UTIs Flashcards
What is a UTI
- Inflammatory response of the urothelium to bacterial invasion
- Usually associated with bacteriuria & pyuria
- Bacterial infection of the urine with>10^5 colony forming units/ml of urine. (allow lower counts in symptomatic pts)
Define bacteriuria
The presence of bacteria in the urine, which may be symptomatic or asymptomatic
Define pyuria
The presence of WBCs (>/=10per HPF x400) in the urine
Define pyelonephritis
Inflammation of the kidney due to a bacterial infection
What falls under simple/uncomplicated UTIs
- Female
- First presentation
- Not pregnant
- No signs of pyelonephritis
What falls under complicated UTIs
- Male
- Recurrent UTIs
- Pregnancy
- Elderly
- Catheter related
- Children
Why are UTIs more common in women
cos they have a shorter urethra so bacteria don’t have to travel much distance to reach the bladder
Outline the difference between ‘recurrent UTIs’ and ‘Persistent UTIs’
- ) Recurrent UTIs= >2 in 6/12 (or >3 in 1 year)
2. ) Persistent UTIs= hasn’t been managed or organism is resistant to the abx you have given
State and give egs of the different types of UTIs
- ) Lower UTIs:
- urethritis
- cystisis
- prostatitis - ) Upper UTIs:
- Pyelonephritis
- Intrarenal/perinephric abscess (this may be a reason for no improvement on treatment cos the abscess would need to be drained)
What are the risk factors for a UTI
- previous UTI
- surgery
- catheterisation
- upper tract obstruction (stones)
- Neurogenic bladder
adults:
- sex,spermicides;diaphragm
- pregnancy
- diabetes mellitus
- BPE
older age:
- prolapse
- oestrogen deficiency
Outline the different uropathogens
- streptococci
- proteus
- Klebsiella
- E coli
- Staphylococci
How can we classify bacteria?
- )COCCI(round)
- Gram positive: staphylococcus;streptococcus;enterococcus
- Gram negative: Aerobes=neisseria - ) BACILLI(RODS)
- Gram positive: a.) Aerobes=corynebacteria(c.urealyticum)
b. )anaerobes= lactobacillus
- Gram negative
a. ) Aerobes= enterobacteria(escherichia, Klebsiella, proteus), peudomonas
b. ) Anaerobes: bacteroides
- )Others:
- Filamentous bacteria(M.tuberculosis), chlamydiae, fungi, mycoplasma
Outline the characteristics of STD: what it may be; symptoms; investigations & examinations
- Chlamydia trachomatis or Neisseria gonorrhea
- Chlamydia= frequently asymptomatic in females, but can present with dysuria, discharge or pelvic inflammatory disease
- Send urinalysis, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
- Pelvic exam-send discharge from cervix or urethra for chlamydia PCR
- Low estrogen in post menopausal women
Define post void residual
The amount of urine left in your bladder after using the toilet
How can a MSU be used as a useful assessment for STD
- urine dipstick +/- microscopy
- Ensure accurate collection of mid stream sample
- Process specimen promptly, or refrigerate to prevent overgrowth of contaminants
What further investigations may be carried out following complications to an STD?
- Imaging: USS&PVR(post void residual bladder), KUB(kidney,ureter&bladder) X-ray
- Cytoscopy
In which cases should asymptomatic bacteriuria be treated?
- Pregnancy
- Patients prior to undergoing a surgical procedure
- Post renal transplant-early postop (cos you would’ve immunosuppressed them so something which is aysmptomatic could turn into a full blown UTI)
Outline the mechanism of penicillin/cephaloporin
- bactericidal
- Inhibits bacterial wall synthesis
Outline the mechanism of aminoglycosides
- bactericidal
- Inhibits ribosomal protein synthesis
outline the mechanism of tetracyclines
bacteriostatic
-translocation interference
Outline the mechanism of trimethoprim
bacteriostatic
- nucleic acid interference
- dihydrofolate reductase inhibition
Outline the mechanism of Fluroquinolones
bacteriostatic
-inhibit DNA gyrase
Why is routine use of prophylactic abx in catheterized pts not recommended
- Because the actual bugs are sitting on the catheter
- There’s no way you can penetrate the catheter with the abx so there’s no point in treating them
- If the urine looks ‘mucky’ or they have a UTI you’ll have to change the catether and give abx if really needed
What strategies are available to reduce risk of UTI
- ) ABX
- ) Behaviour
- )Cranberry
- ) Developing vaccines D-mannose
- )Estrogens
How can lifestyle measures reduce the risk of a UTI
- increased fluid intake
- post-coital voiding
- perineal hygiene
Which fruit may present risk of UTI
cranberry
-better concentration when taken as tablets
Which vaccines may reduce risk of UTI
- Urovac:vaginal mucosal vaccine
- Intranasal vaccine for proteus mirabilis
- PapDG vaccine for E coli
- Fim CH vaccine for E coli
- Vaccine for chlamydia Trachomatis
How can administration of estrogens reduce risk of UTI
- giving women topic estrogens to rebalance pH levels; meaning the Ecoli are less able to attach, reduces risk of UTI
- Post menopausal they sometimes get atrophic vaginitis i.e the area in/around the vagina becomes beneficial/correct for the e coli to attach due to the change in environment
- Ensure no contraindications: eg DVTs/ Ca breast
What are the symptoms of UTI
- burning, frequency, urgency of peeing
- Pyuria= pus m(WBC) in the urine
- Urine culture- growth of bacteria in the urine
