UTI's Flashcards
what is the term for pus cells in the urine and what does this represent?
pyuria
neutrophil polymorphs in the urine - inflammatory process usually UTI
what is the term for inflammation / infection of the bladder?
cystitis
what are the symptoms of a UTI?
dysuria polyruia frequency of urination / strangury suprapubic tenderness flank pain haematuria pyrexia / chills cloudy offensive urine confusion
what is dysuria?
painful or difficult urination
what are the guidelines wit regards to tretament/investigation women presenting with a suspected UTI?
women presenting with 3 or more symptoms should be started on antibiotic treatment (3 day course)
2 symptoms or fever = mid-stream urine sample
what 2 tests can be carried out to investigate a UTI?
urine dip stick
mid-stream urine samlple
what does can a dipstick test detect that can suggest a UTI?
nitrite (metabolic by product of some bacteria)
protein (sign of inflammation)
leucocyte (inflammatory marker)
in dipstick testing: if there is positive leucocyte but protein and nitrite are negative, does this indicate a UTI ?
it doesn’t exclude or diagnose UTI alone
a urine culture would be required for further investigation
on urine dip stick, if there is protein but negative leucocyte and nitrite, does this indicate UTI and why?
the protein can be due to other causes so should be further investigated with urine culture
what is the cause of increasing rates of men with UTI as they age?
secondary to obstruction caused by prostatic hypertrophy
what organisms may be responsible for UTI in younger men?
STI’s;
- chlamydia
- gonorrhoea
what may be recurrent UTI in older men the sign of?
prostatitis
at what percent does someone with a catheter have of a UTI?
5% per day
should asymptomatic bacteriuria patients be treated and why/
no as treatment shows no benefit
however there is exception with pregnancy, people undergoing urological surgery or surgery involving artificial prosthesis
what is acute pyelonephritis?
infection of the upper urinary tract
what are the presentations of acute pyelonephritis?
loin pain & fever (most common)
sterile pyuria
urinary symptoms i.e. frequency, dysuria
may be systemically unwell = signs of sepsis; rigors, nausea/vomiting,
in a patient with suspected pyelonephritis, what is the initial management?
urine culture
start antibiotic treatment immediately
(blood cultures if the patient is systemically unwell)
what is the difference in antibiotic treatment for cystitis vs acute pyelonephritis?
cystitis = 3 days pyelonephritis = 7 days
what is asymptomatic bacteriuria in pregnancy associated with and what is done to reduce this?
increased risk of pyelonephritis
premature delivery
screening pregnancy women by urine (MSU) culture
what are the causes of sterile pyuria?
undeclared presence of antibiotics in the urine treated UTI < 2 weeks prior inadequately treated UTI renal TB chlamydia pyelonephritis bladder tumour appendicitis calculi: prostatitis polycystic kidneys papillary necrosis (i.e. BM) chemical cystitis i.e. cyclophosphamide
why is it extremely important to follow up and treat UTI in children?
there is an association between UTI in children and chronic pyelonephritis (renal damage/scarrin) in adulthood
what is the most common presentation of chronic pyelonephritis?
vague abdominal discomfort
hypertension
impaired renal function only in a minority of patients
what factors predispose someone to a UTI?
pregnancy - stasis of urine
sexual intercourse - damage to urethra, STI’s
female - short urethra & proximity to the colon
obstruction i.e. BPE - stasis of urine
foreign bodies i.e. catheterisation
pre existing renal parenchymal damage i.e. from recurrent pyelonephritis
renal cysts
congenital abnormalities i.e. vesico-ureteric reflux
what organisms are responsible for uncomplicated UTI in women?
e. coli
staph. saprophyticus
what investigations should be carried out if its a complicated UTI?
for lower tract; - flow studies - residual bladder scan - cystoscopy upper tract; - USS kidneys - CT-KUB - IV Pyelogram /urogram
when should urine cultures be undertaken for a UTI?
women with mild symptoms or dipstick test is inconclusive suspected UTI in men suspected acute pyelonephritis pregnant women with symptoms after failed antibiotic treatment persistant symptoms recurrent UTI children
how is a urine sample collected from a patient who has a catheter?
urine collected from catheter sampling port and not the collection bag
why are urine samples more likely to be positive in the morning ?
over night growth of bacteria
what are the common species that cause UTI’s in the hospital?
e. coli
enterococcus faecalis
klebsiella pneumonia
what are the common species that cause community acquired UTI?
e.coli
proteus mirabilis
enterococcus faecalis
what organism that causes UTI’s promotes the formation of stones and why?
proteus sp. because it produces the enzyme urease which splits urea to release ammonia thus making urine alkaline encouraging stone formation
- also associated with klebsiella
what antibiotics are given to treat UTI in women?
nitrofurantoin
trimethoprim
what is the treatment for UTI in males?
