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Renal SOH > UTI's > Flashcards

UTI's Flashcards

1
Q

Definition

A

Presence of micro-organisms in the urinary tract that cause clinical infection

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2
Q

Complicated UTI - definition

A

Presence of systemic symptoms OR
Due to urinary structural abnormality OR
Due to presence of stones

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3
Q

Urine in the kidneys, ureters and bladder is normally sterile. True or false?

A

True

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4
Q

The lower end of the urethra is normally sterile. True or false?

A

False

- it is normally colonised by bacteria (mainly coliforms and enterococci from the large bowel)

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5
Q

Common routes of UTI infection

A 
Ascending infection (most common)
Blood stream (less common)
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6
Q

What word is used to describe upper UTIs ?

A

Pyelonephritis

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7
Q

Pyelonephritis - definition

A

Infection involving the ureters +/- kidneys

Systemic involvement present

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8
Q

Pyelonephritis - who gets it

A

Commonly patients are in hospital

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9
Q

Pyelonephritis - causative organisms (gram -ve)

A

Coliforms

  • e.coli
  • klebsiella
  • proteus

Pseudomonas aeruginosa

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10
Q

Pyelonephritis - causative organisms (gram +ve)

A

Enterococcus faecalis

Staph aureus

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11
Q

Pyelonephritis - clinical features

A 
Fever 
Rigors 
Loin pain
Malaise 
Nausea/vomiting 
Dysuria 
Frequency
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12
Q

Pyelonephritis - investigations

A 
MSU 
- collect mid stream of urine in a foil bowl 
Urine culture 
Urine microscopy (rare) 
- do this only in transplant pts
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13
Q

What blood culture container is MSU put in in hospital setting?

A

White top

- must reach the lab within 2 hours

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14
Q

Do you do urinalysis in patients with upper UTI?

A

NO

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15
Q

When do you NOT do urinalysis?

A

In patients who have upper UTI
Catheterised patients
Elderly patients (above 65)

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16
Q

Urine culture - how many organisms need to be present to be deemed as ‘significant’ and suggestive of UTI?

A

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

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17
Q

Pyelonephritis - management (community)

A

Co-amoxiclav
OR
Co-trimoxazole

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18
Q

Pyelonephritis - management (hospital)

A

Amoxicillin IV + Gentamicin IV

  • gentamicin only given for 3 days
  • use co-trimoxazole if pt penicillin allergic
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19
Q

Pseudomonas aerginosa - management

A

Ciprofloxacin (4C)

- not used young children or pregnant women

20
Q

Catheterised patients with blood culture results revealing >10^5 organisms/ml urine should always be given antibiotics. True or false?

A

False

- they should only be given antibiotics if there is supporting evidence of UTI (i.e. symptoms)

21
Q

What word is used to describe lower UTI’s?

A

Cystitis

22
Q

Cystitis - definition

A

Infection confined to the bladder

There is NO systemic involvement

23
Q

Cystitis is more common in the hospital setting / community setting ?

A

Community setting (GP)

24
Q

Which gender are more likely to get UTI’s and why?

A

Females

  • short, wide urethra
  • proximity of urethra to anus
25
Q

Risk factors for developing lower UTI

A

Female
Sexual activity
Pregnancy

26
Q

Cystitis - causative organisms (gram -ves)

A

Coliforms

  • E coli
  • Klebsiella
27
Q

Cystitis - causative organisms (gram +ves)

A

Staphylococcus saphrophyticus

Enterococcus faecalis

28
Q

Cystitis - clinical features

A 
Dysuria 
Suprapubic pain
Frquency of urination 
Nocturia 
Haematuria
29
Q

Cystitis - investigations

A

MSU
- collect mid stream of urine in foil bowl
Urinalysis

30
Q

What blood culture container is MSU put in in community (GP) setting?

A

Red top

  • boric acid container (this inhibits the overgrowth of organisms)
  • works for 24 hours
31
Q

Urinalysis for lower UTI

A

Good for ruling out infection in some patients
Leukocyte esterase - presence of WBC in the urine
Nitrites - bacteruria

32
Q

“Young previously healthy woman presents to GP with cystitis. What is the best investigation?”

A

Urinalysis (dipstick)

33
Q

Cystitis - management (uncomplicated female, community)

*include duration

A

Trimethoprim (3 days)
OR
Nitrofurantoin (3 days)

34
Q

Nitrofurantoin is effective in the upper and lower urinary tract. True or false?

A

FALSE

- nitrofurantoin is NOT effective in the upper UT as it needs to be activated in the bladder

35
Q

Cystitis - management (male, community)

*include duration

A

Trimethoprium (7 days)
OR
Nitrofurantoin (7 days)

36
Q

Both males and females with uncomplicated lower UTI require urine cultures? True or false

A

False

- only males need cultures

37
Q

Cystitis - management (male/female, complicated, community)

*include duration

A

Co-amoxiclav (14 days)
OR
Co-trimoxazole (14 days)

38
Q

Abacterial cystitis - definition

A

Patient with symptoms of UTI but no organism growth on investigation

39
Q

Abacterial cystitis - causes

A

Urethral trauma

Urethritis (caused by STI)

40
Q

Abacterial cystitis - management

A

Citrate salts (alkalinise urine)
- useful in relieving dysuria
Empty bladder after sex
- if sexually related

41
Q

Asymptomatic bacteruria - definition

A

Patient who is asymptomatic but has significant bacteruria

- since the patient has no symptoms they do not have an infection

42
Q

Asymptomatic bacteruria - management

A

Do not need antibiotics

43
Q

Asymptomatic bacteruria - management (pregnancy)

A

Must treat with antibiotics (cephalexin or nitrofurantoin)

  • if not treated, patient could get pyelonephritis
44
Q

What is proteus

A

Gram -ve coliform

Causative organism of upper UTI

45
Q

Which organism is likely to cause renal stone formation?

A

Proteus

- it produces urease

46
Q

Which organism causes “stag horn calculi?”

A

Proteus

Renal SOH (25 decks)

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