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ESA 3 - Urinary System > UTIs > Flashcards

UTIs Flashcards

1
Q

How common are UTIs?

A

Very! Particularly in women.

1-3% of all GP consultations in UK
1-3% prevalence in adult women 
30% of women have UTI by age 24 
up to 50% women treated for symptomatic UTI in lifetime
Common source of Gran-negative sepsis
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2
Q

When are UTIs common?

A

Women

Rise in infancy nd preschool. Also sexual activity, pregnancy and when older and things get blocked.

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3
Q

What host factors can cause UTIs?

A

Shorter urethra in women so more common in them.

Obstructions - enlarged prostate, pregnancy, stones, tumours

Neurological problems - incomplete emptying, residual urine

Ureteric reflex - ascending infection from bladder, especially in children.

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4
Q

In what sites can you get urinary obstructions?

A 
Ureteropelvic junction: calculi
Ureter: calculi, Ca, retroperitoneal fibrosis 
Badder: neuropathic bladder 
Ureterovesical junction: calculi
Bladder neck: hypertrophy 
Prostate: BPH / Ca 
Urethra: stricture
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5
Q

What things in bacteria enhance infection?

A

Fimbrae allow attachment to host epithelium
K antigen permits production of polysaccharide capsule
Urea breaks down urea creating a favourable environment for bacterial growth
Haeolysis (produce haemosins) damage host membrane and cause renal damage.

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6
Q

What are the most popular organisms to cause UTIs?

A

Coliforms - gram negative rods (e.g. E. Coli)

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7
Q

What clinical syndromes for UTI?

A

Cystitis - frequency and dysuria (lower UTI)
Acute pyelonephritis (Upper UTI)
Chronic pyelonephritis
Asymptomatic bacteriuria (Usually be fine but in some this may be bad e.g. pregnancy -look to see if bacteria in urine)
Septicaemia +/- shock

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8
Q

What are the symptoms of a lower UTI?

A

Dysuria
Frequency
Urgency
Sometimes low grade fever

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9
Q

What are the symptoms of an upper UTI?

A

Fever
Loin pain - kidney pain (Right renal pain, could be ‘back pain’)
May have dysuria, frequency

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10
Q

Define uncomplicated UTI

A

An infection by a usual organism in a patient with a normal urinary tract and normal urinary function.

Uncomplicated UTIs may occur in males and females of any age.

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11
Q

What is a complicated UTI?

A

UTI when one or more factors are present that predispose the person to persistent infection, recurrent infection or treatment failure. e.g:

  • Abnormal urinary tract (catheter)
  • Virulent organism (Staph aureus)
  • Impaired host defences (diabetes, immunosuppression)
  • Impaired renal function
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12
Q

How do the use of complicated and uncomplicated differ to actual definition?

A

Complicated is anything but cystitis in healthy young(ish) women.

e.g pregnany, males, children

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13
Q

How do you investigate UTI?

A

In healthy non-pregnancy women of child bearing age (uncomplicated UTI) no need to culture urine.
Culture urine in ‘complicated UTI’ e.g. pregnancy, treatment failure, recurrent infections, suspected pyelonephritis, complications, males, children

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14
Q

How do you collect urine specimen?

A

MSU (midstream urine) - cleansing not required in women
Clean catch in children - no antiseptic
Collection bag (20% false positive)
Catheter sample
Supra-pubic aspiration
Transportation: 4 degrees Celsius +/- boric acid (to preserve urine and stop multiplication of oranisms)

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15
Q

What do you do with urine sample?

A

Screening:

  • Turbidity (visual inspection) -cloudy or not.
  • Urine dipstick: leukocyte esterase (sign of pus and WBCs), nitrite (some bacteria release enzyme that breaks nitrates into nitrites), haematuria, proteinuria

Microscopy

Screening in lab - detect white cells, red cells, bacteria and casts (can be rapid negative result)

Urine culture - one plate for four samples

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16
Q

When are dipsticks useful and when are they not?

A

Useful to exclude UTI in:

  • Children over 3
  • Men with mild / non-specific symptoms
  • Elderly / institutionalised women

NOT useful:

  • Acute uncomplicated UTI in women
  • Men with typical / severe symptoms
  • Catheterised patients
  • Older patients without features of infection (because of asymptomatic bacteriuria common)
17
Q

How does culturing urine help?

A

Investigation of children, males and other ‘complicated’ infections.

Increased sensitivity

Epidemiology of isolates

Susceptibility data

Control of specimen quality

18
Q

How do you interpret the culture report?

A

Clinical details - symptoms, previous antibiotics

Quality of specimen

Delays in culture

Microscopy

Organism(s) isolated

19
Q

Wha imaging can you do for a UTI?

A

Image if young children with UTI - especially if recurrent

In septic patients - see if there is renal envolvemnt (kidneys or urethers enlarged.)

Males - posterior urethral valves

Females - vesico-uteric reflux

20
Q

What things increase your risk of sterile pyuria (WBCs in urine without positive culture) ?

A 
Antibiotics 
Urethritis (chlamydia / gonococci) 
Vaginal infections / inflammation 
Chemical inflammation 
TB 
Appendicitis 
Fastidious organisms
21
Q

What is asymptomatic bacteriuria?

A

When there is bacteria in urine but it isn’t causing symptoms.

High prevalence in older people, especially elderly females.

Generally have associated pyuria - positive dip stick

Not associated with Increase is of morbidity / mortality

Leads in unnecessary antibiotic treatment

Only requires action in pregnancy and urological surgery

22
Q

How do you treat UTIs?

A

Increase fluid intake
Address underlying disorders
3 day course for uncomplicated UTI
5-7 days for complicated lower UTI e.g. pregnancy, males, underlying disorders
Catheters: only treat if systemically unwell

23
Q

How do you treat simple cystitis?

A

Trimethoprim or nitrofuratoin - 3 days just as effective as 5 or 7

3 days reduces the selection pressure for resistance.

24
Q

How do you treat complicated UTIs?

A

Trimethoprim, nitrofurantoin or cephalexin.

5-7 day course

50% of isolates resistant to amoxicillin.

Post treatment follow up - cultures in paeds and pregnancy.

25
Q

How do you treat pyelonephritis or sepsis?

A

14 day course

Agent with systemic activity.

IV usually - co-amoxiclav or ciprofloxacin (7 days) or gentamicin

26
Q

When do you give patient prophylaxis for a UTI?

A

Three or more episodes in one year

No treatable underlying condition

Trimethoprim or nitrofurantoin - single nightly nose and document all breakthrough infections.

ESA 3 - Urinary System (20 decks)

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