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PPS - infections > UTIs > Flashcards

UTIs Flashcards

1
Q

What is the classical presentation of UTI?

A

Lower abdominal pain

Frequent and urgent need to urinate

Little urine

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2
Q

What is another name for UTI?

A

Acute cystitis

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3
Q

What is a UTI?

A

Bacterial infection of the bladder

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4
Q

What is a rare complication of a UTI?

A

Can ascend to the kidneys causing pyelonephritis

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5
Q

What are diagnostic methods of UTIs?

A

Dipsticks

Examining urine characteristics

Microscopy

Culture

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6
Q

Why are antibiotic sensitivity tests important when treating UTIs?

A

Many uropathogens are resistant to common antibiotics

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7
Q

UTI is one of the most common infectious diseases in the world

TRUE or FALSE

A

TRUE

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8
Q

Why are UTIs more common in women than men?

A

Outside environment is closer to the female anatomy

Urethra is much shorter in women than men

Easier for pathogens to reach the bladder in females

Bacteria present in faeces or skin of the perineum of the anus may find their way to the distal urethra

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9
Q

What proportion of females in the UK will develop a UTI at some point in their life?

A

Up to half of all women in the UK

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10
Q

What proportion of men develop a UTI in the UK yearly?

A

1 in 2000 healthy men

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11
Q

What is the length of the urethra in women?

A

4-5 cm

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12
Q

What is the length of the urethra in men?

A

20-25 cm

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13
Q

What are common causes and risk factors of UTIs in males?

A

Enlarged prostate

Kidney stones

Catherisation

Weakened immune system

Diabetes

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14
Q

How does an enlarged prostate increase the risk of developing UTIs in males?

A

Prevents the bladder from fully emptying

Causes urine to stagnate

Allows bacteria to multiply

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15
Q

How does diabetes increase the risk of developing UTIs in males?

A

Glucose which may be present in the urine supports the growth of bacteria

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16
Q

What are common causes and risk factors of UTIs in females?

A

Factors which prevent full emptying of the bladder

Catherisation

Weakened immune system

Diabetes

Being sexually active

Spermicide

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17
Q

What are factors that prevent full emptying of the bladder in females?

A

Kidney stones

Using contraceptive diaphragm

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18
Q

Are UTIs sexually transmitted diseases?

A

No

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19
Q

How does being sexually active increase chances of developing UTIs?

A

Sex can irritate the urethra

Allows bacteria to enter more easily

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20
Q

How does spermicide increase the chances of developing UTIs?

A

Can irritate the vagina and reduce its immune defences

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21
Q

Is voided urine sterile?

A

Yes

Sterile or have low levels of bacteria

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22
Q

How does the vagina prevent bacterial contamination of the urethra?

A

Immune defences

Flushing with urine - bladder is constantly washed out and emptied

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23
Q

What has recent evidence showed about the environment of the bladder?

A

Originally thought there was no bacteria in the bladder

Recent work shows bladder may normally harbour some bacteria

Can now see them due to molecular techniques like sequencing and PCR

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24
Q

What is cystitis?

A

Infection and inflammation of the bladder

Causes the discomfort and pain associated with UTIs

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25
Q

What is pyelonephritis?

A

Infection can spread from the bladder via the ureters to infect the kidneys

Happens in minority of patients

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26
Q

What is the main symptom of pyelonephritis?

A

Pain in the lower back

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27
Q

What are possible complications of pyelonephritis?

A

Renal failure

Septimcaemia

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28
Q

What percentage of all nonconsomial infections are UTIs?

A

40%

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29
Q

Which population is particularly at risk of developing UTIs?

A

Catherised

Undergo cystoscopy

30
Q

What is the sample taken to test for UTIs?

A

Midstream specimen of urine

First 20 ml of urine should be passed into the toilet and a sample should be collected midstream into a sterile container

31
Q

Why should a midstream specimen of urine be collected for UTI testing?

A

Prevent the initial urine from picking up bacteria from the skin

32
Q

What volume of urine is required for UTI testing?

A

5-10 ml of urine

33
Q

How should the patient prepare before taking urine sample?

A

Patient should wash around their genital area first with soap and water

34
Q

When is lab testing of urine not necessary?

A

If patient is in pain/ cloudy urine

35
Q

What does a dispstick urinalysis indicate?

A

Presence of several markers of urinary tract

36
Q

What are the key features of UTI that show up on dispstick urine test?

A

Leukocytes

Nitrites

Blood

Glucose

Urobilinogen

37
Q

Why is a nitrite dipstick urine test inaccurate?

A

Not all bacteria produce nitrites

Only gram negative

Break down urine to form nitrite

38
Q

What is pyuria?

