UTI's Flashcards
Definition
Presence of micro-organisms in the urinary tract that cause clinical infection
Complicated UTI - definition
Presence of systemic symptoms OR
Due to urinary structural abnormality OR
Due to presence of stones
Urine in the kidneys, ureters and bladder is normally sterile. True or false?
True
The lower end of the urethra is normally sterile. True or false?
False
- it is normally colonised by bacteria (mainly coliforms and enterococci from the large bowel)
Common routes of UTI infection
Ascending infection (most common) Blood stream (less common)
What word is used to describe upper UTIs ?
Pyelonephritis
Pyelonephritis - definition
Infection involving the ureters +/- kidneys
Systemic involvement present
Pyelonephritis - who gets it
Commonly patients are in hospital
Pyelonephritis - causative organisms (gram -ve)
Coliforms
- e.coli
- klebsiella
- proteus
Pseudomonas aeruginosa
Pyelonephritis - causative organisms (gram +ve)
Enterococcus faecalis
Staph aureus
Pyelonephritis - clinical features
Fever Rigors Loin pain Malaise Nausea/vomiting Dysuria Frequency
Pyelonephritis - investigations
MSU - collect mid stream of urine in a foil bowl Urine culture Urine microscopy (rare) - do this only in transplant pts
What blood culture container is MSU put in in hospital setting?
White top
- must reach the lab within 2 hours
Do you do urinalysis in patients with upper UTI?
NO
When do you NOT do urinalysis?
In patients who have upper UTI
Catheterised patients
Elderly patients (above 65)
Urine culture - how many organisms need to be present to be deemed as ‘significant’ and suggestive of UTI?
Over 10^5 organism /ml urine
(this is KASS criteria)
However if there is mixed growth (2 or more organisms) and there is over 10^5 organisms then it is probe not a UTI
Pyelonephritis - management (community)
Co-amoxiclav
OR
Co-trimoxazole
Pyelonephritis - management (hospital)
Amoxicillin IV + Gentamicin IV
- gentamicin only given for 3 days
- use co-trimoxazole if pt penicillin allergic
Pseudomonas aerginosa - management
Ciprofloxacin (4C)
- not used young children or pregnant women
Catheterised patients with blood culture results revealing >10^5 organisms/ml urine should always be given antibiotics. True or false?
False
- they should only be given antibiotics if there is supporting evidence of UTI (i.e. symptoms)
What word is used to describe lower UTI’s?
Cystitis
Cystitis - definition
Infection confined to the bladder
There is NO systemic involvement
Cystitis is more common in the hospital setting / community setting ?
Community setting (GP)
Which gender are more likely to get UTI’s and why?
Females
- short, wide urethra
- proximity of urethra to anus
Risk factors for developing lower UTI
Female
Sexual activity
Pregnancy
Cystitis - causative organisms (gram -ves)
Coliforms
- E coli
- Klebsiella
Cystitis - causative organisms (gram +ves)
Staphylococcus saphrophyticus
Enterococcus faecalis
Cystitis - clinical features
Dysuria Suprapubic pain Frquency of urination Nocturia Haematuria
Cystitis - investigations
MSU
- collect mid stream of urine in foil bowl
Urinalysis
What blood culture container is MSU put in in community (GP) setting?
Red top
- boric acid container (this inhibits the overgrowth of organisms)
- works for 24 hours
Urinalysis for lower UTI
Good for ruling out infection in some patients
Leukocyte esterase - presence of WBC in the urine
Nitrites - bacteruria
“Young previously healthy woman presents to GP with cystitis. What is the best investigation?”
Urinalysis (dipstick)
Cystitis - management (uncomplicated female, community)
*include duration
Trimethoprim (3 days)
OR
Nitrofurantoin (3 days)
Nitrofurantoin is effective in the upper and lower urinary tract. True or false?
FALSE
- nitrofurantoin is NOT effective in the upper UT as it needs to be activated in the bladder
Cystitis - management (male, community)
*include duration
Trimethoprium (7 days)
OR
Nitrofurantoin (7 days)
Both males and females with uncomplicated lower UTI require urine cultures? True or false
False
- only males need cultures
Cystitis - management (male/female, complicated, community)
*include duration
Co-amoxiclav (14 days)
OR
Co-trimoxazole (14 days)
Abacterial cystitis - definition
Patient with symptoms of UTI but no organism growth on investigation
Abacterial cystitis - causes
Urethral trauma
Urethritis (caused by STI)
Abacterial cystitis - management
Citrate salts (alkalinise urine)
- useful in relieving dysuria
Empty bladder after sex
- if sexually related
Asymptomatic bacteruria - definition
Patient who is asymptomatic but has significant bacteruria
- since the patient has no symptoms they do not have an infection
Asymptomatic bacteruria - management
Do not need antibiotics
Asymptomatic bacteruria - management (pregnancy)
Must treat with antibiotics (cephalexin or nitrofurantoin)
- if not treated, patient could get pyelonephritis
What is proteus
Gram -ve coliform
Causative organism of upper UTI
Which organism is likely to cause renal stone formation?
Proteus
- it produces urease
Which organism causes “stag horn calculi?”
Proteus
