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Renal > UTI > Flashcards

UTI Flashcards

1
Q

What is a UTI?

A

Bacteria in the urinary tract that causes clinical infection.

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2
Q

What is cystitis?

A

LUTI/infection of bladder

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3
Q

What is another term for a LUTI?

A

Cystitis

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4
Q

What is pyelonephritis?

A

UUTI/Kidney infection

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5
Q

What is another term for a UUTI?

A

Pyelonephritis

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6
Q

Which parts of the urinary tract are normally sterile?

A

Kidneys, ureters and bladder

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7
Q

What kind of bacteria normally colonize the lower urethra?

A

Coliforms and enterococci

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8
Q

What makes a UTI complicated?

A

Systemic upset or urinary tract structural abnormalities.

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9
Q

What is bacteriuria?

A

Bacteria in the urine

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10
Q

Does bacteriuria always mean a UTI?

A

No, elderly or catheterised patients may have it too.

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11
Q

Is cystitis just caused by infection?

A

No, just means inflammation of bladder so can be many causes.

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12
Q

What three factors regulate the presence of infection?

A

Host- Immunological status, behaviour etc
Organism- Type of organism, virulence etc
Environment- Medical devices, anatomy/urinary retention

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13
Q

What are some risk factors for contracting a UTI?

A

Women
Catheter
Structural abnormalities

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14
Q

What are the two routes bacteria can take to infect the urinary tract?

A

Ascending

Blood

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15
Q

How common is blood stream infection of the kidneys?

A

Quite uncommon

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16
Q

What is an important factor of bloodstream infections of the kidney?

A

Multiple small abscesses

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17
Q

Name five important bacteria that can cause UTI

A 
E. Coli
Klebsiella
Enterobacter
Proteus
Pseudomonas
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18
Q

What is the most common form of bacteria to infect the urinary tract?

A

Lactose fermenting coliforms such as E. Coli, Klebsiella and Enterobacter

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19
Q

What makes E. Coli exceptionally good at causing UTI?

A

Long flagellum that allow it to adhese and climb up.

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20
Q

What part of E. Coli is responsible for a lot of its effects such as fever?

A

Endotoxin

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21
Q

Where is endotoxin found in E. Coli?

A

LPS layer

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22
Q

What does proteus do in urine?

A

Breaks down urea to ammonia to increase pH and precipitate out struvite stones.

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23
Q

What does proteus infection smell like?

A

Burnt chocolate

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24
Q

What is pseudomonas infection associated with?

A

Catheters and medical devices

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25
Q

What is the best antibiotic for a pseudomonas infection?

A

Ciprofloxacin

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26
Q

How should ciprofloxacin be administered?

A

Oral or IV

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27
Q

Which groups should not receive ciprofloxacin?

A

Children and pregnant women

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28
Q

What are the three major gram negative causes of UTI?

A

E. Coli
Proteus
Pseudomonas

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29
Q

What are the two main gram positive causes of UTI?

A

Enterococci

Staph

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30
Q

Which enterococci is important to know?

A

Enterococci faecalis

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31
Q

Where is enterococci usually acquired?

A

Hospital

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32
Q

Which two forms of staph commonly cause UTI?

A

S. Aureus

S. Saprophyticus

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33
Q

What kind of UTI does S. Aureus normally cause?

A

Blood born

34
Q

Where is S. Saprophyticus normally found?

A

Female reproductive tract

35
Q

What group is most affected by S. Saprophyticus?

A

Women of childbearing age

36
Q

How do you diagnose a UTI?

A

Dysuria
Increased urination frequency
Nocturia (change from baseline)
Haematuria

37
Q

What three factors suggest UUT involvement?

A

Fever
Rigors
Loin pain

38
Q

What are some risk factors for a LUTI?

A

Female
Sexually active
Diabetes
Obesity

39
Q

What three organisms tend to cause LUTI?

A

Klebsiella
Enterobacter
S. Saprophyticus

40
Q

What are some risk factors for UUTI?

A

HIV/Immunosuppression
Diabetes
Congenital abnormalaties

41
Q

What four organisms tend to cause UUTI?

