CLINICAL INFECTIONS: urinary Flashcards
Pyelonephritis
Infection of kidney and/or renal pelvis
Symptoms of lower UTI: Loin/abdominal pain/tenderness, Fever, Other evidence of systemic infection: Rigors, nausea, vomiting, diarrhoea, Elavated CRP, WBC
caused by bacterial infection that has spread up the urinary tract or travelled through the bloodstream to the kidneys. A similar term is “pyelitis” which means inflammation of the pelvis and calyces.
Evidence of UTI from urinalysis or culture, along with signs and symptoms suggesting upper UTI
Empiric therapy Cefuroxime, ciprofloxacin, Piperacillin-tazobactam (if >65 yrs old)
Targeted therapy: Based on sensitivity results
Duration: 7-14 days depending on antibiotic used
Renal abscess
Abdominal pain, Burning with urination, Chills, Fever, UTI.
urinary tract infections that start in the bladder. They then spread to the kidney, and to the area around the kidney. Surgery in the urinary tract or reproductive system and a bloodstream infection can also lead to a perirenal abscess.
Non-antimicrobial management: Percutaneous drainage plus parenteral antibiotics is indicated as the initial treatment for abscesses 3-5 cm in size
Prostatitis
Inflammation of prostate. Prevelance 2-16%.
Lower urinary tract symptoms. Fever. Tender tense prostate on PR palpation.
Acute bacterial: post procedure, trans-urethral resection of prostate.
Caused by Uropathogens e.g. E.coli
Cystitis: lower UTI
inflammation of the bladder.
Symptoms: Dysuria, Urinary frequency, Urgency, Supra-pubic pain/tenderness, Polyuria, nocturia, haematuria.
Aetiology: bacterial infection due to sex wiping the wrong way, catheters.
Diagnosis: symptom based and urine sample.
Non-antimicrobial management: females- short course of antibiotics for 3 days. Males: 7 days.
Asymptomatic bacteriuria
Significant bacteriuria With a single organism. No symptoms of urinary tract infection
antimicrobial management: Treat only specific groups: Pregnant –> Association with upper UTI, pre-term delivery, and low birth weight babies. Confirm “genuine” with second sample.
Infant –> Prevention of pyelonephritis and renal damage
Prior to urological procedures –> Prevention of UTI/bacteraemia
Elderly (♀♂), catheterised etc. do not require antibiotics
UTI in children
Suspect UTI in infants less than 3 months of age with any combination of:
Fever (without an obvious cause), vomiting, irritability, lethargy (most common presentation).
Poor feeding, failure to thrive (intermediate). Abdominal pain, jaundice, haematuria, offensive urine (least common presentation).
Children with a condition called vesicoureteral reflux (VUR) are at higher risk for UTIs. VUR causes urine to reflux at the point where one or both ureters attach to the bladder. When urine stays in the urinary tract, bacteria have a chance to grow and spread
Recurrent UTI’s
Clinical history: Re-infection or bacterial persistence “Significant” recurrent UTIs > 3 episodes within 12 months.
Urostomy associated UTIs
A urostomy is a surgical procedure that creates a stoma (artificial opening) for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, e.g. after extensive surgery or in case of obstruction
Nephrostomy associated UTIs
Clinical history: A nephrostomy is a tube that’s used to drain urine from a kidney into a bag outside the body. It helps to relieve a build-up of urine in a kidney, which can be caused by a blockage
Symptoms & signs: Dysuria, Urinary frequency, Urgency, Supra-pubic pain/tenderness, Polyuria, nocturia, haematuria
Aetiology: Stasis increased likelihood for bacteria to grow. Also eternal entrance site direct to kidney.
Diagnosis: dipstick testing of nitrites in urine, blood cultures, mid-stream urine testing.
Non-antimicrobial management: anti-inflammatories e.g. NSAIDS, drainage.
Catheter associated UTIs (permanent and intermittent catheters)
Indwelling catheterisation results in bacteriuria Biofilm formation -> colonisation. Need to distinguish between colonisation and infection. Don’t expect “normal” / “sterile” results.
UTI antibiotics- Requirements
Present in urine. Minimally toxic
Effective against likely organisms: Increasing resistance and Lack of “collateral” damage
Easily administered, Cheap
Predisposing factors for UTI
Female sex 10:1 female: male ratio, Urinary stasis
Pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
Instrumentation,
Sexual intercourse: Associated with recent sexual intercourse and commoner in sexually active women, Fistulae: Recto-vesical, vesico-vaginal
Congenital abnormalities: Vesico-ureteric reflux (VUR), Perineum: Movement of bacteria along a lumen, Fistulae, Movement of bacteria from genital/GI tract to urinary tract, Haematogenous, Seeding of infection from the blood (rare)
Staphylococcus aureus
