UTIs Flashcards

(44 cards)

1
Q

define UTI

A
  • Defined as presence of significant bacteriuria and characteristic signs and symptoms
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2
Q

what are the risk factors for UTIs?

A

iatogenic/ drugs- catheter, antibiotic use, spermacides
behavioral- voiding dysfunction, frequent or recent sex
physiologic- female, pregnant
genetic- familal tendency, vaginal mucus properties

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3
Q

what can pyleonephritis lead to?

A

AKI/sepsis- if it becomes systemic

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4
Q

who/ what is classified as an uncomplicated UTI?

A
  • Caused by a usual pathogen in a person with a normal urinary tract and normal kidney
    function
    – Female (not elderly)
    – First presentation
    – No signs of pyelonephritis
    – Not pregnant
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5
Q

what classifies as a complicated UTI?

A
  • Pregnant
  • Male
  • Children
  • Elderly
  • Pyelonephritis
  • Recurrent
  • Factors present that predispose to persistent or re-current infection or treatment failure
    – Abnormal urinary tract
    – Virulent organism
    – Impaired host defences
    – Poorly controlled diabetes
    mellitus,
    – Immunosuppressive treatment
    – Impaired renal function.
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6
Q

what are the typical symptoms of uncomplicated UTI?

A
  • Dysuria
  • Frequency
  • Suprapubic tenderness
  • Urgency
  • Polyuria
  • Haematuria
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7
Q

why would you suspect an upper UTI?

A
  • +/- UTI Symptoms
  • Fever
  • Flank, loin or lower back pain
  • Can lead to renal failure and
    septicaemia
  • Empirical antibiotics +/-
    admission to hospital required
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8
Q

how do you diagnose a UTI?

A
  • Clinical history and symptoms
  • Near patient tests?
    – Appearance of urine – smell? cloudy? blood?
    – Urine microscopy
    – Dipstick tests – leucocyte and nitrite
  • Urine culture
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9
Q

why are urine dipsticks not used?

A

Dipsticks become more unreliable with increasing age over 65 years. Up to half of older adults, and most with a urinary catheter, will have bacteria present in the bladder/urine without an infection. This “asymptomatic bacteriuria” is not harmful, and although it causes a positive urine dipstick, antibiotics are not beneficial and may cause harm

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10
Q

how do you manage an uncomplicated lower UTI?

A
  • Empirical Antibiotics
    – Nitrofurantoin MR 100mg twice daily for THREE days or 50mg QDS
  • First line treatment option
  • Contraindicated in significant renal impairment
  • Activity affected by urinary pH
    – OR Trimethoprim 200mg twice daily for THREE days
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11
Q

what do complicated UTIs need?

A
  • Complicated infection requires 5- 10 day treatment courses to eradicate bacteriuria
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12
Q

when do you have to be cautious with nitrofurantoin in renal impairment?

A
  • Caution in renal impairment
    – eGFR less than 45ml/minute/1.73m2
    – Ineffective (inadequate concentration in the urine….site of action)
    – 30-45ml/minute/1.73m2 – only if multi-drug resistant(risk/benefit)
    – Increased risk of peripheral neuropathy
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13
Q

what patients are already at risk of peripheral neuropathy?

A
  • DM
  • Anaemia
  • Folate deficiency
  • Electrolyte
    imbalances
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14
Q

what are some side effects of nitrofuratoin?

A

– GI
– Pulmonary – cough, chest pain, dysphonea,
hypoxemia….(<1%) – withdraw + corticosteroid

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15
Q

when would you be cautious with trimethoprim in renal impairment?

A
  • Caution in severe renal impairment (accumulation - less of an issue with 3
    day courses)
    – GFR 15-25 ml/min – normal dose for 3 days then half dose
    – GFR <15 ml/min – half normal dose
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16
Q

what is trimethoprim contraindicated with?

A
  • CI with blood dyscrasias – antifolate effects
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17
Q

what interactions does trimethoprim have?

A
  • Interactions (bigger issue with long-term treatment)
    – Methotrexate (folate antagonist)
    – Azathioprine (increased risk of haematological toxicity)
    – Phenytoin (increased levels)
    – Digoxin (increased levels)
    – Warfarin? (often the case with all Abx)
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18
Q

what should be done if patient is resistant to first line antibiotics?

A

urine culture

19
Q

define pyelonephritis

A

Infection within the renal pelvis, with or without active infection of the renal parenchyma

20
Q

what are the symptoms of pyelonephritis?

A

UTI + loin pain and/or fever

21
Q

what are the common pathogens of pyelonephritis?

A

Common pathogens:
* Escherichia coli
* Klebsiella pneumonia.
* Proteusspecies
* Pseudomonasspecies
* Enterococcus species

22
Q

who would you be extra cautious about with pyelonephritis?

A
  • Pregnancy
  • Elderly…care homes
  • Lack of improvement following antibiotic therapy (24 hours)….close monitoring
  • Immunocompromised
  • Renal impairment
  • Diabetes
23
Q

what is the management of pyelonephritis?

