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Renal System > UTIs > Flashcards

UTIs Flashcards

1
Q

What are the px groups that are more at risk of UTIs (5)?

A

1) <3 y/o (eg. underlying abnormality
2) Young healthy women (short urethra)
3) Elderly
4) Catheterised px (in-hospital, stroke)
5) Underlying abnormalities (eg. obstruction, calculi, neurogenic bladder)

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2
Q

What are 6 predisposing factors for UTIs?

A

1) Young child (obtuse vesicourethral angle → reflux)
2) Calculi (renal and ureteric)
3) Obstruction (eg. prostatism)
4) Congenital structural abnormalities
5) Catheter
6) Neurological conditions
7) Pathogenic factors (eg. attachment, type 1, P fimbriae)

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3
Q

What are upper urinary tract infections known as?

A

Pyelonephritis

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4
Q

What are lower urinary tract infections known as?

A

Cystitis

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5
Q

Are upper or lower urinary tract infections more common?

A

Lower

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6
Q

Does bacteraemia indicate upper or lower urinary tract infection?

A

Upper

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7
Q

What are 8 possible pathogens for UTIs?

A

1) E. coli
2) Staph saprophyticus
3) Klebsiella spp.
4) Proteus spp.
5) Citrobacter spp.
6) Enterococci
7) Pseudomonas aeruginosa
8) Candida spp.

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8
Q

What are 4 causative organisms for UTIs in catherised px/ px with structural abnormalities?

A

1) Proteus spp.
2) P. aeruginosa
3) Enterococci
4) Candida spp.

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9
Q

How are urine samples collects in px with catheters?

A

Through a sampling port (not urine bag)

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10
Q

What are 4 UTI lab investigations?

A

1) Urine dipstick (WBC, RBC, nitrates)
2) Urine microscopy (Pyuria)
3) Urine culture
4) Suprapubic aspirate

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11
Q

What are the 3 most important things to look out for in a Urine “dipstix” for px with UTI?

A

1) Leukocyte esterase → WBC (infection)
2) Nitrate reduction → E. coli or other common UTI organisms
3) Blood (hematuria)

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12
Q

What are the parameters for pyruria?

A

WBC > 100/uL

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13
Q

What are the parameters for haematuria?

A

RBC > 100/uL

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14
Q

If RBC>100/uL and WBC>100/uL in a urine microscopy, what would be the most accurate conclusion?

A

Haematuria, not pyuria

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15
Q

Overgrowth during storage and transport of urine samples for UTI testing >____mins can give a false positive.

A

90mins

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16
Q

Is a urine culture of >100 000 cfu/ml, single species significant?

A

Yes

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17
Q

Is a urine culture of 1000-100 000 cfu/ml, single species significant?

A

Maybe lmao

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18
Q

What are some key steps to prevent mixed culture due to contaminating organisms?

A

1) Clean perineum before collection
2) Collect cleanly (mid-stream)
3) Ensure quick transport to lab (<90min)
4) Boric acid in urine specimen container
5) Use dip-slide
6) Refrigerate @ 4 deg C if delay

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19
Q

What are 4 key things to take into account in diagnosing a px for UTI using urine culture?

A

1) Bacterial count
2) Mixed/single organism
3) Presence/absence of catheter
4) px age/clinical context/symptoms/signs

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20
Q

What are 5 empirical antibiotics used in UTI?

A

1) Co-amoxiclav
2) Cephalosporins
3) Cotrimoxazole
4) Aminoglycosides
5) Fluoroquinolones

21
Q

What are 2 antibiotics ONLY used in lower UTIs?

A

1) Nitrofurantoin
2) Nalidixic acid

22
Q

What antibiotics are most commonly used for uncomplicated UTIs?

A

Oral cephalosporins

23
Q

What 2 antibiotics CANNOT be used for urinary infection?

A

1) Erythromycin
2) Clindamycin
(metabolised in liver, don’t make it to urinary tract)

24
Q

How long is a typical course of antibiotics for an uncomplicated UTI?

A

3 days

25
Q

How long is a typical course of antibiotics for an upper UTI?

A

at least 2 weeks (usually start with IV ABs until fever subsides)

26
Q

What are some causative organisms of STDs that result in urogenital infections?

