UVI - Amboss

Question 1

Hvilken etiologi har UVI?

Answer 1

Bakterier

Virus

Sopp

Question 2

Hvilke kjennetegner bakterielle UVI, og hvilke patogener kan føre til infeksjon?

Answer 2

Question 3

Hva kjennetegner virale UVIer?

Answer 3

Question 4

Hvilke sopptyper kan gi UVIer?

Answer 4

Fungi is a rare cause of UTI. Candiduria is a common finding on urine culture but usually represents contamination or colonization rather than a true infection.

Question 5

Hva mener man med SEEK PP = S?

UVI

Answer 5

Question 6

Hvilke predisponerende faktorer fører til UVIer?

Answer 6

Strukturelle eller funksjonelle abnormaliteter i urinveiene

Kjønn

Graviditet

Postmenopausal

Kronisk obstipasjon

Tidligere lidelser

Medisinering

Samleie

Kateter

Question 7

Hvilke strukturelle eller funksjonelle abnormaliteter i urinsystemet er en årsak til UVI?

Answer 7

Anatomical abnormalities are more commonly responsible for UTIs in men.

Question 8

Hvilket kjønn er anatomisk predisponert for UVI, og hvorfor?

Answer 8

Question 9

Hvilken gruppe menn har høyere risiko for UVI?

Ikke strukturelle abnormaliteter

Answer 9

Bacterial colonization of the foreskin during the first 6 months of life is an important risk factor for the development of UTIs.

Question 10

Hvorfor er gravide og postmenopausale kvinner mer utsatt for UVI?

Answer 10

Question 11

Hva er en av de vanligste årsakene til UVIer hos barn?

Answer 11

Retained stool can cause rectal distention, leading to compression and/or obstruction of the bladder and subsequent inadequate bladder voiding. This can lead to overgrowth of bacteria in the bladder due to urinary stasis.

Question 12

Hvilke tidligere lidelser er en predisponerende faktor til UVI?

Answer 12

Previous UTI; Potentially attributable to biological/behavioral features and/or persistent bacterial colonization of the urinary tract.

Question 13

Hvilket medikament er predisponerende for UVI?

Answer 13

Nylig brukt ab.

Question 14

Hva er “honeymoon cystitis”?

Answer 14

Question 15

Hvilke prevensjonsmidler er predisponerende for UVIer?

Answer 15

Cervikalhette og spermicide midler:
- Alter the vaginal flora, increasing the risk of UTIs.

Question 16

Hva er CAUTI?

Answer 16

Occurs when catheters remain in the urethra for an extended period of time, nursing home residents, and patients with neurologic dysfunction. The risk of infection can be reduced by proper, aseptic catheter placement and intermittent catheterization.

Question 17

Hvilke faktorer er med på å bestemme klassifiseringen av UVIer?

Answer 17

Klinikk

Lokalisasjon

Alvorlighetsgrad

Infeksjonskilde

Hyppighet

Question 18

Hvordan kan man klassifisere UVI basert på det kliniske bildet?

Answer 18

ASB usually represents bacterial colonization and is not considered a UTI by most authors. Typically, a bacterial count of ≥ 10^5 CFU/mL is considered significant. This cutoff is not universally used and some authors define ASB as any bacteriuria without clinical features of UTI.

Question 19

Hvordan klassifiserer man en UVI basert på lokalisasjon?

Answer 19

Question 20

Hvilke alvorlighetsgrader skiller man mellom ved UVI?

Answer 20

Ukomplisert UVI

Komplisert UVI

Urosepsis

Question 21

Hva er ukomplisert UVI?

Answer 21

Infeksjoner hos ikke-gravide, premenopausale kvinner uten risikofaktorer for videre utvikling av infeksjonen, behandlingssvikt eller alvorlige utfall:
- Denne definisjonen samsvarer med European Association of Urology classification (2021).
- Noen eksperter mener og at menn også kan få ukomplisert cystitt, men dette er det manglende konsensus om.

Question 22

Hva er kompliserte UVIer?

Answer 22

The use of complicated UTI is not always consistent throughout the literature and is applied to a highly heterogeneous patient population. Nevertheless, it is necessary to decide whether a UTI is complicated or uncomplicated before beginning treatment. Male sex; This definition is consistent with the 2021 European Association of Urology classification. Some experts believe that men can also have simple uncomplicated cystitis; however, there is a lack of consensus around this change in classification. Significant anatomical or functional abnormalities; E.g., neurogenic bladder, stones, obstruction, vesicoureteral reflux.

Question 23

Hva er urosepsis?

Answer 23

UVI assosiert med en dysregulert immunrespons som kan føre til livstruende organsvikt

I USA, UVIer er den vanligste infeksjonen som fører til septisk sjokk

Question 24

Hvordan klassifiserer man UVIer basert på smittekilde?

Answer 24

Question 25

Hvordan klassifiserer man UVIer basert på hyppighet?

Answer 25

Tilbakevendende UVIer

≥3 episoder med symptomatisk UVIer med oppvekst i kultur i løpet av ett år, eller ≥2 episoder i løpet av 6 mnd.

Question 26

Hva er kliniske kjennetegn ved nedre UVI?

Answer 26

Gross hematuria (means that you can see blood with the naked eye because the urine is pink, red, purplish-red, brownish-red, or tea-colored.) usually indicates a cause in the lower urinary tract (e.g., hemorrhagic cystitis).