A

Presence of pus in the urine

39
Q

Why are urobilinogen levels elevated in YTI?

A

Due to haemolytic processes

40
Q

How does the presence of blood show up in a urine dipstick test?

A

Haemoglobin released from haemolysed RBC causes a colour change from yellow to green

Intact red cells cause intense green speckles

41
Q

What are the advantages of urine dipstick analysis?

A

Quick

Cheap

42
Q

What are the disadvantages of urine dipstick tests?

A

Leukocyte esterase misses some geniune infections

  • Especially if they are subacute
  • Not very specific

Nitrite test is only applicable to bacterial species that reduce nitrate

  • E. coli
43
Q

What is an example of uropathogen that does not reduce nitrates?

A

Enterococcus

44
Q

What happens if urine dipstick test shows up negative with the presence of UTI symptoms?

A

Further tests are warranted

45
Q

What are macroscopic inspections we can do of urine?

A

Turbidity - indicates pyuria

Haematuria

Foul smell

46
Q

What causes the turbidity of the urine?

A

Neutrophils

Recruited to the site of infection in the bladder

47
Q

What is observed during microscopic inspection of urine?

A

Light microscope

Inspected for presence of white and red blood cells

Normally present in very low numbers

When high = strongly indicative of UTI

48
Q

What is the third lab test we can do on urine to identify UTI?

A

Culture

49
Q

How is culture used to diagnose UTI?

A

Confirmates and identifies bacterial infection

By culturing the urine on an agar plate

50
Q

How is a culture carried out

A

A volume of 1-10μl of urine is spread on agar plate

Placed in an aerobic incubator at 37 degrees for 24 hours

Viable bacteria present will grow into colonies

51
Q

How is culture used to diagnose UTI?

A

Count the bacterial colonies

52
Q

What is an example of a modification of culture used in labs to identify bacterial species in urine?

A

Chromogenic agar

Imparts different colony colours to different uropathogens

Useful to distinguish what type of bacteria you have

53
Q

Where are sources of bacteria in urine?

A

From the skin may be introduced during the urine sample collection

Distal urethra

Bladders

54
Q

Does presence of bacteria in urine immediately indicative of UTI?

A

No

Small numbers of bacteria in urine is normal

55
Q

What is the threshold for significant bacteriuria in many european countries?

A

10^5 bacteria/ ml urine

56
Q

Why do some countries have lower thresholds for significant bacteriuria?

A

Recognise that an arbitrary cutoff of 10^5 may not make sense for all patients

Arbitrary threshold would exclude a proportion of the population with the disease

57
Q

What are non-acute symptoms indicative of low-count UTI?

A

Frequency

Urgency

Incontinence

58
Q

What percentage of acute UTIs is E.coli responsible for?

A

E. coli

59
Q

What are most acute UTIs characterised by?

A

Caused by a single type of bacteria

60
Q

What may mixed bacterial growth be indicative of?

A

Contamination during sample collection

61
Q

UTIs cannot be caused by mixed bacterial growths

TRUE or FALSE

A

FALSE

Mixed growths can be significant

Especially in chronic or subacute UTI

62
Q

What is the disk diffusion method?

A

Test to see if the pathogen being treated is sensitive to abtibiotics

63
Q

When are disk diffusions carried out?

A

When urine culture finds a significant bacteriuria

64
Q

Why are disk diffusion methods carried out?

A

To determine the specificity or resistance of the strain to a range of antibiotics

65
Q

How do you carry out a disk diffusion method?

A

Colonies are picked from the first culture plates

They are re-inoculated onto a new agar plate

Antibiotics impregnated in paper discs are placed on the agar plate

66
Q

How long are disk diffusion agar plates incubated?

A

48 hours

67
Q

How do we use the results of the disk diffusion method to conclude sensitivity of the bacteria to antibiotics?

A

Look at zone of inhibition

If the disk is secreting antibiotic that forms a zone of inhibition = bacteria is sensitive to it

68
Q

What is a disadvantage of bacterial culturing?

A

Takes time

Delay diagnosis and treatment

Can take up to 2 days

When a UTI is strongly inspected following microscopy, the initial culture step can be missed out

Move straight on to antibiotic sensitivity testing

69
Q

What are examples of automated microbial identification and antimicrobial susceptibility testing systems (AST) being used?

A

Biotyper

BD Phoenix

70
Q

What is a biotyper?

A

Microbial identification system based on protein signatures

Matrix-assisted laser desorption ionization

Time of flight mass spectrometry

71
Q

What is a form of treatment of UTIs?

A

Empirical use of antibiotics

Take any broad-range antibiotic and hope it works

PPS - infections (8 decks)

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