Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

The Public 20400 > UTIs > Flashcards

UTIs Flashcards

1
Q

What is an uncomplicated UTI

A

Bacterial infection of a structurally/functionally normal urinary tract
Can include acute cystitis in women (lower UTI) and
pyelonephritis (upper UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a complicated UTI

A

Infection of a tract that is abnormal/predisposing conditions

  • Structurally complicated (obstruction, stent, scarring)
  • Functionally complicated (vesicoureteral reflux)
  • Neurologically complicated

Most utis in men, pregnant women and children are considered complicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Whats percentage of HCAIs are UTIs

A

2nd largest group of HCAI in UK

19.7% all HCAI infections. This will often be due to catheterisation

1 in 3 women will experience a UTI by 24y age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does your risk of UTI increase with age?

A

Yes, over 60s have a 10% women, 3% men annual infection risk, over 80s have a 20% women 10% men risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is infected in:
urethritis
cystitis
pyelonephritis

A

urethra
bladder
kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the

cysto-ureteric valve

A

a structure which links the bladder and the urethra which moves up to the kidneys. It stops backflow of urine from the bladder to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the host resistance factors to try to prevent UTIS

A

Bulk flow of urine - can flush any bacteria away from the urethra

Low pH and osmolarity - can lyse bacteria

Urine contains:
salts
organic acids - see above

Lactoferrin - sequests iron (prevents bacteria from being able to use any free iron)

Neutrophil influx
Bladder cell exfoliation - reduces bacterial load attached to bladder cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some general host risk factors

A

In pre-menopausal women

Regular sexual intercourse - daily sex can increase likelihood of uti 9x

Spermicide that use
Nanoxynol-9 (USA) which disrupts normal vaginal microbiota. Decrease of helpful bacteria leads to more space for bad bacteria

Dehydration - decrease of bulk flow

Uropathogenic colonisation of GI tract - most uti bacteria derived from gut

Age - risk increases with age

Pregnancy - can introduce structural changes (enlarged uterus obstructs the ureta affecting urine bulk flow)

Indwelling medical device (catheter) - bypasses innate imune factors increases likelihood of biofilm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Vesicoureteral reflux

A

Urine flows backward from the bladder, up the ureter to the kidney due to a fault with the cysto-ureteric valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which bacteria cause UTIS (common and less common)

A

Common
Escherichia coli (70-95% cases)
Staphylococcus saprophyticus

Less Common
*Klebsiella spp.
*Enterobacter spp.
*Proteus spp.
*Citrobacter spp.
Pseudomonas spp.
Group B Strep
Group D Strep
Enterococci
Corynebacterium urealyticum
Yeasts

*all in the same family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs and symptoms of a UTI

A

Urinary urgency/frequency

Dysuria

Sensation of bladder fullness

Suprapubic tenderness

Bloody urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How high is mortailty vs morbidity

A

Mortality from UTI is negligible. However, there is a significant morbidity
Mean 6.1 days of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Put these steps of infection of the urinary tract in order

Apoptosis and exfoliation of bladder epithelial cells

Adherence to uroepithelial cells by type 1 and p fimbriae

Contamination of periurethral area with uropathogenic E. Coli that has colonized the bowel

Invasion, intracellular multiplication observed for selected strains

influx of PMNs

Type 1 fimbriated e. coli selected at high CFU and low O2

A

Contamination of periurethral area with uropathogenic E. Coli that has colonized the bowel

Adherence to uro-epithelial cells by type 1 and pili/ fimbriae

Invasion, intracellular multiplication observed for selected strains

Apoptosis and exfoliation of bladder epithelial cells - innate defence mechanisms

Influx of PMNs (host inflammatory response)