14 day course of a quinolone e.g. ciprofloxacin
if uncomplicated = 7 day course of nitrofurantoin or trimethoprim
what measures can be taken to reduce recurrent UTI in women?
urinate after sexual intercourse
single dose of antibiotic prophylactally after intercourse
maintain good hygiene
take 1 tablet of nitrofurantoin or trimethoprim for a year
what is a common symptom of UTI’s in the elderly?
incontinence
what are the causes of stasis urine which can predispose someone to a UTI?
obstruction:
- tumours and calculi
- benign prostatic hyperplasia
- uterine prolapse
- vesicoureteric reflux
describe how an obstruction can lead to renal impairment.
obstruction = stasis of urine
stasis urine back up into the ureters = hydroureter
if this is prolonged then it can increase and lead to dilatation of the kidneys = hydronephrosis which can lead to chronic renal impairment
what is the most common cause of UTI in women over child bearing age?
uterine prolapse
what is the most common cause of UTI in children?
vesticoureteric reflux
what is the most common cause of UTI in older and younger males?
younger = chlamydia & gonorrhoea older = benign prostate hyperplasia
what is required for the diagnosis of a UTI?
microbial evidence plus symptoms/signs; Bacterial count of 104 cfu/ml from MSSU with no more than 2 species of bacteria At least one of the following; - fever >38 - loin/frank pain - suprapubic pain or tenderness - urinary frequency - urinary urgency - dysuria
what is the treatment for acute pyelonephritis?
7 day ciprofloxacin
what could be the underlying causes of pyelonephritis in men and recurrent pyelonephritis in women?
renal calculi
if you suspect vesico-ureteric reflux, what investigation would you carry out to confirm?
micturating cystogram
what is chronic interstitial nephritis?
the histopathological appearance common to chronic pyelonephritis due to non-infective causes
What is the most common causative organism of acute pyelonephritis?
E.coli
What are 3 first-line investigations for suspected acute pyelonephritis?
Urinalysis
Urine culture
Gram stain
What is the treatment for acute pyelonephritis?
Ciproflaxacin (flouroquinolone)
What is the most common cause of chronic pyelonpehritis?
Chronic vesico-ureteral reflux
What are the risk factors for chronic pyelonephritis?
Acute pyelonephritis Vesicoureteral reflux Obstruction (calculi, tumour, BPD) Diabetes mellitus Neurogenic bladder
What are 3 first-line investigations for suspected chronic pyelonephritis?
Urinalysis
Urine culture
Renal function
CT-KUB
What is the treatment for chronic pyelonpehritis?
There isn’t specific treatment for chronic pyelonephritis
You have to treat the underlying cause
List three common causative organisms of UTI.
E.coli Enterococcus faecalis Proteus mirabilis klebsiella sp. pseudomonas aeruginosa
List 4 general systemic factors that might predispose an individual to a UTI.
Immunosuppression
Steroids
Malnutrition
Diabetes
What specific urological problems might lead to an increased risk of UTI?
Vesico-ureteric reflux
Catheterisation
Kidney / bladder stones
Female sex (short urethra)
Sexual intercourse and poor voiding habits
Stasis of urine e.g. poor bladder emptying, pregnancy
Oestrogen deficiency in post menapausal women
Vesico-colonic fistula
Congenital abnormalities e.g. duplex kidney
What are the symptoms and signs of a UTI?
Pyrexia, pyrexia Flank pain / suprapubic tenderness Dysuria / polyuria haematuria Cloudy offensive urine Strangury / frequency Confusion
How are UTIs managed?
Trimethoprim, nitrofurantoin
Amoxicillin if kidney disease
What advice would you give for recurrent UTI in young women?
Void before and after intercourse 1 tablet of trimethoprim for a year Antibiotic prophylaxis after intercourse Maintain good hygiene Fluid intake 2l day Void every 2-3 hours by day Void before bedtime
What antibiotic is not suitable for treatment of complicated UTI and why?
Vancomycin
It is only active against gram positive organisms but UTI’s are mostly caused by gram negative
if a male has persistent UTI or fails to respond to treatment, what are the differential diagnoses?
prostatitis
epididymitis
chlamydia infection
what is the treatment for UTI in men?
14 day course of ciproflaxacin (quinolone)
