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IMED3002 > UTIs > Flashcards

UTIs Flashcards

1
Q

What are the types of UTI?

A

Cystitis (infection of bladder [lower UTI])

Pyelonephritis (infection of parenchyma and collecting system of kidneys (upper UTI)

Asymptomatic bacteriuria

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2
Q

What is pyelonephirtis?

A

Infection of parenchyma and collecting system of kidneys

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3
Q

Can cystitis and pyelonephritis coexist?

A

Yes, they often arise from the bottom upwards

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4
Q

What is asymptomatic bacteriuria?

A

Significant Bacteriuria without signs or symptoms. (must be seen in 2 consecutive samples)

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5
Q

Where is asymptomatic bacteriuria typically seen?

A

In children, pregnant women, and elderly

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6
Q

What is asymptomatic bacteriuria associated with?

A

Childbearing

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7
Q

What are uncomplicated UTIs?

A

Infection of bladder or kidney occurring in normal host without structural or functional abnormality in urinary tract

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8
Q

What are complicated UTIs associated with?

A

Factors that increase colonization and decrease efficacy of therapy.

Anatomical or functional abnormality

Immunocompromised host

Multi-drug resistant bacteria

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9
Q

Why are compicated UTIs problematic?

A

They are often more severe, difficult to treat, and recurrent

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10
Q

What kind of organisms cause haematogenous seeding?

A

S. aureus [bacteremia] or candida (rare with gram -ve bacteria)

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11
Q

Where do UTI causing bacteria typically originate from?

A

The bowel, they then colonise the lower vagina and periurethral mucosa

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12
Q

What are risk factors of UTIs?

A

Age-related

Gender related

Pregnancy

Sexual intercourse

Menopause

Congenital abnormalities

Renal calculi

Ureteral occlusion

Vesico-ureteral reflux

Residual urine in bladder (neurogenic bladder, urethral stricture, prostatic hypertrophy)

Instrumentation of urinart tract (especially urinary catheters)

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13
Q

What age groups cause spikes in incidence of UTIs?

A

Infancy

Preschool

Adult years (honeymoon cystitis in females)

pregnancy

Prostatism (males)

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14
Q

What serotypes of E.coli cause UTIs?

A

uropathogenic clones that have virulence factors with adhesion and invasion abilities.

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15
Q

What causes UTIs in a clinical setting?

A

E. coli (more antibiotic resistant than community acquired)

Proteus, Enterobacter, Serratia, Morganella

Pseudomonas aeruginosa

Enterococcus faecalis and faecium

Stenotrophomonas maltophilia

Corynebacterium urealyticum

Staph epidermidis

Candida albicans

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16
Q

What causes UTIs in a community setting?

A

E. coli

Staph saprophyticus

The other species studied in 2001 are way more rare in community setting

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17
Q

How are UTIs acquired in hospitals?

A

Rapid colonisation takes place by resident microflora.

Patients are often debilitated

UTI instrumentation typically colonised by bacteria

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18
Q

What are the clinical features of cystitis?

A

Dysuria (painful, burning urination)

Frequency (frequent passage of small amounts of urine)

Urgency (need to pass urine despite empty bladder)

Suprapubic heaviness or tenderness

Urine is turbid and may be bleedy and bad smelling

Fever usually absent

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19
Q

What are the symptoms of acute pyelonephritis?

A

Flank or back pain

Fever, chills

Rigors suggest bacteraemia

Headache, nausea, vomiting, prostration

Often with dysuria, frequency, urgency

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20
Q

What bacteria causes stones?

A

Corynebacterium urealyticum

21
Q

When can UTIs have atypical clinical presentations?

A

Infants and children: fever, nausea, vomiting, and abdominal pain may predominate

Elderly: bacteraemia and shock

Subclinical pyelonephritis: seen in some women; dysuria, bacteriuria, with minimal or no symptoms of pyelonephritis

22
Q

What are the types of urine specimens used to diagnose UTIs?

A

MSU (mid stream urine)

Suprapubic aspirate

CSU (cather)

Bag urine

23
Q

Why is MSU taken?

A

To wash out colonizing bacterial

24
Q

When is a suprapubic aspirate commonly used?

A

In babies or people powerless to control urine outflow

25
Q

When is a catheter commonly used?

A

Whenever a patient has an obstruction or is unable to pass urine for whatever reason

26
Q

What is the risk of leaving an indwelling catheter in for too long?

A

Increased risk of UTI

27
Q

Where is bag urine used?

A

In babies but are readily contaminated with perinial bacteria

28
Q

What kind of bacteria are often found contaminating specimens? How is this minimised?

A

Commensals are almost identical to UTIs. Using good collection techniques is essential.

29
Q

What is used for lab examination of urine specimen for UTI diagnosis?

A

urine microscopy (white, red, and squamous epithelial cells are looked at under microscope)

Urine culture (quantitative culture where specimen is processed in a way to extrapolate size and growth rate)

30
Q

What parameters are explored in urine microscopy?

A

White cell count

Red cell count (normal <6 x 10^6)

Squamous cells

31
Q

What is the normal white cell count in urine?

A

<10 x 10^6/L (UTI will produce more than 1000 x 10^6)

32
Q

What happens to leucocytes if urine is left standing?

A

It will break down

33
Q

What does elevated WCC in urine look like and what is it called?

A

Cloudy and it is called pyuria

34
Q

What are red cells in urine indicative of?

A

Sources of bleeding in urinary tract (calculi, tumors, inflammation, infection) or from extrusion through damaged glomeruli (glomerulonephritis)

35
Q

What does morphology of red cells indicate?

A

abnormal red cells caused by extrusion through glomerulus. (called glomerular red cells)

36
Q

What can contaminate urine red cells?

A

Menstrual blood

37
Q

Where do squamous cells in urine come from?

A

Originate outside urinary tract. (they are caused by contamination of sample)

38
Q

How are squamous cells expressed?

A

quantitatively or with ++++

39
Q

What other things are reported by microscopy of urine?

A

Crystals

Casts - protein, cellular

Bacteria, eg. GNR +++

Yeasts; usually indicate contamination from vagina although candida UTI is possible but unlikely

40
Q

What is the kass criterion?

A

<10^5/ml (10^8/L) concentration of a bacterium = contaminant

41
Q

What did EH Kass determine?

A

Significant bacteriuria was defined by presence of a single species of bacterium in urine at a concentration of >10^5/ml (10^8/L). Bacteria at lower concentrations were likely to represent contaminants

42
Q

What cutoff values for bacteriuria are currently accepted?

A

10^5/L or 10^2/ml (females)

10^6/L or 10^3/ml (males)

43
Q

What factors should be considered while evaluating a UTI?

A

Patient’s age and sex

Symptoms

Recent or current antibiotic use

Method of collection

Number of leukocytes

Number of squamous epithelial cells

Number of bacterial species grown

Concentration of cultivated bacteria in the urine

44
Q

What are UTIs in children associated with?

A

Urinary tract abnormalities:

Vesico-ureteric reflux

Ureteral duplication

Trabeculated bladder

Hydroureter

Uretopelvic junction obstruction

45
Q

What causes vesicoureteric reflux?

A

Developmental defect causing UTIs at a young age

46
Q

What happens when bladder contracts under normal circumstances?

A

The contraction of bladder closes the input of ureters preventing reflux

47
Q

What percentage of children with UTIs go on to have Vesico-Ureteric Reflux?

A

20 - 30%

48
Q

What is the problem with VesicoUreteric Reflux?

A

It causes renal scarring and in turn severe hypertension and renal failure. (UTI alone causes renal scarring too)

IMED3002 (46 decks)

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