UTIs Flashcards
What defines a recurrent UTI?
3 symptomatic UTIs within a year following therapy
What defines a relapse UTI?
The recurrence of the same bacterial organism within 7 days after completing the antibacterial treatment (it didn’t work)
What defines a reinfection?
Bacterium is absent after treatment for 14 days until the infection comes back with the same or different organisms
What are 4 risk factors for developing a UTI?
- Female: shorter urethra
- Age
- Co-morbidities can change the pH and mean you’re more susceptible to infections
- institutional care
What’s the difference between a complicated and uncomplicated UTI?
Uncomplicated: Infection by a usual pathogen in a person with a normal UT and has normal kidney function
Complicated: everything else
Name 5 things that can present as inflamed in a patient with a UTI
- Pyelonephritis; kidney
- cystitis; bladder
- urethritis
- epididymitis
- prostatitis
List 6 typical symptoms of a UTI
- Frequency
- Dysuria
- Bad smelling urine
- Lower abdominal pain
- Unspecific discomfort; aching, nausea, tiredness
- Urge incontinence: can’t hold it in
How would you diagnose a severe UTI?
3 or more of the following symptoms:
- polyuria: >3L a day of urine
- frequency: normal or small amounts often
- hematuria
- suprapubic tenderness
- urgency
- dysuria
How would you treat women under 65 presenting with 3 severe UTI symptoms
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
How would you treat a women over 65 with symptoms?
If there is vaginal discharge and irritation the chance that it’s a UTI is smaller, need a culture to know
What else should you always consider as a differential?
Sexually transmitted diseases, sepsis
How does a mild UTI present and what investigations would you do?
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
Which urine dipstick results indicate a definite UTI, probably UTI and the likelihood of a different disease?
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
Why are nitrites indicative of infection?
What time of day is best to test for them?
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
How should you treat a woman over 65 who is asymptomatic?
Only send for urine culture if they have 2+ signs of infection (especially temperature), as people with no symptoms usually don’t need treatment
List 6-7 scenarios where you would perform an automatic urine culture
- Pregnancy: send in a culture, put all women on antibiotics and repeat culture and sensitivity 7 days after antibiotic treatment
- suspected pyelonephritis
- suspected UTI in men: also do a chlamydia test
- Failed antibiotic treatment or recurrent symptoms
- Recurrent UTI
- Abnormalities in the GU system
- Renal impairment: an undiagnosed UTI would make the renal impairment worse
What could happen to the fetus if the mother has a UTI?
Fetal death, developmental delay, cerebral palsy
How do UTIs often present in children? Would your investigations differ from those of an adult?
With an unexplainable fever. Perform the same investigations as you would an adult but with a lower threshold for safe netting
What is the difference between a white top and a red top container?
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
How would you obtain a urine sample if someone was unable to provide an MSU?
Condom catheter (in frail and/or elderly men) or a long term urinary catheter
If you don’t have a red top container, how should you proceed?
Process within 4 hours, if it can’t be refrigerated at 4 deg C it is only suitable for culture, not microscopy
What is the main organism causing uncomplicated UTIs?
E-coli is the main organism
Name 3 organisms that can cause an uncomplicated and a complicated UTI
- Klebsiella
- Staphlococci
- Proteus
List 3 ways that bacteria can spread through the urinary tract
- when catheters/instruments are inserted
- infection from the urethra (especially in females)
- blood and lymphatic system
Name 4 things our UT does to protect itself
- secretion of glucosamine from transitional cells, forms a mucin layer to prevent bacterial spread
- Low pH and presence of urea
- Tamm-Horsfall glycoprotein binds to UPEC type 1 fimbriae
- If the bladder layer is inflamed it sheds the inflamed layer which eradicates attached and internalized bacteria from the bladder’s epithelium
Name 4 factors that can predispose someone to a persistent/recurrent infection and treatment failure
- virulent organism
- impaired host defences (diabetes, immune disease)
- impaired renal function
- abnormal GU tract
List 2 antibiotics you could prescribe for a UTI and how long antibiotic treatment is in males and females
Nitrofurantoin: good for genital infection if renal function is working
Trimethoprim
3 days women, 7 days men
At what age do men most commonly acquire UTI?
> 65
