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PHAM02 > UTIs > Flashcards

UTIs Flashcards

1
Q

RF for UTIs

A
  • indwellnig catheter
  • ABX use
  • spermicides
  • sexual intercourse
  • female
  • pregnancy
  • genetic problems
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2
Q

uncomplicated UTIs

A
  • female (not elderly)
  • 1st presentation/infrequent
  • no signs of pyelonephritis
  • not pregnant
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3
Q

complicated UTI

A
  • pregnant
  • male
  • children
  • elderly
  • pyelonephritis
  • recurrent
  • immuncompromised
  • poorly controlled DM
  • impaired renal fxn
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4
Q

Sx of pyelonephritis

A
  • pain in abdomen/back
  • systemically unwell
  • +/- fever
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5
Q

presentation of UTI (typical/uncomplicated)

A
  • dysuria
  • frequency
  • suprapubic tenderness
  • urgency
  • polyuria
  • haematuria
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6
Q

presentation of upper UTI/pyelonephritis

A
  • +/- UTI Sx
  • fever
  • flank/loin/lower back pain
  • can lead to renal failure, sepsis
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7
Q

What to rule out if UTI Sx?

A

possible STI

esp if doesn’t respond to Tx

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8
Q

diagnosis of UTI

A
  • Hx and Sx
  • urine -> appearance, smell, cloudy, blood?
  • urine microscopy
  • dipstick test -> leukocytes, nitrites, protein
  • urine culture
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9
Q

Should urine dipstick be used for diagnosis of UTI? Why?

A

no

  • elderly can have asymptomatic bacteria in urine/bladder
  • especially O65yrs
  • or with catheter
  • not harmful, ABX not beneficial
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10
Q

Tx for uncomplicated UTI

A

** Nitrofurantoin MR 100mg BD for 3 days (or 50mg QDS)
- 1st line Tx
- c/i in severe renal impairment (eGFR <45)
- activtaed by urinary pH

alternative:
** trimethoprim 200mg BD for 3 days
- can be used in renal impairment, reduce dose

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11
Q

Tx duration for complicated UTI

A

5-10 days Tx

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12
Q

How to take nitrofurantoin?

A

take with food

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13
Q

When to be cautious with nitrofurantoin?

A

RENAL IMPAIRMENT
- eGFR < 45
- eGFR 30-45 only if multi-drug resistant

INC RISK PERIPHERAL NEUROPATHY (low risk for short course)
- caution if already have inc risk with DM, anaemia, folate deficiency, electrolyte imbalances

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14
Q

at risk of peripheral neuropathy

A

DM
anaemia
folate deficiency
electrolyte imbalances

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15
Q

s/e of nitrofurantoin

A

GI

pulmonary - cough, chest pain, dyspnoea, hypoxemia (rare, withdraw, Tx with cs)

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16
Q

trimethoprim and renal impairment

A
  • can be used in severe renal impairment
  • need to reduce dose
  • GFR 15-25 normal dose for 3 days, then 1/2 dose
  • GFR <15 half normal dose
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17
Q

Co-trimoxazole drugs?

A

TRIMETHOPRIM
+
sulfametaxozole

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18
Q

Interactions with trimethoprim?

A
  1. MTX - folate antagonist
  2. azathioprine - inc risk haematological toxicity
  3. PHY - inc levels
  4. digoxin - inc levels
  5. warfarin
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19
Q

s/e of trimethoprim

A

GI

blood disorders (LT)

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20
Q

** electrolyte impairment with trimethoprim

A

HYPERKALAEMIA

(eg, with ACEI)

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21
Q

common pathogens that cause pyelonephritis

A
  • E coli
  • Klebsiella pneumonia
  • Proteus species
  • pseudomonas species
  • enterococcus species
22
Q

complications of pyelonephritis

A

renal failure/ AKI

sepsis

23
Q

temperature in sepsis

A

> 38 degC
or
<36 degC

24
Q

Sx of sepsis

A
  • high/low temp
  • tachycardia
  • hypotension
  • SOB
  • impaired consciousness
  • rigors (shivering with high temp then sweating)
  • sweating
  • pallor
  • lack of mobility
  • dehydration
  • don’t tolerate oral foods/meds
25
Q

at risk of sepsis

A

pregnant
elderly
immunocompromised
renal impairment
diabetes
no improvement after 24hr of ABX

26
Q

Tx for pyelonephritis in primary care

A

co-amoxiclav 625mg TDS 7 days
or
ciprofloxacin 500mg BD 7 days

27
Q

co-amoxiclav problems

A

pen allergy

cholestatic jaundice (rare)

28
Q

ciprofloxacin problems

A

tendonitis

reduces seizure threshold, + NSAIDs inc risk of seizure

CYP450 inhibitor

29
Q

IV ABX for pyelonephritis in secondary care

A

gentamycin
tazocin
meropemem
teicoplanin
ciprofloxacin

30
Q

relapse vs reinfection

A

relapse = same strain of organism within 2 weeks of finishing Tx

reinfection = diff strain of organism, >2 weeks after Tx

31
Q

What can be used for UTI prophylaxis?