A

Primary care
* Co-amoxiclav 625mg TDS 7 days or
* Ciprofloxacin 500mg BD 7 days
* Cautions with above agents???
Secondary Care
* Optionsinclude, gentamicin, tazocin®, meropenem, teicoplanin,
ciprofloxacin

24
Q

what is defined as a relapsed UTI?

A
  • Same strain of organism within 2 weeks of finishing treatment
25
what is defined as a reinfection UTI?
* Different strain of organism, most likely if >2 weeks after treatment
26
how do you manage recurrent UTI?
* Patient initiated self treatment * Post coital prophylaxis - * Non antibiotic treatment – Cranberry products – no longer recommended * Continuous prophylaxis – option, but poor evidence – e.g. trimethoprim100mg ON
27
why are UTIs more uncommon in men?
longer urethra – antibacterial activity of prostatic secretions
28
what should be done in all men with suspected UTI?
urine culture
29
how do you treat a UTI in men?
– Seven day course of trimethoprim or nitrofurantoin recommended (HPA) – Treatment failure should be managed according to urine culture results – Recurrent UTI in men and febrile UTI often associated with prostate involvement * Quinolones indicated due to ability to penetrate prostatic fluid
30
what is bacteriuria in pregnant women associated with?
The presence of bacteriuria (with/ without symptoms) is associated with premature rupture of membranes and pre- term labour
31
what is done to prevent bacteruria in pregnant women?
* Routine screening for asymptomatic bacteriuria by midstream urine culture recommended in early pregnancy (NICE)
32
what can be given for cystitis in pregnancy?
* Paracetamol may be recommended for symptomatic relief * Alkalizing agents and cranberry should be avoided * Urine culture + empirical antibiotic therapy * Fever and loin pain suggests upper UTI – Hospital admission and IV antibiotics recommended
33
how may a UTI present in elderly?
* Chronic genitourinary symptoms may be present and not associated with acute infection – Functional decline, increased confusion and non specific symptoms are often attributed to UTI
34
how do you diagnose UTI in elderly?
* Diagnosis of UTI in an older person requires the presence of new urinary symptoms.
35
what must be done for patients with UTIs with indwelling catheters?
* The catheter must be checked for correct positioning and to ensure it is not blocked. * If the catheter has been in place for more than a week, it may be advisable to change it before starting antibiotic treatment * Urine culture must be taken prior to initiating empirical antibiotics * If symptoms are mild, treatment may be delayed to await results of culture & sensitivities * Seven day courses recommended
36
why are people with diabetes at higher risk of UTIs?
* Increased risk of asymptomatic bacteriuria * Higher risk of recurrent infections * Higher prevalence of atypical pathogens * Bilateral infections are more common * Greater likelihood of antimicrobial resistance * Hospital acquired infections are more common * Fungal urinary tract infection is more common * Increased risk of complications like renal failure and septicaemia
37
are UTIs common in children?
* Occurs in 3-7% girls and 1-2% boys before the age of 6 years * 12-30% experience recurrence within a year * Up to half patients have a structural abnormality of urinary tract * Pyelonephritis can damage growing kidney causing scarring
38
how do infants present with UTIs?
* Fever * Vomiting * Lethargy * Irritability * Offensive urine * Poor feeding / failure to thrive * Jaundice * Febrile convulsion * Septicaemia
39
how do children present with UTIs?
* Dysuria and frequency * Abdominal pain or loin tenderness * Fevers +/- rigors * Lethargy * Anorexia * Vomiting, diarrhoea * Haematuria * Offensive/ cloudy urine * Febrile convulsion * Recurrence of enuresis
40
what investigations should be done for infants and children?
Infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested within 24 hours (NICE)
41
what indications are there to do a culture?
– Diagnosis of acute pyelonephritis/upper urinary tract infection – High to intermediate risk of serious illness – Under 3 years – Single positive result for leukocyte esterase or nitrite – Recurrent UTI – Infection that does not respond to treatment within 24–48 hours – Clinicalsymptoms and dipstick tests do not correlate
42
what are the risk factors for UTI in children?
* Incomplete bladder emptying – Poor urine flow – Dysfunctional voiding resulting in enlarged bladder – Obstruction by loaded rectum from constipation – Neuropathic bladder * Antenatally-diagnosed renal abnormality * Family history of vesicoureteric reflux (VUR) or renal disease * History suggesting, or confirmed, previous UTI * Evidence of spinal lesion * Poor growth * High blood pressure
43
how do you treat children / infants over 3 months?
* Oral antibiotics recommended for children and infant over 3 months: – Acute pyelonephritis: * 7 days - 10 days * IV antibiotics for 2– 4 days if oral antibiotics cannot be used followed by oral treatment for 10 days total – Low UTI: * 3 days * Re-assess if child remains unwell after 24-48 hours * Choice of antibiotic – Trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
44
how can you prevents UTIs in children?
* High fluid intake to produce a high urine output * Regular voiding * Ensure complete bladder emptying – Double micturition * Prevention or treatment of constipation * Good perineal hygiene * Probiotic?? * Antibiotic prophylaxis – Not recommended after first infection – May be indicated in recurrent UTI – Under 2’s with congenital abnormality – Severe reflux – Trimethoprim