UTI Flashcards
How would a UTI present? [6]
- Dysuria (pain on micturation)
- Frequency/urgency
- Smelly cloudy urine
- Flank Pain
- Strangury (Wanting to void but can’t)
- Signs of systemic infection: confusion, chills
What microorganisms cause UTI? [5]
Mostly bowel organisms
- E. Coli
- Proteus Spp.
- Klebsiella Spp.
- Pseudomonas Aeruginosa
- Enterococci
State medical terms for inflammation of the urethra, bladder, ureter or kidney? [4]
Urethritis
Cystitis
Ureteritis
Acute Pyeonephritis (chronic if recurrent or prolonged)
What are the main tests for UTI?[3]
Dipstick Urinalysis
Mid Stream specimen of Urine - MSSU for urine culture & Microscopy
Suprapubic aspiration (mainly for people who cant give an MSSU e.g. young kids or elderly)
How do you tell if bacteria in a urine culture are pathogenic or contaminating commensals? [1]
They grow in log scales in the culture. 10^5 is almost certainly infectious even if asymptomatic.
What are the complications of a UTI? [3]
- Sepsis, septic shock
- Chronic pyelonephritis
- Calculi –> Obstruction –> Hydronephrosis –> Hypertension & chronic renal failure
What are the categories of UTI aetiology? [3]
1) Stasis of Urine (either obstruction or loss of full bladder feeling)
2) Pushing bacteria up urethra (sex in women or urological procedures)
3) Generalised predisposition to infections (e.g. diabetes)
What can cause you to lose the feeling of a full bladder? [1]
A spinal cord or brain injury
Whats the main cause of urinary obstruction in children? [1]
Vesicouretic reflux
Its a loss of the angle of entry of ureter to bladder
What are the main causes of obstruction in adults? [3]
- Benign Prostatic Hyperplasia (men)
- Uterine Prolapse (Women)
- Tumours & Calculi (both)
What are the consequences of an obstruction? [2]
Back up of urine causing hydroureter and hydronephrosis and eventually chronic renal failure.
Slowed flow –> Infection & sediment formation (calculi)
Why are women more at risk of UTIs? [5]
- Short urethra
- No prostatic bacteriostatic secretion
- Close urethral orifice to rectum
- Sexual activity (vagina just behind urethra so pushes bacteria up)
- Pregnancy places pressure on the ureter & bladder
Why does diabetes predispose you to UTIs? [2]
1) Glc in urine
2) Poorly functioning WBCs
How would a UTI present in a small child? [4]
How does initial management differ in treatment of a small child with UTI? [1]
Dysuria unlikely as they cannot complain of it
- Diarrhoea
- Crying & not eating
- N&V
- Fever
In contrast to adults, the development of a urinary tract infection (UTI) in childhood should prompt an investigation for possible underlying causes and damage to the kidneys
How would pyelonephritis appear? [5]
~dehydration Fever Loin/flank pain ~systemic unwellness/bacteraemia Cloudy Urine
Risk factors for a UTI? [9]
Name 5 female specific risk factors
- Sex
- Renal Stones
- Immunosuppression (Long term CCS, DM or transplant meds)
- Anatomical Abnormalities e.g. horseshoe kidney or duplex collecting system
- Foreign Body e.g. catheter or stent
- Static urine due to poor bladder emptying e.g. retention
- Malnutrition
- Pre-existing parenchymal disease
- Fistula between bladder/bowel
Female specific:
- Female
- Oestrogen Deficiency
- Pregnancy
- Childbirth
- Poor hygiene e.g. not wiping from front to back in girls
What other tests would we do in kids with UTIs? [1]
A micturating Cystogram to check for vesico-ureteric reflux
How do we treat most UTIs? [4]
State 2nd line and 3rd line
3d of trimethoprim
send a urine culture if:
aged > 65 years
visible or non-visible haematuria
How would we advise women with recurrent UTIs? [2]
Drink plenty of fluids
Urinate frequently, particularly bbed and before/after sex.
How do we handle UTIs due to indwelling catheters [2]
How to treat UTI in men?
Only treat if the patients symptomatic.
If you do treat you have to change the catheter before starting treatment
a 7-day, rather than a 3-day course should be given
Men: an immediate antibiotic prescription should be offered
What radiological signs (CT) may indicate pyelonephritis? [4]
- Scarring
- Clubbing of calyces
- Abscess
- Emphysematous (gaseous) pyelonephritis. Lots of gas pockets within the kidney due to gas-forming bacteria.
Causative organisms UTI [3]
Causative organisms
E. coli
Proteus
Pseudomonas
In a recurrent UTI, differentiate between reinfection vs relapse
Relapse is recurrence of bacteriuria with same organism within 7 days of completion of antibiotics - implies failure to eradicate organism.
Reinfection is when bacteriuria is absent after antibiotics for 14 days followed by recurrence of infection by same/different organism. Implies poor bladder defense mechanisms or increased susceptibility
