UTI - Learning Package Flashcards

1
Q

What is cystitis?

A

Cystitis = inflammation of the bladder which can by due to infection (bacterial cystitis) or other cause

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2
Q

What is bacteruria?

A

Bacteruria = presence of bacteria in urine, note anterior urethra is not sterile and presence of urethral organisms washed out during micturition is not bacteriuria

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3
Q

What is pyuria?

A

Pyuria = presence of pus cells (neutrophil polymorphs) in significant quantities in urine

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4
Q

What is sterile pyuria?

A

Sterile pyuria = urine is negative on culture but significant numbers of pus cells present

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5
Q

What is acute pyelonephritis?

A

Acute pyelonephritis = infection of the upper urinary tract involving the kidneys

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6
Q

What is chronic pyelonephritis?

A

Chronic pyelonephritis = pathological condition with renal scarring and potentially loss of renal function

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7
Q

Describe the aetiology of UTI?

A

Aetiology in men:

  • Prostatitis
  • Infection of the prostate
  • STIs

Aetiology in woman:

  • Sex
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8
Q

What are some predisposing factors for UTI?

A
  • In females, short urethra and its proximity to rectum
  • Trauma to female urethra during coitus and childbirth
  • In pregnancy due to stasis of urine allowing bacteria to flourish
  • Anatomical abnormalities
    • Congenital pelvi-ureteric junction obstruction, vesico-ureteric reflux, duplex kidneys, horseshoe kidney, urethral valves, prostatic enlargement etc
  • Renal cysts
  • Pre-existing renal parenchymal damage
    • Such as from recurrent pyelonephritis
  • Stones in urinary tract
  • Immunosuppression including diabetes, prolonged steroid therapy, transplant rejection medication
  • Instrumentation of urinary tract
  • Presence of foreign body in urinary tract including catheter
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9
Q

How can UTI be classified?

A
  • Complication
    • Those which occur in situations other than young, sexually active woman
  • Uncomplicated
    • Occur in healthy, sexually active young woman
    • Organisms usually E-coli or skin commensals such as staph saprophyticus
    • Further investigations not required
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10
Q

What organisms are usually responsible for uncomplicated UTI?

A
  • Organisms usually E-coli or skin commensals such as staph saprophyticus
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11
Q

In what situations should cultures be done to diagnose UTI?

A

There are many cases when clinical diagnosis of simple, uncomplicated UTI does not require lab confirmation and empirical antibiotics can be used

But, situations where cultures should be done:

  • Woman with mild or limited symptoms for whom dipstick testing is inconclusive
  • Suspected UTI in men
  • Suspected acute pyelonephritis
  • Pregnant woman with symptoms and for screening
  • After failed antibiotic treatment or persistent symptoms
  • Recurrent UTI
    • Defined as >2 UTIs within 6 months or >3 in a year
  • Children with suspected UTI
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12
Q

What is recurrent UTI defined as?

A

Defined as >2 UTIs within 6 months or >3 in a year

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13
Q

How is urine collected for culturing?

A

Urine collected with mid-stream urine (MSU), should be done early morning

Catheter specimens should be obtained from the catheter sampling port and not from the collection bag

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14
Q

What are some common organisms that cause UTI?

A
  • E-coli most common cause
  • Staph. Saprophyticus is a common cause in young sexually active woman
  • Protease, Klebsiella and Pseudomonas are more often found in hospital patients
    • Often associated with catheters
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15
Q

Other than culturing, what other investigation can help diagnosis?

A

Microscopy of unstained urine can also be carried out:

  • To determine whether or not there are cells, casts or organism present
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16
Q

What are the classical symptoms of urinary tract infection?

A
  • Dysuria
  • Frequency of urination
  • Suprapubic tenderness
  • Urgency
  • Polyuria
  • Haematuria
17
Q

Describe the general treatment for urinary tract infection?

A
  • Antibiotics
  • Drinking lots of fluid
  • Alkalinising agents (OTC)
18
Q

Describe the presentation of UTI in woman?

A
  • Dysuria (pain on passing urine)
  • Frequency (passing urine more often than usual in small amounts)
  • Urgency (feeling that you need to pass urine)
  • Suprapubic pain
  • Polyuria (increased volume of urine)
  • Haematuria (blood in the urine)
19
Q

Describe the treatment for UTI in woman?

A
  • If have 3 of above symptoms or severe symptoms should be treated with antibiotics without further investigation
    • 3 day course
  • If mild or only 2 symptoms or fever should have mid-stream urine (MSU) collected and dipstick test performed
    • UTI unlikely if urine not cloudy
20
Q

What can be detected in dipstick test?

A
  • Nitrate (metabolic product of some bacteria)
  • Protein (not normally detectable, sign of inflammation)
  • Lecucocytes (leucocyte esterase is an enzyme found in leucocyte ie pus cells, marker of inflammatory response)
21
Q

What is the commonest renal disease?

A

Acute pyelonephritis

22
Q

Describe epidemiology of acute pyelonephritis?

(how common, age)

A
  • Commonest renal disease
  • Usually woman of child bearing age
23
Q

Describe the presentation of acute pyelonephritis?

A
  • Loin pain
  • Fever
  • Urinary symptoms less pronounced but possible
    • Frequency and dysuria
  • May be systemically unwell
  • Bacteraemia in most severe cases
    • Rigors, nausea and vomiting
24
Q

What investigations are done for acute pyelonephritis?

A
  • Urine cultured
  • Blood culture if systemically unwell
25
Q

Describe the epidemiology of catheter related infection?

(how common)

A
  • Very common, 5% per day
26
Q

Describe the epidemiology for asymptomatic bacteriria?

(who)

A
  • Presence of bacteria in urine of asymptomatic woman and older men with prostatic hyperplasia is relatively common
27
Q

What is asymptomatic bacteriruia associated with during pregnancy?

A
  • Associated with increased risk of pyelonephritis and premature delivery
  • Pregnant woman screened at booking by urine (MSU) culture and treated
28
Q

Describe the aetiology of sterile pyuria?

A
  • Usually renal tuberculosis
  • Genito-urinary infections such as chlamydia trachomatis
  • Non-infective pathology in bladder or kidney
29
Q

What investigations should be done for sterile pyuria?

A
  • Collect 3 early morning urine samples for a ZN strain and TB culture
30
Q

Describe the treatment for simple cystitis in woman?

A
  • Oral antibiotics to which organism is sensitive
    • 3 day course of Trimethoprim or Nitrofurantoin
  • Cultures taken if no response
31
Q

Describe the treatment for suspected lower UTI in men?

A
  • 14 days of quinolone such as ciprofloxacin to cover possible prostatitis
  • 7 days of nitrofurantoin or trimethoprim if infection uncomplicated
32
Q

Describe the treatment for acute pyelonephritis?

A
  • 7 days of antibiotics guided by sensitivity testing
  • Non-pregnant woman with ciprofloxacin
33
Q

Describe the treatment for UTI during pregnancy?

A
  • Nitrofurantoin
    • Trimethoprim is not recommended during pregnancy
34
Q

Describe the treatment for catheter related UTI?

A
  • Only patients with symptoms treated
  • Appropriate antibiotics preceded by changing the catheter
35
Q

Describe the treatment for asymptomatic bacteriuria?

A
  • No indication for treatment, other than in pregnancy or when operation procedure involving UTI is planned
36
Q

Describe treatment for recurrent infections?

A
  • Drink lots of fluids
  • Emptying bladder after sexual intercourse
  • Further investigations
    • Gynaecological examination and IVP
  • Long term antibiotic prophylaxis
    • 1 tablet or nitrofurantoin or trimethoprim per night