Urinary Tract Infections
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Urinary Tract Infections - Marcador
Urinary Tract Infections - Detalles
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| 🇬🇧 | 🇬🇧 |
| What are some risk factors of UTIs | Age Female Catheters Pregnancy Diabetes Immunocompromised Shorter urethra Sexual activity |
| How do bacteria enter the Urinary Tract | Retrograde → ascending infection from the urethra Via blood/lymphatics Direct → catheter, surgery , instrumentation |
| What are some bacterial virulence factors involved in infection of the UT | Adhesion – fimbriae and adhesins allow attachment to uroepithelium K antigens – capsule resistant to phagocytosis |
| What are some bacteria that cause uncomplicated UTIs | E.coli , Staphylococcus saprophyticus |
| What are some natural defences | Low pH, high concentration of urea Regular flushing – removes bacteria from distal urethra Mucin layer Antibacterial secretions by urothelium into the mucin layer Inflammation & exfoliation of cells |
| What are some common presentations | Dysuria Frequency / Urgency Haematuria Incontinence Cloudy/Offensive smelling urine Pain |
| What is urethral syndrome | About 50% of women who present with the clinical features of cystitis do not have positive urine cultures, a ‘urethral syndrome’ It could be an infection with low counts of bacteria STIs Non-infective inflammation e.g. chemical Infection with fastidious organisms not detected on routine culture |
| What does urine dipstick look for | Nitrites --> Nitrite produced by bacterial nitrate reductase when bacteria in contact with urine Leucocytes |
| What are some treatments for UTIs | Uncomplicated lower UTIs --> Short course of ABx (women 3 days, men 7 days) or delay and Nitrofurantoin (check eGFR) or Trimethoprim first line Supportive measures --> fluids etc. Always safety net Guided by results of culture |
| What is asymptomatic bacteruria | Common in elderly Unless patient has symptoms , dont treat --> also if pregnant then treat Does not reduce morbidity/mortality Can lead to increase in antibiotic resistance |
| What is the difference between reinfection and relapse | Reinfection --> Infection within 14 days but can be any organism while relapse is within 7 days and is the same organism Relapse can be due to failure of treatment |
| Difference between complicated and uncomplicated UTIs | Complicated: UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection Uncomplicated: UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities |
| What are the different ways of taking urine cultures | Mid-stream Urine (MSU) sample preferred Catheter technique Pad sample |
| When do you order a urine culture | Only if there is higher risk of complications e.g. Pregnancy Suspected pyelonephritis Suspected UTI in men Failed antibiotic treatment or recurrent symptoms Recurrent UTI It is not used routinely in uncomplicated UTIs |
| What is treatment for UTIs | For uncomplicated lower UTIs then short course of antibiotics ( 3 days for women and 7 days for men ) Supportive measures Guided by results of culture |