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Urinary (Semester 3) > UTIs > Flashcards

UTIs Flashcards

1
Q

What defines a recurrent UTI?

A

3 symptomatic UTIs within a year following therapy

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2
Q

What defines a relapse UTI?

A

The recurrence of the same bacterial organism within 7 days after completing the antibacterial treatment (it didn’t work)

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3
Q

What defines a reinfection?

A

Bacterium is absent after treatment for 14 days until the infection comes back with the same or different organisms

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4
Q

What are 4 risk factors for developing a UTI?

A
  1. Female: shorter urethra
  2. Age
  3. Co-morbidities can change the pH and mean you’re more susceptible to infections
  4. institutional care
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5
Q

What’s the difference between a complicated and uncomplicated UTI?

A

Uncomplicated: Infection by a usual pathogen in a person with a normal UT and has normal kidney function

Complicated: everything else

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6
Q

Name 5 things that can present as inflamed in a patient with a UTI

A
  1. Pyelonephritis; kidney
  2. cystitis; bladder
  3. urethritis
  4. epididymitis
  5. prostatitis
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7
Q

List 6 typical symptoms of a UTI

A
  1. Frequency
  2. Dysuria
  3. Bad smelling urine
  4. Lower abdominal pain
  5. Unspecific discomfort; aching, nausea, tiredness
  6. Urge incontinence: can’t hold it in
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8
Q

How would you diagnose a severe UTI?

A

3 or more of the following symptoms:

  1. polyuria: >3L a day of urine
  2. frequency: normal or small amounts often
  3. hematuria
  4. suprapubic tenderness
  5. urgency
  6. dysuria
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9
Q

How would you treat women under 65 presenting with 3 severe UTI symptoms

A

If under 65 with 3 severe symptoms and NO discharge, there is a 90% chance the culture will be positive and you should give treatment immediately

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10
Q

How would you treat a women over 65 with symptoms?

A

If there is vaginal discharge and irritation the chance that it’s a UTI is smaller, need a culture to know

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11
Q

What else should you always consider as a differential?

A

Sexually transmitted diseases, sepsis

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12
Q

How does a mild UTI present and what investigations would you do?

A

Mild UTI is 2 or less of the symptoms:
Obtain a urine specimen and do a dipstick test: if it is cloudy check the nitrate levels and if it isn’t cloudy it’s likely another disease

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13
Q

Which urine dipstick results indicate a definite UTI, probably UTI and the likelihood of a different disease?

A

Definite UTI: positive nitrites, leukocytes and blood or positive nitrites alone

Possible UTI: negative nitrites but positive leukocytes

Probably something else: Negative all 3: nitrites, leukocytes and blood OR negative leukocytes and nitrates but positive blood and protein

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14
Q

Why are nitrites indicative of infection?

What time of day is best to test for them?

A

When urine interacts with bacteria, bacteria releases nitrate reductase enzyme which reduces nitrate into nitrite

Test in the morning: as they’ve likely built up overnight

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15
Q

How should you treat a woman over 65 who is asymptomatic?

A

Only send for urine culture if they have 2+ signs of infection (especially temperature), as people with no symptoms usually don’t need treatment

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16
Q

List 6-7 scenarios where you would perform an automatic urine culture

A
  1. Pregnancy: send in a culture, put all women on antibiotics and repeat culture and sensitivity 7 days after antibiotic treatment
  2. suspected pyelonephritis
  3. suspected UTI in men: also do a chlamydia test
  4. Failed antibiotic treatment or recurrent symptoms
  5. Recurrent UTI
  6. Abnormalities in the GU system
  7. Renal impairment: an undiagnosed UTI would make the renal impairment worse
17
Q

What could happen to the fetus if the mother has a UTI?

A

Fetal death, developmental delay, cerebral palsy

18
Q

How do UTIs often present in children? Would your investigations differ from those of an adult?

A

With an unexplainable fever. Perform the same investigations as you would an adult but with a lower threshold for safe netting

19
Q

What is the difference between a white top and a red top container?

A

Whitetop: collect and dip

Red top: has boric acid, can be left at room temp and still preserved culture and microscopy for up to 96 hours

20
Q

How would you obtain a urine sample if someone was unable to provide an MSU?

A

Condom catheter (in frail and/or elderly men) or a long term urinary catheter

21
Q

If you don’t have a red top container, how should you proceed?

A

Process within 4 hours, if it can’t be refrigerated at 4 deg C it is only suitable for culture, not microscopy

22
Q

What is the main organism causing uncomplicated UTIs?

A

E-coli is the main organism

23
Q

Name 3 organisms that can cause an uncomplicated and a complicated UTI

A
  1. Klebsiella
  2. Staphlococci
  3. Proteus
24
Q

List 3 ways that bacteria can spread through the urinary tract

A
  1. when catheters/instruments are inserted
  2. infection from the urethra (especially in females)
  3. blood and lymphatic system
25
Q

Name 4 things our UT does to protect itself

A
  1. secretion of glucosamine from transitional cells, forms a mucin layer to prevent bacterial spread
  2. Low pH and presence of urea
  3. Tamm-Horsfall glycoprotein binds to UPEC type 1 fimbriae
  4. If the bladder layer is inflamed it sheds the inflamed layer which eradicates attached and internalized bacteria from the bladder’s epithelium
26
Q

Name 4 factors that can predispose someone to a persistent/recurrent infection and treatment failure

A
  1. virulent organism
  2. impaired host defences (diabetes, immune disease)
  3. impaired renal function
  4. abnormal GU tract
27
Q

List 2 antibiotics you could prescribe for a UTI and how long antibiotic treatment is in males and females

A

Nitrofurantoin: good for genital infection if renal function is working
Trimethoprim

3 days women, 7 days men

28
Q

At what age do men most commonly acquire UTI?

A

> 65

Urinary (Semester 3) (14 decks)

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