Question 27

Hva er kliniske trekk ved øvre UTI?

Answer 27

In patients with fever and/or flank pain, which are usually absent in lower UTIs, consider a more serious infection (e.g., pyelonephritis).

Question 28

Hva kan klinikken ved UVI i tillegg bestå av hos spesielle pas. grupper?

Ikke de vanlige symptomene

Answer 28

Menn:
- Smerter i perineum
- Smerter i prostata

Eldre:
- Delirium/akutt forvirring; “The mechanism is not completely understood. One theory suggests changes in the central nervous system due to a generalized inflammatory process caused by cytokines and activation of toll-like receptors.”

Barn:
- Egen klinikk

Question 29

Hva bør man starte med når det kommer til å diagnostisere UVI?

Nedre UVI

Answer 29

Symptomatic, uncomplicated lower UTIs can be diagnosed clinically. In all other patients, urinalysis is the most important initial diagnostic test. Typical symptoms in uncomplicated lower UTI in women; Dysuria, urgency, and/or frequency without abnormal vaginal discharge. A negative dipstick (U-sticks) does not exclude the diagnosis when the pretest probability is high. Using a urine dipstick test can speed up the diagnostic process but, because of limited reliability, any equivocal results should be confirmed with microscopy. In complicated lower UTI in women, further diagnostics can be e.g., gynecologic examination, imaging of the urinary tract. Culture is important in men with lower UTI, to differentiate infection from chronic pelvic pain syndrome, a condition that may mimic UTI. Additional testing may be necessary, e.g., fractional urine examination or cystoscopy. UTI is primarily a clinical diagnosis that is supported by typical findings on urinanalysis. Urin cultures is indicated in select cases to determine the causative pathogen and adapt ab. treatment.

Question 30

Hva viser bildet?

Answer 30

Question 31

Hvilke to labprøver er viktig ved mistenkt UVI?

Answer 31

Urinalyse (urinalysis)

Urinkultur

Question 32

Ved urinanalyse, hva er hhv.:
- Indikasjonen
- Prosedyren
- Innsamling av prøvematerialet

Answer 32

Urinalysis may be foregone in women with typical symptoms and no complicating factors. Clean-catch midstream sample first requires the skin and mucosa around the urethral orifice be cleaned. The first part of the urine stream should be passed into the toilet and the midstream urine is then collected. Although commonly recommended, cleansing has not been proven to significantly decrease contamination. Straight catheterization e.g., in children who are not toilet trained, patients who are bedridden, or individuals who are currently menstruating.

Question 33

Hva er typiske funn ved urinalyse ved UVI?

Answer 33

In a patient with sufficiently high pretest probability, either positive leukocyte esterase or positive nitrites on urine dipstick are sufficient for a diagnosis. The cutoff varies according to source, and leukocyte esterase is commonly used as a surrogate value for the diagnosis of pyuria. In men, ≥ 2 WBC/HPF may be sufficient to diagnose pyuria. Nitrites; False-positive results may occur if urine containers are left open for an extended period of time. Several pathogens commonly involved in UTIs do not produce nitrite, however, so a negative result does not rule out UTI. In addition, false negatives are possible in samples with a low number of pathogens (e.g., due to frequent voiding) and patients following a low-nitrate diet.

Question 34

Hvilke andre funn ved urinalyse forekommer ved UVI?

Ikke de typiske funnene

Answer 34

If hematuria is detected, repeat urinalysis after 6 weeks to confirm that hematuria has resolved. In case of persistent hematuria, initiate diagnostic workup. Urease converts urea into CO2 and ammonia. Chronic or recurrent infection with urease-producing organisms may lead to the formation of struvite stones, which can cause obstruction and in turn lead to UTI recurrence.

Question 35

Når er det indikasjon for å gjøre en urinkultur ved UVI?

Answer 35

Question 36

Hvordan skal man tolke svaret man får av en urinkultur?

Answer 36

CFU; Colony forming unit. The diagnosis of UTI cannot be made based on laboratory results alone; symptoms must also be present. The cutoff of ≥ 10^5 CFU/mL is widely accepted, but in symptomatic patients, lower cutoffs (≥ 10^2 CFU/mL in women, ≥ 10^3 CFU/mL in men) have proven more sensitive and specific. There is varying data on the appropriate threshold for diagnosing bacteriuria from suprapubic bladder aspiration and straight catheterization, and some institutions use a threshold of ≥ 10^2 CFU/mL or higher.

Question 37

Hvilke typiske bakterier finner man i urinkulturen?

Answer 37

E.coli; An indicator of lactose fermentation. K.pneumoniae; Bacteria have large mucoid capsules. Serratia marcescens; Bacteria produce red pigment. P.mirabilis; Refers to target or branching appearance on agar caused by synchronous bacterial movement.

Question 38

Hvilke andre labprøver er akt. ved UVI?

Answer 38

STI risk factors/symptoms; E.g., women reporting abnormal vaginal discharge.

Question 39

Ved hvilke indikasjoner bruker man bildediagnostikk ved nedre UVIer?

Answer 39

Imaging is generally not indicated or helpful for the diagnosis of lower UTI, but it may be performed in select patients to rule out complicating factors (e.g., urinary tract obstruction) or if complicated pyelonephritis or urosepsis are suspected.

Question 40

Hvilke bildemodaliteter kan brukes ved UVIer?

Answer 40