[53] Cystitis Flashcards
What is cystitis?
Inflammation of the urinary bladder that can occur alone or in conjunction with pyelonephritis
What is the most common cause of cystitis?
UTI
Where can UTI’s affect?
Any part of the urinary tract
How do lower UTI’s typically occur?
Pathogens that colonise periurethral areas ascend the urethra to the bladder
Where can pathogens spread to once they reach the bladder?
- Ureters
- Kidneys
- Bloodstream
What is often seen in infants under 2 months with a UTI?
Poor containment of infection and spread to bacteraemia
What organism causes 90% of UTI’s?
E. coli
What other bacteria can cause UTI’s?
- Klebsiella
- Proteus
- Enterococcus
- Staphylococcus saprophyticus
- Group B Strep
- Pseudomonas aeruginosa
When are fungi more likely to be the cause of a UTI?
After instrumentation of the urinary tract
What are the risk factors for developing a UTI?
- Antibiotic therapy
- Anatomical abnormalities
- Bowel and urinary bladder dysfunction
- Urinary retention
- VUR
Why can antibiotic therapy increase risk of developing a UTI?
Alters the periurethral flora
What are the signs and symptoms of UTI in a 0-2 month old?
- Jaundice
- Fever
- Failure to thrive
- Poor feeding
- Vomiting
- Irritability
What are the signs and symptoms of UTI in a 2 month - 2 year old?
- Poor feeding
- Vomiting
- Strong smelling urine
- Abdominal pain
- Irritability
What are the signs and symptoms of UTI in a 2-6 year old?
- Vomiting
- Abdominal pain
- Fever
- Strong smelling urine
- Enuresis
- Dysuria
- Frequency
- Urgency
What are the signs and symptoms of UTI in a 6+ year old?
- Fever
- Vomiting and abdominal pain
- Strong smelling urine
- Dysuria
- Urgency
- Frequency
- Enuresis
Who is more likely to present with typical urinary symptoms in a UTI?
Adolescents
What is required to diagnose a UTI in a child?
Urine culture
How should culture sample be obtained in children with urinary control?
Mid-stream, clean catch specimen
Why is obtaining a urine sample for culture in younger children more difficult?
They are unable to void on request
How should urine sample be obtained in children unable to void on request?
Suprapubic aspiration or urethral cathaterisation
What results on sample culture indicate probable infection?
Bacterial culture of more than 10^5 colony forming units of a single organism
What does a mixed growth usually suggest?
Contamination
What group of children should undergo imaging following UTI diagnosis?
Only those with an atypical UTI
What are some features of an atypical UTI?
- Seriously ill/septic
- Poor urine flow
- Abdominal or bladder mass
- Raised creatinine
- Failure to respond to suitable antibiotics within 48 hours
- Infection with atypical organisms
What is the first imaging test conducted in an atypical UTI investigation?
Renal USS
What can a renal USS identify?
Serious structural abnormalities, urinary obstruction and renal defects
What do subsequent investigations depend on?
Results of USS
What are some differentials of a UTI?
- Epididymitis/orchitis
- Prostatitis
- Urethritis
- Pregnancy
- Urolithiasis
- Bladder and bowel dysfunction
How should infants under 3 months be managed with suspected UTI?
Immediate referral to hospital for IV antibiotics e.g. co-amoxiclav for 5-7 days
How can older children be treated for cystitis?
Oral antibiotics e.g. trimethoprim/nitrofurantoin for 3 days
What should parents be given regarding UTI’s?
Advice on how to prevent further infections
How can further UTI be prevented?
- High fluid intake
- Regular voiding
- Ensure complete bladder emptying
- Treatment/prevention of constipation
- Good perineal hygiene
- Lactobacillus acidophilus probiotic
How can parents encourage their child to fully empty their bladder?
Encourage trying to go a second time a few minutes later
What are the potential complications of a UTI?
- Pyelonephritis
- Sepsis
- Dehydration
