[6] Urinary Tract Infections Flashcards
What is a urinary tract infection?
An infection that affects any part of the urinary tract
What is cystitis?
An infection affecting the bladder
What is urethritis?
An infection affecting the urethra
What is pyelonephritis?
An infection affecting the kidneys
How serious are UTIs?
They can be very simple and self-resolve, or can be very serious if they become complicated
What is bacteruria?
The presence of bacteria in the urine
Is bacteruria symptomatic or asymptomatic?
Can be either
How should asymptomatic bacteruria be confirmed?
By two seperate urine samples
What is an uncomplicated UTI?
An infection of the urinary tract by a usual pathogen in a person with a normal urinary tract and normal kidney function
When does a complicated UTI occur?
When anatomical, functional, or pharmacological factors predispose the person to persistent infction, recurrent infection, or treatment failure
What is the most common pathogens in the community causing UTIs?
Gram -ve rods, particularly enterobacteriae, especially E. Coli
What bacteria might cause a UTI in young women and hospitalised patients?
Coagulase-negative staphylococci, e.g. Staph Saphrophyticus
Who is more likely to get a UTI with less common organisms?
Patients who have an underlying pathology and/or frequent infections, are immunosuppressed, or who are catheterised
What are the less common organisms causing UTIs?
- Klebsiella
- Proteus vulgaris
- Candida albicans
- Pseudomonas
What are the causes of UTIs?
- Sexual activity
- Pregnancy
- Conditions that make it difficult to fully empty the bladder
- Urinary catheter
- Immunocompromisation
- Antibiotic use
Give two examples of conditions that might make it difficult to empty the bladder
- Prostatic hypertrophy
- Constipation
Give two examples of things that can cause immunocompromisation
- T2DM
- Chemotherapy
- HIV
What are the symptoms of UTIs?
- Urgency and frequency of urination
- Dysuria or burning sensation
- Strong smelling urine
- Haematuria
- Lower abdominal pain
- Feeling tired or unwell
What symptom might be seen in an older person with a UTI?
Changes in behaviour, including severe confusion and agitation
What investigations should be done into UTIs?
- History
- Examination of bladder and kidneys
- Dipstick analysis of urine
- Urine microscopy and culture
- Ultrasound evaluation
What information should be obtained in the history for a UTI?
- Any previous UTI
- Sexual history
- Antibiotic use
- Any history of renal tract abnormality or diabetes
- Use of immunosuppressant agents such as steroids
- Family history
What might be found on urine dipstick in UTIs?
Presence of nitrate and/or leukocytes, indicating a bacterial infection
What indicates the presence of infection on urine microscopy?
Leukocytes
When might urine culture be used in suspected UTI
- To exlcude the diagnosis
- In high risk patients
- If the patient has failed to respond to earlier empirical treatment
- In men with a history suggestive of UTI, regardless of results of urine dipstick test
Give 3 examples of high risk UTI patients who should have a urine culture
- Pregnant
- Immunosuppressed
- Have renal tract anomaly
Which UTI patients do not require urine culture?
Non-pregnant women with a symptomatic lower UTI
When might ultrasound evaluation be considered in UTI?
In acute, uncomplicated pyelonephritis
Why should ultrasound evaluation be considered in acute, uncomplicated pyelonephritis?
To rule out urinary obstruction or renal stone disease
What are the indications for referral in UTI?
- Persistent non-response to treatment
- History of renal tract disease or anomaly
- Haematuria
- Men with two or more episodes in three months
- Suggestion of urinary tract obstruction in men
What may many women find helpful in the prevention of UTIs?
Being made aware of the risk factors for recurrent infection, including the use of spermicide, frequent sexual intercourse, and having a new sexual partner
What measures can be suggested to prevent UTIs?
- Avoiding delay in urination
- Wiping from front to back after defecation
- Drinking cranberry juice
The evidence suggesting the efficacy of these measures is limited
What are the first line agents in the empirical treatment of an uncomplicated UTI?
Trimethoprim or nitrofurantoin
What % of E. Coli infections may be resistant to trimethoprim or nitrofurantoin?
10-20%
How long should antibiotics be given for in an uncomplicated UTI?
3 days in women, 7 days in men
What is first-line therapy in mild cases of uncomplicated pyelonephritis?
Oral ciprofloxacin for 7-10 days
What are alternatives to oral ciprofloxacin in mild cases of uncomplicated pyelonephritis?
Co-amoxiclav and cephalexin
What may be helpful in the prevention of recurrent UTIs?
Prophylactic low-dose antibiotics
What prophylactic antibiotics can be used for recurrent cystitis associated with sexual intercourse?
Trimethoprime 100mg within 2 hours of intercourse
What prophylactic antibiotic may be given to women with recurrent UTIs not associated with sexual intercourse?
6 month course of low-dose antibiotics
What can be used for symptomatic relief in UTIs?
Paracetamol and/or NSAIDs
What are the complications of UTIs?
- Pyelonephritis
- Perinephric and intrarenal abscess
- Hydronephrosis or pyonephrosis
- Acute kidney injury
- Sepsis
- Prostatitis
What complications may develop from untreated asymptomatic bacteruria in pregnancy?
- Pyelonephritis
- Preterm delivery and low birth weight
- Anaemia
