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Urinary Tract Infections


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[Front]


What are some risk factors of UTIs
[Back]


Age Female Catheters Pregnancy Diabetes Immunocompromised Shorter urethra Sexual activity

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15 questions
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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