A

Ulcers:
1) Syphilis
2) Haemophilus ducreyi
3) HSV

Discharge:
1) Neisseria gonorrhoeae
2) Chlamydia trachomatis
3) Mycoplasma genitalium

Warts:
1) HPV

Systemic:
1) HIV
2) Hep B

Others:
1) Lymphogranuloma venerum

27
Q

What are the tests for syphilis (3)?

A

Treponemal (recommended but stays +ve for life):
1) TPHA (Treponema pallidum haemagglutination)
2) EIA (Enzyme immunoassay)

Non-treponemal:
1) RPR (Rapid Plasma Reagin)
2) VDRL (Venereal Disease Research Laboratory)

28
Q

Which syphilis tests are used for screening?

A

Treponemal: EIA and TPHA
(stay positive for life)

29
Q

Which syphilis tests are used to monitor disease activity?

A

Non-treponemal: RPR and VDRL
(prone to false +ve/-ve)

30
Q

Which syphilis tests cross-react with non-syphilis treponemal infections (eg. yaws)?

A

Treponemal: TPHA and EIA

31
Q

What are the clinical presentations of Neisseria gonorrhoeae infections?

A

1) Copious urethral discharge in men
2) Asymptomatic/mild in women
3) Anal discharge in proctitis (HIV/male)
4) Acute calpingitis
5) Pharyngitis
6) Disseminated gonococcal infection

32
Q

What are the lab tests for N. gonorrhoeae infections?

A

1) NG culture in special media (Use Amies transport media ± charcoal)
2) NG PCR

33
Q

What are the antibiotics used for N. gonorrhoeae infections?

A

1) Ceftriaxone (though there is growing 3rd gen cephalosporin R)
2) Azithromycin
3) Ciprofloxacin (R in most communities)

34
Q

What are the antibiotics used for concurrent N. gonorrhoeae and C. trachomatis infections?

A

Ceftriaxone + Doxycycline /+ Azithromycin

35
Q

What are the clinical presentations of Chlamydia trachomatis infections?

A

Usually silent or cause simmering disease over the years but sequelae:
1) PID → infertility
2) Acute salpingitis
3) Ectopic pregnancy

36
Q

What is the criteria for C. trachomatis screening?

A

Sexually active women < 25 y/o

37
Q

What are the lab tests for a possible C. trachomatis infection?

A

CT PCR
(collect from endocervical, vaginal, urine)

38
Q

What are antibiotics are used for Neisseria gonorrhoeae UTI?

A

1) Doxycycline
2) Azithromycin

39
Q

What are antibiotics are used for Mycoplasma genitalium infections?

A

1) Doxycycline
2) Azithromycin

40
Q

What are the lab tests for a possible Mycoplasma genitalium infection?

A

NAAT (eg. PCR)

41
Q

What are some non-gonorrhoeae and non-chlamydia UTI/discharge-causing infections?

A

1) Candida
2) BV (eg. Gardenerella, mobiluncus. etc.)
3) Trichomonas vaginalis

42
Q

What are the lab tests for a possible Bacterial Vaginosis?

A

1) Gram stain
2) PCR for causative organisms

43
Q

What are the lab tests for a possible Trichomonas vaginalis infection?

A

1) Wet mount
2) PCR

44
Q

What are the 2 most common causes of uncomplicated UTI/cystitis?

A

1) E. coli
2) S. saprophyticus

45
Q

What are the empirical treatments for complicated UTI/cystitis in a non-pregnant px?

A

Nitrofurantoin/Cotrimoxazole

  • escalate with Ciprofloxacin/ Coamoxiclav/ 1-3rd gen cephs/ Fosfomycin
46
Q

What are the empirical treatments for complicated UTI/cystitis in a pregnant px?

A

Coamoxiclav/1-3rd Gen Cephs
(eg. ceftazidime, cefuroxime, cephalexin)

  • escalate with: Fosfomycin/ Nitrofurantoin (if not @ term)
47
Q

What are the 6 most common causes of complicated UTI/pyelonephritis?

A

1) ESBLs
2) E. coli
3) Klebsiella spp.
4) Pseudomonas aeruginosa
5) Proteus spp.
6) Enterococcus

48
Q

What are the empirical treatments for complicated UTI/pyelonephritis in a non-pregnant px?

A

Ciprofloxacin/Cotrimoxazole

  • escalate with: Carbapenems/Aminoglycosides
49
Q

What are the empirical treatments for complicated UTI/pyelonephritis in a pregnant px?

A

Pip-tazo/Meropenem

Renal System (8 decks)

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