Clinical infections: Urinary Flashcards
Pyelonephritis
- Upper UTI
- loin and abdomen pain or tenderness
- Other evidence of systemic infection
Prostatitis
- Inflammation of prostate
- Can be acute bacterial or chronic
Acute bacteria Prostatitis
- Post procedure
- Lower UTI symptoms - fever, tender prostate
- Uropathogens = E.coli
Chronic Prostatitis
- Recurrent UTI’s with same organism
- Fluoroquinolones - Ciprofloxacin used
Abscesses
Perinephric: - Can cause renal stones - Due to obstruction of infected kidney - Caused by gram negative bacteria Intrarenal: - Haematogenous spread - S.aureus - Associated with acute pyelonephritis
Cystitis treatment
- Antibiotic therapy
- Females - 3 days
- Males - 7 days
Pyelonephritis treatment
- Empiric therapy
- 7-14 days use of Cefuroxime, Ciprofloxacin
Cystitis
- Lower UTI infection
- Caused by E.coli + others
- Symptoms include dysuria, frequency+urgency, supra-pubic pain
Urinary tract flora
- Urethra has perineal flora
- Skin = negative staphylococci
- Lower GIT = Enterobacteria
Urethral syndrome (Abacterial cystitis)
- symptoms of lower UTI without demonstrable infection
- Caused by hormonal imbalances, inflammation of Skene glands
- Hypersensitivity following UTI
Asymptomatic bacteriuria
- No symptoms of UTI bur cultured urine sample grows a single organism in significant numbers
- Affects people with catheters, haemodialysis, diabetics, pregnant women
Sterile pyuria
- Pus cells in urine
- No organisms grown
Causes: - Inhibition of bacterial growth
- Urinary tract inflammation
- Urethritis
Treatment for asymptomatic bacteriuria
- Antibiotic course
- Only test specific groups
Pregnant women
Infants
Prior to urological procedures
Recurrent UTI
- Re-infection - 3 episodes within 12 months is significant
- bacterial persistence
Recurrent UTI treatment
- Lifestyle modification - more intake of fluids, change contraception
- Continuous prophylaxis with methenamine Hippurate
- Continuous antibiotic prophylaxis
Complicated UTI causes
- Underlying abnormality - structural and functional
- Presence of foreign body = catheter, renal calculi
- Children under 12 and men under 65 often have complications
Urostomy associated UTI’s
- Bacteria can colonise catheters
- Fever, ascending infection = upper UTI
symptoms - Para-stomal skin infections
What is a Urostomy
- Ileal conduit/urostomy
- short section of ileum used to drain the ureters directly to a stoma on the anterior abdominal wall after cystectomy
What is a Nephrostomy
- Percutaneous straight into the kidney
- drains urine from the kidney if there is a blockage in the urinary system
Nephrostomy associated UTI
- Bacteria colonise nephrostomy tube
- Fever, tenderness at site
- Haematuria or purulent discharge
Catheter associated UTI treatment
- Catheter removal/change
- Pre-emptive catheter cover: gentamicin
Catheter associated UTI
- Indwelling catheterisation results in bacteriuria; Biofilm formation = colonisation
- Manipulation or catheter removal may result in bacteraemia
When can antibiotic prophylaxis be used for Catheter associated UTI
- History of similar infection
- Purulent urethral catheter exit site discharge
- Exit site colonisation
