no symptoms?

A

NO

25
Q

Should asymptomatic pregnant women be treated for an UTI?

A

YES; 20-30% will progress to pyelonephrtiis

26
Q

What is the treatment for an uncomplicated lower UTI in females?

A

Trimethoprim or nitrofurantoin orally for 3 days

27
Q

What is the treatment for an uncatheterised UTI in a male?

A

Trimethoprim or nitrofurantoin orally for 7 days

28
Q

Should you get cultures in male UTIs?

A

YES

29
Q

What is the treatment for a complicated UTI or pyelonephritis in the community?

A

Co-amoxiclav or co-trimoxazole for 14 days

30
Q

What is the treatment for a complicated UTI or pyelonephritis in hospital?

A

Amoxicillin and gentamicin IV for 3 days

31
Q

How long can gentamicin be given for?

A

3 days

32
Q

What antibiotics can be used in ESBL producing UTIs?

A

Nitrofurantoin, pivmecillinam

Meropenem, ertapenem

33
Q

What is a carbapenamase-producting enterobacteriaceae?

A 
Gram negative (coliform) bacilli that are resistant to meropenem 
Resistant to ALL current antibiotics
34
Q

What is second line for gram negs - after gent?

A

Aztreonam

35
Q

What is second line for gram positives, after amox?

A

Vancomycin

36
Q

What is the mechanism of action of trimethoprim?

A

Inhibits bacterial folic acid synthesis

37
Q

Can trimethoprim be given in pregnancy?

A

Avoid in 1st trimester (first 3 months)

38
Q

Can nitrofurantoin be used in pregnancy?

A

Avoid in late pregnancy, breast feeding and children under 3 months as can cause neonatal haemolysis

Renal (22 decks)

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