UTIs Flashcards
Infection of lower urinary tract?
Urethritis or cystitis
Infection of kidneys?
Pyelonephritis
What is vesicouretal reflux?
Backflow of urine into kidneys, may be due to malfunction of cysto-uretic valve
When is a UTI complicated?
Abnormality in urinary tract:
Pregnancy, stent, indwelling device, scarring
Neurological
Bacterial causes of UTIs?
E. coli
S. saprophyticus
Klebsiella, Enterobacter, Proteus and Citrobacter
What is urosepsis?
Infection spread to kidneys, bacteria may be found in blood
Common source of bacteria causing UTIs?
Gut contamination
Host resistance mechanisms? (6)
1) Bulk urine flow
2) Low pH and osmolarity
3) Lactoferrin
4) Colonisation resistance
5) Neutrophil influx
6) Bladder cell exfoliation
Host risk factors? (6)
1) Sex and spermicide use (nonoxynol)
2) Dehydration
3) Uropathogenic colonisation of GI tract
4) Pregnancy - high progesterone and uterus enlargement
5) Colonisation/blockage of indwelling devices
6) Poorly managed diabetes
UTI pathogenesis?
Adhere to epithelium using pili (type 1 for bladder, P. fimbriae for kidneys)
Forms pods or biofilms in bladder
Inflammatory response damages epithelium, causes symptoms
UTI symptoms? How long for? (5)
1) Need to urinate
2) Feeling of bladder fullness
3) Pain when urinating
4) Suprapubic tenderness
5) Sometimes blood in urine
Symptoms of pyelonephritis? (5)
1) Lower back pain
2) Fever
3) Chills
4) N&V
5) Pain around ribs
PLUS UTI symptoms
What is seen under microscope in pyelonephritis?
Red and white blood cells in urine surrounded by bacterial cells
Define recurrent UTI
2 proven episodes in 6 months, 3 suspected in 12 months
Causes of UTI recurrence? (4)
1) Genetics
2) Congenital abnormalities
3) Behaviours
4) Presence of pods or biofilms
Describe E. coli biofilms?
Invades superficial cells, surrounded by polysaccharide matrix and coated in uroplakin
Treatment of UTIs?
First line - Trimethoprim or nitrofurantoin
Second line - Nitrofurantoin, pivmecillinam, fosfomycin (if no improvement in 48 hours)
Novel treatment of UTIs?
Around 15 new drugs, mainly for complicated UTIs
Pilicides - Interfere with pilus assembly
Mannosides - Interfere with anti-adhesives
UTI vaccinations?
Urovac - 90 day tablet, 18 types of E. coli
Uro-vaxom - Pessary
ExPEC4V - Injection, 4 types of E. coli
Uromune - Sublingual spray, in phase 3 trials