A

Klebsiella
Enterobacter
S. Aureus
Proteus

42
Q

How should you collect a urine sample?

A

Midstream

43
Q

Why should you collect a midstream urine sample?

A

Because the first part tends to contain bacteria from the urethra

44
Q

What should you do before collecting a midstream urine sample?

A

Clean perineal/urethral meatus with sterile saline (not antiseptic!)

45
Q

What type of container should you ideally collect a urine sample in?

A

Sterile universal (white top)

46
Q

How soon should a sample in a sterile universal be tested?

A

<2h

47
Q

If it’s going to take longer than 2h to test a urine sample what type of container should you use?

A

Boricon (red top)

48
Q

How long is a Boricon container good for?

A

Up to 24h

49
Q

If a midstream sample isn’t possible what other collection techniques are there?

A

Clean catch
Bag urine
Catheter specimen
Suprapubic aspiration

50
Q

What groups is a clean catch urine sample good for?

A

Children

Cog or physically impaired

51
Q

How does a clean catch sample work?

A

Clean, urinate but into toilet, stop, urinate into container until half full.

52
Q

Which group is a bad urine sample good for?

A

Babies

53
Q

What is a major problem with a bag urine sample?

A

Often contaminated with bowel flora

54
Q

What is a good result from a bag urine sample?

A

Negative (positive could be contaminated)

55
Q

Can a dipstick test be used to diagnose a UTI?

A

No but can indicate one in select patient groups

56
Q

Which groups should not have their urine dipstick tested?

A

Elderly or catheterised

57
Q

What two things on a urine dipstick indicate infection?

A

Leukocytes

Nitrites

58
Q

Infection with which organism does not give positive nitrites test?

A

Pseudomonas

59
Q

How is a UTI diagnosed in the lab?

A

Microscopy- rare and only in urgent cases

Urine culture

60
Q

What are the three categories in the Kass criteria?

A

Probable UTI- >10^5 organisms/ml
Probably contamination- 10^4 organisms/ml
No significant bacteriuria- <10^3

61
Q

What group is the Kass criteria applied to?

A

Women of childbearing age

62
Q

What are pure and mixed growths?

A

Pure- one organism

Mixed- 2+

63
Q

When is a >10^5 organisms/ml significant?

A

When it’s caused by one organism (if 2+ then probably not significant)

64
Q

How should you treat an uncomplicated LUTI?

A

Antibiotics

65
Q

How long should antibiotics be given for in a LUTI?

A

3 days

66
Q

What is Abacterial cystitis/Urethral syndrome?

A

Symptoms of UTI and pus cells in urine but no growth.

67
Q

What can cause Abacterial cystitis/Urethral syndrome?

A

Early phase of UTI
Urethral trauma (honeymoon cystitis)
Chlamydia/gonorrhoea

68
Q

How can you treat Abacterial cystitis/Urethral syndrome?

A

Alkalise urine for symptomatic relief

69
Q

What is Asymptomatic bacteriuria?

A

Significant bacteriuria (>10^5 orgs/mL) but no pus cells and patient is asymptomatic.

70
Q

How do you treat Asymptomatic bacteriuria?

A

You don’t unless pregnant

71
Q

When should a catheterised patient be treated for a UTI?

A

> 10^5 orgs/mL and symptomatic

72
Q

What is the empirical treatment for a LURI in a female?

A

Nitrofurantoin or trimethoprim orally (3 days)

73
Q

What is the empirical treatment for uncatheterised male UTI?

A

Nitrofurantoin or trimethoprim orally (7 days)

74
Q

What is the empirical treatment for complicated UTI or pyelonephritis seen by a GP?

A

Co-amoxiclav or co-trimoxazole (14 days)

75
Q

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

A

Amoxicillin and gentamicin IV for 3 days

76
Q

What is the local treatment for coliforms?

A

IV Gent for UUTI

Oral trimethoprim for LUTI

77
Q

What is the local treatment for enterococci?

A

IV Amoxicillin

78
Q

Which group should gent not be given to?

A

Pregnant women

79
Q

What are some dangers of gent?

A

Renal damage

CNVIII damage

80
Q

How long should gnet be prescribed for?

A

3 days

Renal (13 decks)

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