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PHAM02 - term 2 > Wk 28: UTI > Flashcards

Wk 28: UTI Flashcards

1
Q

Who would be classed as complicated UTI?

A
  • Pregnant
  • Male
  • Children
  • Elderly
  • Pyelonephritis
  • Recurrent
  • Abnormal urinary tract
  • Poor diabetes control
  • Immunosuppressive
  • Impaired renal function
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2
Q

What are typical signs of uncomplicated UTI?

A
  • Dysuria
  • Freq
  • Suprapubic tenderness
  • Urgency
  • Polyuria
  • Haematuria
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3
Q

What are signs of pyelonephritis?

A
  • +- UTI symptoms
  • Fever
  • Flank, loin, lower back pain
  • Can lead to renal failure + septicaemia
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4
Q

How is UTI diagnosed?

A
  • Clinical history + symptoms
  • Urine - smelly, cloudy, blood
  • Urine microscopy
  • Dipstick test - leukocyte + nitrite
  • Urine culture
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5
Q

When would you not perform a urine dipstick?

A
  • Over 65
  • Unreliable
  • Most w/ urinary catheter will have bacteria present in bladder w/o infection
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6
Q

How is uncomplicated UTI managed?

A
  • Nitrofurantoin MR 100mg BD for 3 days/ 50mg QDS
  • Trimethoprim 200mg BD for 3 days
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7
Q

How is complicated UTI managed?

A

Requires 5-10 days treatment

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8
Q

What are the important points of nitrofurantoin?

A
  • Taken w/ food
  • eGFR <45 caution
  • eGFR 30-45 only if muti-drug resistant
  • Inc risk of peripheral neuropathy
  • S/e: GI, cough, chest pain, hypoxemia (w/draw + corticosteroids)
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9
Q

What inc risk of peripheral neuropathy?

A
  • Diabetes
  • Anaemia
  • Folate deficiency
  • Electrolyte imbalance
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10
Q

What are important points of trimethoprim?

A
  • eGFR 15-25: normal dose for 3 days then half dose
  • eGFR <15: half dose
  • CI: blood dyscrasias - antifolate
  • Interactions: mxt, aza, phenytoin, digoxin, warfarin
  • Adverse: GI, blood disorders
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11
Q

What are common pathogens that cause pyelonephritis?

A
  • E coli
  • Klebsiella pneumonia
  • Proteus, pseudomonas + enterococcus species
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12
Q

When would you admit pyelonephritis to hospital?

A
  • > 38 + <36 degrees
  • Tachycardia, hypotension, SOB
  • Impaired consciousness, rigors, sweating
  • Dehydration
  • Not able to tolerate fluids/oral meds
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13
Q

When would you be cautious when managing pyelonephritis?

A
  • Pregnancy
  • Elderly
  • Lack improvement follow Abx 24 hrs
  • Immunocompromised
  • Renal impairment
  • Diabetes
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14
Q

How would you manage pyelonephritis in primary care?

A
  • Co-amoxiclav 625mg TDS 7 days
  • Ciprofloxacin 500mg BD 7 days
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15
Q

How would you manage pyelonephritis in secondary care?

A
  • Gentamicin
  • Tazocin
  • Meropenem
  • Teicoplanin
  • Ciprofloxacin
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16
Q

What are the causes of recurrent UTI?

A
  • Relapse: same strain w/in 2 wks of treatment
  • Reinfection: diff strain, >2wks after
17
Q

What is the treatment for UTI in men?

A
  • 7 days of trimethoprim/nitro
  • Recurrent in men/febrile: quinolones
18
Q

What is the presence of bacteriuria in pregnant women associated with?

A
  • Premature rupture of membranes + pre-term labour
  • Requires midstream urine culture
19
Q

Which bacteria found in pregnant women require antibiotics during delivery?

A

Group B streptococcus

20
Q

How is cystitis in pregnancy managed?

A
  • Paracetamol
  • Alkalizing + cranberry = avoid
  • Fever + loin pain = hospital admin
21
Q

How does UTI usually present in elderly?

A
  • Functional decline
  • Inc confusion
22
Q

How is UTI in patients with indwelling catheters managed?

A
  • Catheter checked for correct position + ensure not blocked
  • If more than 1 wk, change before starting Abx
  • Urine cultures taken prior to initiating
  • 7 day course
23
Q

What are the risks of UTI in diabetes?

A
  • Inc risk of asymptomatic bacteriuria
  • Inc risk of recurrent infections
  • Higher prevalence of atypical pathogens
  • Antimicrobial resistance
  • Fungal UTI more common
24
Q

What are clinical presentations of UTI in infants?

A
  • Fever
  • Vom
  • Lethargy
  • Offensive urine
  • Poor feeding
  • Jaundice
25
Q

In children and infants, when would you give a urine sample test?

A

Fever > 38 + w/in 24 hrs

26
Q

What are the indications for a culture?

A
  • Pyelonephritis/upper UTI
  • <3 yrs
  • Single positive for leukocyte or nitrite
  • Recurrent
  • No response w/in 24-48 hrs
27
Q

What are the risk factors for UTI in children?

A
  • Incomplete bladder emptying: constipation, poor urine flow
  • Fx: vesicoureteric reflux or renal disease
  • Previous UTI
  • Spinal lesion
  • Poor growth
  • High BP
28
Q

How is UTI managed in children or infants >3 months?

A
  • Acute pyelonephritis: 7-10 days, IV for 2-4 days then oral
  • Low UTI: 3 days, reassess if unwell after 24-48hrs
  • Trimethoprim, nitro, cephalosporin, amox
29
Q

How is UTI prevented in children?

A
  • High fluid
  • Regular voiding
  • Complete bladder emptying
  • Prevent constipation
  • Good perineal hygiene
30
Q

When is antibiotic prophylaxis indicated in children?

A
  • Recurrent
  • <2 w/ congenital abnormality
  • Severe reflux
  • Trimethoprim

PHAM02 - term 2 (21 decks)

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