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Yr 3 Infection > UTI > Flashcards

UTI Flashcards

1
Q

definition of UTI

A

bacturia - bacteria in the urine - this is not a disease, can be symptomatic or not

UTI - dx based on sx and signs, tests that show bacteria in urine may provide more info

Characterized by presence of>100,000 of colony-forming units per ml of urine.

may affect bladder (cystitis), kidney/renal pelivis (pyelonephritis) or prostate (prostatitis).

lower UTI - cystitis, prostatitis

upper - pyelonephritis

abacterial cystitis/urethral syndrome - dx of exclusion in patients with dysuria and frequency, without demondtratable infection

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2
Q

aetiology of UTI

A

usually transurethral ascent of normal colonic organisms

most common - E coli

others include Proteus mirabilis, Klebsiella and Enterococci (more common in hospitals).

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3
Q

epidemiology UTI

A

common in females - 30% experience UTI at some point

seen in 5% pregnant women, 2% non-preg, 20% of elderly living at home and 50% of institutionalised elderly

UTI is rare in children and young men (if present, suspect an underlying cause).

Annual incidence of UTI in women is 10–20%.

10% of men and 20% of women >65 years have asymptomatic bacteriuria (>65 years MSU is no longer diagnostic and clinical assessment is mandatory).

Pyelonephritis = 3 per 1000 patient years

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4
Q

general sx of UTI

A

may be asymptomatic bacturia

Up to 30% of women with UTI symptoms may not have bacteruria

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5
Q

sx of cystitis

A

frequency

urgency

dysuria - pain on micturition

haematuria

suprapubic pain

smelly urine

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6
Q

sx of acute pyelonephritis

A

fever

malaise

rigors

loin/flank pain

vomiting

costovertebral pain

associated cystitis sx

septic shock

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7
Q

sx of prostatitis

A

fever

malaise

nausea

low back/perineal/rectum/scrotum/penis/bladder pain

irritative/obstructive symptoms - hesitancy, urgency, intermittency, poor stream, dribbling

swollen or tender prostate on PR

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8
Q

sx of UTI in elderly

A

malaise,

nocturia,

incontinence,

confusion

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9
Q

signs of cystitis

A

asymptomatic

fever

abdo/suprapubic/loin tenderness

bladder distension

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10
Q

signs of pyelonephritis

A

asymptomatic

fever

loin/flank tenderness

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11
Q

signs of prostatitis

A

asymptomatic

tender

swollen prostate

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12
Q

ix for uti

A

In non-pregnant women, if ≥ 3 (or one severe) symptoms of cystitis, and no vaginal discharge, treat empirically without further test

midstream urine

  • dipstick test
    • use in non-pregnant women <65 years with less than three symptoms. A negative dipstick reduces probability of UTI to <20%. Do not use in pregnant women. Limited data for men.
    • nitrites (urinary bacteria reduces nitrites to nitrates)
    • leucocytes
    • protein
    • blood
  • microscopy, culture and sensitivity
    • >=10(5)colonies/mL indicates a significant bacteriuria, but in the presence of UTI symptoms, the threshold is lower, in women (>10(2)/mL) and in men(>10(5)/mL).
    • Use in pregnant women, men, children, and if fail to respond to empirical antibiotics. Catheterized sample only if septic.
  • if sterile pyuria (pus cells with no organisms) - consider if may be partially treated UTI, TB stones, tumour, interstitial nephritis or renal papillary necrosis

blood - only if systemically unwell (FBC, UE, CRP, blood culture - positive in only 10–25% of pyelonephritis. consider fasting glucose)

renal US or IV urogram considered in women with frequent UTIs, and in children and men

  • exclude predisposing structural/functional abnormalities.

cystoscopy, urodynamics, CT from urology for men with upper UTI, failure to respond to treatment, recurrent UTI (>2/yr), pyelonephritis, unusual organism, persistent haematuria

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13
Q

Mx of cystitis

A

If three or more symptoms (or one severe) of cystitis, and no vaginal discharge; consider local microbiological policies: co-trimoxazole, trimethoprim, nitrofurantoin (if eGFR >30) or amoxicillin (in non-pregnant females) and ciprofloxacin (males).

If first-line empirical treatment fails, culture urine and treat according to antibiotic sensitivity

If symptoms suggest prostatitis (pain in pelvis, genitals, lower back, buttocks) consider a longer (4-week) course of a fluoroquinolone (eg ciprofloxacin) - ability to penetrate prostatic fluid

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14
Q

Mx for pyelonephritis

A

IV gentamicin, cefuroxime, ciprofloxacin

women

  • take culture and treat initially with broad spectrum AB eg co-amoxiclav
  • consider hospitalisation because of AB resistence
  • Avoid nitrofurantoin as it does not achieve eff ective concentrations in the blood.

men - refer to urology

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15
Q

Mx for catheterised pts - UTI

A

obtain culture and consider changing catheter

only treat if symptomatic - catheters invariably get colonised

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16
Q

UTI prophylaxis

A

high fluid intake

regular micturition to keep bladder empty

cranberry based products reduce frequency of recurrence

In some cases, low-dose long-term (6–12 months) antibiotics for women with frequent UTIs.

17
Q

surgical Mx for UTI

A

rarely necessary

relief of obstruction and removal of any renal calculi

18
Q

complications for UTI

A

Renal papillary necrosis (in those with underlying renal disease, e.g. diabetes mellitus or stones).

Renal/perinephric abscess (seen on renal ultrasound).

Pyonephrosis (pus in palvicalyceal system)

Gram-negative septicaemia.

19
Q

prognosis for UTI

A

Mostly resolve with treatment.

Among pregnant women, 20% developacute pyelonephritis if not treated;

there is a high relapse rate.

20
Q

uncomplicated UTI

A

normal renal tract structure and function

21
Q

complicated UTI

A

structural/functional abnormaloty of GUT eg obstruction, catheter, stones, neurogenic bladder, renal transplant

22
Q

RF for UTI

A

increased bacterial inoculation - sexual activity, urinary incontinence, faecal incontinence, constipation

increased binding of uropathic bacteria - spermicide use, low oestrogen, menopause

reduced urine flow - dehydration, obstructed urinary tract

increased bacterial growth - DM, immunosuppression, obstruction, stones, catheter, renal tract malformation, pregnancy

23
Q

general signs for UTI

A

fever

abdo or loin tenderness

check for distended bladder, enlarged prostate

if vaginal discharge consider PID

dont rely on classical sx and signs in a catheterised pt

24
Q

organisms for UTI

A

usually anaerobes and gram -ve bacteria from bowel and vaginal flora

E coli is the main organism (75-95% in community byt less in hospital)

Staphylococcus saprophyticus (a skin commensal) in 5–10%.

Other enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumonia.

25
Q

infection causes of sterile pyuria (high WCC, sterile on standard culture)

A

TB

recently treated UTI

inadequately treated UTI

fastidious culture requirement

appendicitis, prostatitis, chlamydia

26
Q

non-infectious causes of sterile pyuria

A

calculi

renal tract tumour

papillary necrosis

tubulointerstitial nephritis

chemical cystitis

polycystic kidney

recent catheter

pregnancy

SLE

drugs eg steroids

27
Q

Mx of UTI in pregnancy

A

expert help

associated with pre-term delivery and intrauterine growth restriction

. Asymptomatic bacteriuria should be confi rmed on a second sample.

Treat with an antibiotic

28
Q

Mx of UTI in catheterised patients

A

all are bacteriuric - only send MSU if symptomatic

symptoms of UTI may be non-specific or atypical

fever, flank/suprapubic pain, change in voiding pattern, vomiting, confusion, sepsis

change long term catheter before starting AB

29
Q

urinary tract TB

A

A cause of sterile pyuria: dysuria, frequency, suprapubic pain but negative standard culture

malaise, fever, night sweats, weight loss, back/flank pain, visible haematuria

can cause interstitial nephritis and renal amyloidosis. glomerulonephritis is rare

dx by microscopy with acid-fast techniques adn mycobacterial culture of an early morning MSU and or urinary tract tissue

Treat with rifampicin and isoniazid for 6 months in conjunction with pyrazinamide and ethambutol for 2 month

Yr 3 Infection (25 decks)

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