34 - UTI Flashcards
What flora would be present in urethra
Perineal flora
What is in perineal flora
Skin flora + similar to the orifice
Anaerobic bacteria
Aerobic - enterobacteria
Gram-+ve cocci - enterococcus
Cystitis
Low urinary tract infection
Syndrome: dysuria Urinary freq. Urgency Supra-pubic pain/tenderness Polyuria, nocturia, haematuria
Pyelonephritis
Upper UTI - kidney and/or renal pelvis
Symptoms of lower UTI
Loin/ab pain/tenderness
Fever
Systemic infection evidence - rigors, nausea, vomiting, diarrhoea w/ elevated CRP + WBC
Urethral syndrome
aka Abacterial cystitis
aka frequency-dysuria syndrome
30-50 yo women
UTI symptoms w/o demonstrable infection
Aetiology - hormones, inflammation of skene / paraurethral glands, foods, environmental chemicals, hypersensitivity, traumatic intercourse
“the female prostate” inc.
Skene glands / paraurethral glands
Number of bacteria/ml urine - normal
10^2
Number of bacteria/ml urine - abnormal
10^5 - lower in men
Sterile pyuria - definition
Pus cells in urine which doesn’t grow in culture
Predisposing factors for UTI
Sex 10f:1m Urinary stasis - pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine Sex Fistulae Congenital - vesico-ureteric reflux
Sources of infection for UTI
Perineum - bacteria along lumen
Fistulae - bacteria from genital/GI to urinary
Haematogenous - seeding of infection
Most common cause of UTI
E.coli
Which organism is noticeably more responsible for UTIs in hospitals
Enterococcus
Causes of sterile pyuria
Inhibition of bacterial growth via antibiotics or contaminated specimen
Fastidous (hard to grow) organisms
Urinary tract inflammation via renal/bladder stones or other renal disease
Fastidous organisms e.g.
Mycobacterium TB
Haemophilus spp.
Neisseria gonorrheaae
Anaerobes
Catheter UTI
Need to distinguish between colonisation and infection via clinical features
History of infections w/ catheter
Purulent urethral/suprapubic catheter exit site discharge
Catheter or meatal/suprapubic catheter exit site colonisation with Staph. aureus (inc. MRSA)
Tests for UTI
Dipstick
Bloods
Microbiological
Imaging
Dipstick tests what parameters usefully
Blood
Protein
Nitrite
WBCs
Microbiological tests
Urine - mid-stream, catheter urine, ‘clean-catch,’ supra-pubic aspirate
Blood: suspected pyelonephritis
Tests inc. microscopy, culture and sensitivity testing
Mid-stream urine testing
Sample procurement needs specific instructions
Transport via boric acid preservative
Sample processed in semi-quantative culture
Special test - early morning urine (EMU) x 3
Whole content of bladder
Suspected urinary tuberculosis
Further investigations indicated when:
recurrent UTI
any UTI in male patient
any UTI in childhood
Pyelonephritis
What further investigations would you do?
Renal tract USS
Specialised tests inc. isotope scans, micturating cystourethrogram
UTI antiobiotics
Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin
Treatment for cystitis
Treatment pre-empts microbiology report
Short antibiotic course of 3 days for females
7 days course for males
Treatment for pyelonephritis
Empiric therapy w/ cefuroxime, ciprofloxacin
Piperacillin-tazobactam if >65 yo
Targeted therapy based on sensitivity results
7-14 day course of antibiotics
Asymptomatic bacteriuria treatment
Treat only specific groups:
Pregnant - association w/ upper UTI, pre-term delivery, + low birth weight babies
Infant - prevention of pyelonephritis and renal damage
Prior to urological procedures
Elderly are catheterised
