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Glasgow Phase 3 > UTIs > Flashcards

UTIs Flashcards

1
Q

What is the definition of:
- Relapse,
- Recurrent,
- Urosepsis/complicated UTI

A
  • Relapse = infection with the same organism.
  • Recurrent = infection with same or different species with > 3 infections per year.
  • Complicated UTI = Temp>38, HR>90, RR>20 and WBC >15 or <4.
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2
Q

What are the risk factors and management for bacteriuria?

A
  • Risk factors onclude urinary catheterisation, diabetes, anatomical abnormalities and pregnancy.
  • Only treat asymptomatic bacteriuria in preschool children, pregnancy and immunocompromised.
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3
Q

What are the different methods of transmission for UTIs?

A

Ascending - Urethral colonisation which can have bladder and ureteric involvement.
Descending - Haematogenous spread involving renal parenchyma

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4
Q

What are the common causative organisms in UTIs?

A
  • Gram negative bacilli such as E.coli, klebsiella, proteus.
  • Gram positive such as streptococcus, enterococcus sp, group B strep, staphylococcus, candida and anaerobes
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5
Q

What are the clinical features of UTIS

A
  • Suprapubic discomfort,
  • Dysuria,
  • Urgency,
  • Frequency,
  • Cloudy, blood stained, smelly urine,
  • Low grade fever or sepsis.
  • In Neonates it can cause failure to thrive, jaundice.
  • In children it can cause abdominal pain and vomiting.
  • In elderly it can cause nocturia, incontinence and delirium.
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6
Q

What is the management of a UTI in a non-pregnant women, children and men

A
  1. First presentation, do urine dip, check previous culture results are prescribe empirically (trimethoprim or nitrofurotoin). If there is no response to treatment then do a urine culture and change abx.
  2. In children and men send a urine sample for culture first them prescribe
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7
Q

What is the management of a UTI in pregnancy?

A
  • Always send urine sample.
  • Check previous sensitivities. Amoxicillin is relatively safe but avoid trimethoprim in 1st trimester and avoid nitrofurantoin near term.
  • Hospital admission for IV if severe.
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8
Q

Explain the management of recurrent UTIs

A
  1. Send samples from each episode and emphasise importance of hygiene, hydration, post coital voiding.
  2. Urology investigations
  3. Self administered single dose (can be taken post coital)/short course therapy,
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9
Q

What is the management of catheter associated UTIs and the prevention

A
  1. Send CSU,
  2. Start antibiotics (initially empirically)
  3. Remove/replace catheter.
    Prevention - Only catheterise if necessary, remove when no longer needed, remove/replace if causing infection, catheter care bundles and infection prevention precautions
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10
Q

What are the symptoms of acute pyelonephritis

A
  • Flank pain +/- systemic infection,
  • Enlarged kidney,
  • Potential abscesses on surface of kidney
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11
Q

What is the management of acute pyelonephritis?

A
  • Send urine culture, blood culture and maybe do imaging. Always do blood cultures if pyrexial/septic.
  • For community pyelonephritis give oral co-amoxiclav/ciprofloxacin/trimethoprim. In hospital give IV abx.
  • Complicated UTIs may need surgical intervention
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12
Q

What are some complications of pyelonephritis?

A
  • Scarring,
  • Renal abscess which has similar symptoms to pyelonephritis and usually has a positive urine and blood culture. Can progress to emphysematous pyelonephritis which has a high mortality rate. Requires surgical drainage and abx
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13
Q

What are the symptoms and features of perinephric abscesses

A
  • Uncommon infections which occur due to haematogenous spread. Common organisms incl. e.coli or s.aureus.
  • Symptoms are similar to pyelonephritis but with a slow onset.
  • Treatment is surgical drainage with empirical abx therapy such as co-amoxiclav (treat as complicated UTI)
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14
Q

What are the typical antibiotics for complicated and uncomplicated UTIs

A
  • Always check previous microbiology, local guidelines and drug allergies.
  • Uncomplicated UTI is oral amoxicillin, trimethoprim or nitrofurantoin.
  • Complicated UTIs is with IV amoxicillin and vancomycin. Need to be dual therapy. If penicillin allergy then musty find a substitute for amoxicillin
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15
Q

Describe symptoms and complications of acute bacterial prostatitis

A
  • Usually occurs spontaneously. Presents with perineal and back pain, UTI symptoms, urinary retention and pyrexia.
  • Complications include prostatic abscess, spontaneous rupture, epididymitis, ascending infection or systemic sepsis
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16
Q

What are the investigations, likely organisms and treatment for acute bacterial prostatitis

A

Investigations - Urine culture, blood culture, trans-rectal ultrasound, CT/MRI.
- Likely organisms are gram neg bacilli like e.coli. S.aureus or N.gonorrhoea.
- Treatment is ciprofloxacin or ofloxacin but always check previous/recent microbiology

17
Q

Describe features of chronic prostatitis

A
  • May follow chlamydia urethritis.
  • Can present as recurrent UTI symptoms. Relapse is common.
  • Likely orgnaisms include gram negative bacilli such as E.coli, or enterococcus or s.aureus
18
Q

What is epididymitis and symptoms

A
  • Inflammation of epididymis. Occurs due to ascending infection from the urethra.
  • Symptoms include pain, fever, swelling, penile discharge and UTI symptoms
19
Q

What are the common organisms which cause epididymitis

A
  • E.coli is the most common cause
  • Staphylococci,
  • TB in high risk areas,
  • Chlamydia and N.gonorrhoea is the mist likely in sexually active males
20
Q

What is orchitis and its symptoms

A
  • Inflammation of one or both testicles which is usually viral (mumps) but can be bacterial.
  • Symptoms include testicular pain and swelling, fever, dysuria and penile discharge
21
Q

Describe features and complications of bacterial orchitis

A
  • Usually a complication of epididymitis. It is Severe infection requiring urological review. Treated as compilated UTI.
  • Complications include testicular infarction or abscess formation
22
Q

What is Fournier’s Gangrene and the risk factors?

A
  • Form of necrotising fasciitis which normally occurs over the age of 50.
  • risk factors include UTI, complications of IBD, trauma and recent surgery.
23
Q

What are the investigations and treatment for Fournier’s gangrene?

A
  • Blood culture, urine culture and intra operative samples of tissue and pus.
  • 1st line treatment is surgical debridement combined with broad spectrum antibiotics such as piperacillin and tazobactam with gentamycin and metronidazole

Glasgow Phase 3 (148 decks)

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