Type 1 fimbriated e. coli selected at high CFU and low O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Put these steps of infection of the urinary tract in order (part 2)

haemolysin damages epithelium

P fimbriae bind to renal tutbular epithelial cells

sat vacuolates epithelial cell and damages glomeruli

cytokines induced

e. coli crosses tubular epithelial cell barrier to initiate bacteraemia

E coli ascends to the kidney

A

E coli ascends to the kidney

There is a change in virulence factors - P fimbriae (not type 1 pili) bind to renal tutbular epithelial cells

cytokines induced

haemolysin damages epithelium

sat (protease virulence factor - toxin which can lead to host cell death) vacuolates epithelial cell and damages glomeruli leading to the presence of blood in the urine

e. coli crosses tubular epithelial cell barrier to initiate bacteraemia (enters blood supply)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference between pili and fimbrie

A

They are the same thing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs and symptoms of pyelonephritis

A

Initially of cystitis but then…

severe lower back pain
Fever, chills, nausea and vomiting

Bacteraemia is often present

Costovertebral (CVA) tenderness (between the ribs and the backbone)

Elevated RBC in the urine and WBC casts can be seen (due to immune response)

17
Q

What is the definition of reccurent utis

A

Two proven episodes of a UTI within 6 months or three episodes of a UTI within 12 months

18
Q

Who is affected by recurrent utis

A

Reported in 27-48% healthy women

Very uncommon in healthy men

19
Q

What can cause recurrent utis

A
  • Voiding dysfunction
  • Congenital anomalies (vesicoureteral reflux)
  • Behavioural (again)
  • Genetic risk factors
  • Pod formation (biofilms in the bladder)
20
Q

What influence do POD forming bacteria have on UTIs

A

POD communities of UPEC found in the bladder lumen may be a reservoir of viable bacterial cells which could be a cause of reccurent utis.

21
Q

When do we prescribe back up antibiotics

A

For women with uncomplicated UTIs before test results have come back. If symptoms haven’t resolved within 48hrs prescription should be used. In all other cases, immediate antibiotic should be offered.

22
Q

When do we refer patients with suspected utis onto hospital treatment

A

If a person aged 16+ has symptoms of a more serious uti (such as sepsis)

23
Q

How do we diagnose UTIs

A

Using reported symptoms

Urine dipstick
tests for: 
nitrites (indication of bacterial metabolism)
leucocytes (due to immune response)
protein
blood

Mid Stream Sample of Urine (MSSU) to identify organism responsible - reduces contamination likelihood. Only done for complicated ones

24
Q

What is the first line treatment for a lower uti for all women

A

Nitrofurantoin 100mg mr 2 times daily
3/7 non pregnant women
7/7 pregnant women

25
Q

How does nitrofurantoin work

A

Targets dna and bacterial rna and is bacteriacidal
It concentrates in the urine
active against gram negative and gram positive

26
Q

What is a second first line therapy for non pregnant women

A

trimethoprim 200mg 2x day 3/7
Targets bacterial dna synthesis and inhibits their growth
Not used in pregnant women because it can affect folate metabolism

27
Q

How do we manage cystitis in the community pharmacy

medicines and advice

A

OTC potassium and sodium citrate (alkaline urine is less painful to pass)

OTC analgesia (dont use to delay attendance at gp)

Public health role
Differential diagnosis of STI, pregnancy

28
Q

Which patients should we prefer if they present with uti symptoms

A

Pregnancy (higher risk of kidney infection)
Recurrent or non-resolving / worsening cystitis
Children and men
Symptoms suggestive of ascending infection (pyelonephritis)
Diabetes (elevated urine glucose levels can enhance bacterial growth)

29
Q

What advice should be given to patients to prevent and control symptoms

A

Drink plenty of clear fluids (increased urine output)
Avoid caffeine (can encourage dehydration)
Empty bladder often and ensure full emptying (esp in children); wipe front to back
Empty bladder after sexual intercourse
Analgesia

30
Q

When do we use cefalexin first line in UTI treatment

A

For the treatment of pyelonephritis. This is because nitrafurantoin shows poor tissue penetration in the kidney and lacks effective therapeutic concentrations in the kidney - it collects in the urine instead so good for lower utis

31
Q

What are the issues around resistance in upec (inc. %resistance)

A

Various in vitro studies report UPEC insensitivity to:
Nitrofurantoin (10% isolates)
Trimethoprim (up to 70% isolates)
Regional variability

The Public 20400 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions