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Antimicrobials > UTI > Flashcards

UTI Flashcards

1
Q

Which group of patients are at risk of urinary tract infection?

A
  1. child <3 yr old (underlying abnormalities eg spina bifida, vesicourethral reflux)
  2. yg female
  3. elderly
  4. catheterised pt (hosp/stroke)
  5. underlying abnormalities
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2
Q

What are the predisposing factors for urinary tract infections?

A
  1. reflux - vesicourethral angle not acute
  2. calculi
  3. prostatism
  4. congenital
  5. catheter
  6. neurological
  7. pathogen factors (attachment, type 1, P fimbriae)
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3
Q

What are the 2 sites of UTI?

A
  1. Upper UTI (pyelonephritis)
  2. Lower UTI (cystitis)
  • bacteraemia = upper tract infection
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4
Q

What are the likely pathogens?

A
  1. E coli

2. Staphylococcus saprophyticus

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5
Q

In pt w structural anomalies/ catheter, what kinds of UTI pathogens are common?

A
  1. Proteus
  2. Pseudomona aeruginosa
  3. Enterococcus
  4. candida
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6
Q

Where should you collect urine specimen?

A
  1. catheterised pt: collect from port and not from bag

2. clean catch urine

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7
Q

What should you do when collecting urine specimen?

A
  1. Clean adequately
  2. Collect before antibiotics
  3. Transport immediately to lab
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8
Q

What is a screening tool for UTI?

A

Urine dipstick

  • rbc (haem),
  • wbc (leukocyte esterase),
  • nitrates (E coli metabolites)
  • note but err on oversensitivity so need microscopy
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9
Q

What are the possible findings of urine microscopy?

A
  1. Hematuria: RBC > 100/uL + WBC > 100/uL

2. Pyuria: WBC > 100/uL + RBC <10/uL

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10
Q

If WBC count is low, does it mean patient does not have UTI?

A

No, as

  1. dilution effect
  2. WBC degraded on storage
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11
Q

Diagnosis of UTI using urine culture

A
  1. Single colony + >100,000 cfu/mL : significant
  2. 1000-100,000 cfu/mL + single colony: may also be significant
  • mainly gram -ve
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12
Q

How do you know if urine culture is inaccurate?

A
  1. Mixed growth
  2. Overgrowth if > 90min storage & transport –> false positives
  3. Non pathogenic species eg coagulase-negative staph
so need to take into account
Bacterial count
Mixed / single organism
Presence or absence of catheter
Patient’s age and background
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13
Q

What’s needed to diagnose UTI?

A

Any 2 of 3

  1. Symptoms
  2. Urine WBC ++ pyuria
  3. Culture ++ growth
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14
Q

How long do you treat uncomplicated UTI?

A

3 days

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15
Q

How long do you treat upper tract infection?

A

at least 2 weeks

  • look for underlying abnormalities
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16
Q

What are the empiric antibiotics for UTI?

A
  1. Cotrimoxazole
  2. Amoxy-clavulanic acid
  3. Cephalosporins
  4. Aminoglycosides
  5. Fluoroquinolones
17
Q

What are the antibiotics ONLY used for lower tract UTI?

A
  1. Nitrofurantoin

2. nalidixic acid

18
Q

What are the antibiotics used for uncomplicated UTI?

A

Oral cephalosporins

19
Q

Antibiotics not for X urinary infection

A

Erythromycin &

Clindamycin

20
Q

Special cases

A 
Pyelonephritis
Recurrent UTI
Paediatric UTI
Catheter-associated UTI
Asymptomatic bacteriuria
21
Q

Sexually-transmitted diseases

A

Ulcer
Syphilis *
Haemophilus ducreyi
Herpes simplex virus

Discharge
Neisseria gonorrhoeae *
Chlamydia trachomatis *

Warts
Human papillomavirus

Systemic
HIV, hepatitis B

Others
lymphogranuloma venerum

22
Q

What are the tests for syphilis?

A

Treponema:

  1. TPHA
  2. EIA

Non-treponema:
1. VDLR

Rapid plasmid reagin:
RPR

23
Q

Which would be the syphilis screening test recommended?

A

TPHA/EIA as life long positives

24
Q

What must you take note of if TPHA/EIA used to screen for syphilis?

A

Cross-reactivity with non-syphilis treponema infection

eg yaws

25
Q

Why not use VDLR or RPR to screen for syphilis?

A
  1. biological false positives
  2. false negatives due to pro-zone
  3. more used to monitor disease activity
26
Q

How do you screen for Neisseria gonorrhea?

A

Lab tests:
1. Culture on Thayer-Martin agar
(use Amies transport media +/- charcoal)
2. PCR, usually w chlamydia PCR - replace culture but no info on susceptibility

27
Q

Treatment of N gonorrhea

A

high prevalence of penicillin resistance (penicillinase + PBP)

  1. ceftriaxone (emerging resistance)
  2. alt: azithromycin
  3. X ciprofloxacin
  4. concurrent chlamydia: doxycycline
28
Q

How do you screen for chlamydia?

A

screen sex active women – 25 yr old

  1. CT PCR (cyclic threshold-CT)
  2. endocervical, vagina, urine specimens
29
Q

Treatment of chlamydia

A

doxycycline

azithromycin

30
Q

What are the causes of vaginal discharge?

A
  1. candida
  2. bacterial vaginosis (gram stain, VP3 DNA probe test)
  3. trichomonas vaginalis (wet mount, PCR)
31
Q

Reasons for a negative culture but with UTI symptoms and pyuria

A
  1. Started on antibiotics
  2. “acute urethral syndrome”
    - Due to chlamydia, other organisms
    - With symptoms, may respond to treatment
  3. Others e.g. TB
32
Q

What measures can be taken to overcome the problem of prolonged transport time for urine?

A

Keep in fridge 4 deg C – send within 24 h
Boric acid in container (supplied by lab)
Urine dipslide

Antimicrobials (11 decks)

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