A

trimethoprim 100mg ON

more common in elderly

poor evidence

32
Q

Why are UTIs less common in men?

A

longer urethra

antibacterial activity of prostatic secretions

33
Q

Tx for UTI in a man

A

7 day course of trimethoprim or nitrofurantoin

34
Q

Tx if recurrent UTI in man

A
  • quinolones
  • can penetrate prostatic fluid
  • (often prostate involvement if recurrent UTI in male)
35
Q

bacturia risk in pregnancy

A

premature delivery

36
Q

What does treating asymptomatic bacturia in pregnancy help with?

A
  • reduces risk of pyelonephritis
  • reduces risk of low birth weight
  • reduces premature birth
37
Q

group B streptococcus in pregnancy

A

prophylactic ABX may be started during labour and delivery

can be passed to baby during birth and needs Tx

38
Q

Tx for cystitis in pregnancy

A
  • paracetamol for pain relief
  • urine culture & empirical ABX
  • nitrofurantoin

NOT trimethoprim (anti folate)
NOT cranberry products

  • fever & loin pain = pyelonephritis -> admit and IV ABX (risk of premature birth)
39
Q

UTI in elderly

A

Sx:
- inc confusion
- functional decline
(non-specific Sx)

  • asymptomatic bacturia common, don’t treat
  • UTI diagnosis required new urinary Sx
  • short course of ABX for older female patients
  • nitrofurantoin c/i in severe renal impairment
  • nitrofurantoin toxicity more common in elderly
40
Q

UTI with indwelling catheter

A
  • all pts with LT indwelling catheter have bacturia
  • repeated Tx of asymptomatic bacturia inc risk of colonisaiton of drug resistant bacteria
  • check for correct positioning and ensure not blocked
  • if in place for >1 week, change before starting ABX
  • urine culture before ABX
  • mild Sx, delay Tx and wait for culture/sensitivity
  • 7 day course
41
Q

RF for UTI in DM patients?

A
  • inc risk asymptomatic bacturia
  • higher risk of recurrent infections
  • higher prevalence of atypical pathogens
  • bilateral infections more common
  • inc risk resistance
  • hospital acquired infections more common
  • fungal causes of UTI more common (glucose in urine)
  • inc risk complicaitons (renal failrue, sepsis)
42
Q

presentation of UTI in children

A
  • dysuria
  • frequency
  • abdominal pain, loin tenderness
  • fever, rigors
  • lethargy
  • vomiting, diarrhoea
  • haematuria
  • cloudy urine
  • febrile convulsions
  • recurrence of enuresis
43
Q

presentation of UTI in infants

A
  • fever
  • vomiting
  • lethargy
  • irritability
  • offensive urine
  • poor feeding
  • jaundice
  • febrile convulsions
  • septicaemia
44
Q

complication of UTI in children

A

pyelonephritis can damage growing kidney and cause scarring

45
Q

What to do if unexplained fever of >38 in child/infant?

A

urine sample tested within 24hrs

46
Q

RF for UTI in children

A
  • incomplete bladder emptying
  • poor urine flow
  • dysfunctional voiding resulting in enlarged bladder
  • obstruction from constipation
  • neuropathic bladder
  • renal abnormality
  • FHx of VUR/renal disease
  • Hx UTI
  • spinal lesion
  • poor growth
  • high BP
47
Q

Tx for UTI in children

A

ACUTE PYELONEPHRITIS:
- 7-10 days
- IV ABX 2-4 days if oral can’t be used then oral Tx for 10 days total

LOWER UTI:
- 3 days Tx
- re-assess if child unwell after 24-48hrs

ABX:
trimethoprim, nitrofurantoin, cephalosporin, amoxicillin

48
Q

preventing UTI

A
  • high fluid intake to give high urine output
  • regular voiding
  • complete bladder emptying
  • prevent/Tx of constipation
  • good hygiene
  • probiotic?
  • ABX prophylaxis -> recurrent UTI, congenital abnormality U2yrs , severe reflux (trimethoprim)
49
Q

indications for culture of urine in children

A
  • diagnosis of acute pyelonephritis/upper UTI
  • high/intermediate risk of serious illness
  • U3yrs
  • single +ve result for leukocyte esterase or nitrate
  • recurrent UTI
  • infection that doesn’t respond to Tx within 24-48hrs
  • Sx and dipstick tests don’t correlate
50
Q

low risk over 3yrs child and UTI

A

can be diagnosed based on Sx and dipstick test

PHAM02 (32 decks)

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