Infections of UT Flashcards
What is meant by a UTI?
What is the most common UTI?
- Infection of the urethra, bladder or kidneys
- Cystitis is the most common UTI
Discuss the epidemiology of UTIs
- Very common
- Mostly affects women (due to shorter urethra length)
What is the most common causative organism for UTIs?
Escherchia coli
*Other organisms include: Staphylococcus saprophyticus, Staphylococcus aureus, group B Streptococcus, Pseudomonas aeurginosa
What is honeymoon cystitis?
Cystitis that is caused by/asscociated with sexual activity or a new sexual partner
State somr risk factors for developing a UTI
- Immunosupression
- Diabetes
- Renal tract abnormalities
- Sexual activity
- Spermicide use (decrease vaginal lactobacilli which faciliitates growth of E-coli)
- Post-menopause (lack of oestrogen causes urogenital and vaginal atrophy- increasing risk of UTIs)
- Catheter
- Pregnancy
What are the symptoms & signs of a UTI?
- Dysuria (pain or discomfort on passing urine)
- Increased urinary frequency or urgency
- Foul-smelling urine
- Cloudy urine
- New nocturia
- Fever, loin pain, back pain (suggests uper urinary tract infection)
What investigations would you do if you suspect a pt has a UTI, include:
- Bedside
- Bloods
- Imaging
*NOTE: for UTI would usually just do urine dipstick. You would consider others if you think there may be an upper urinary tract infection and potential systemic infection. Depends on presentation of pt.
Bedside
- Urine dipstick
- Urine sample for microscopy & culture
Bloods
- FBC
- U&Es
- CRP
Imaging
- Ultrasound
- CT
Remind yourself what a urinary dipstick tests for
- pH
- Nitrites
- Leucocyte esterase/leucocytes
- Blood
- Protein
- Glucose
- Ketones
- Bilirubin & urobilinogen
What would you find on the urine dipstick of a pt with a UTI?
Positive for:
- Nitrites
- Leucocyte esterase
Discuss whether we need to do a urine dipstick on all women who present with symptoms & signs of a UTI
If a woman has 2 or more of teh key diagnostic signs or symptoms (dysuria, new nocturia, cloudy urine) urine dipstick isn’t necessary to provide antibiotics. If they have less than 2 symptoms do a urine dipstick..
We can give immediate antibiotics is pt has severe symptoms and can give back-up prescription if woman has mild symptoms. You would advise themt to take the antibiotics if symptoms do not improve withing 48hrs.
UTIs can be classifie as complicated, uncomplicated, recurrent or relapsing; describe what is meant by each
- Uncomplicated: normal underlying genitourinary anatomy & physiology
- Complicated: underlying anatomical or physiological abnormality predisposed to UTI (e.g. outflow obstruction, response to medications)
- Recurrent: repeated infection with new organism
- Relpasing: repeat infection with same organism
Discuss the management of UTIs in men
- Antibiotics: e.g. trimethoprim or nitrofurantoin for 7-14 days
- Paracetamol
- Drink more fluids
*often treat UTIs in males as complicated- hence longer course of antibiotics. UTI in males should raise suspicion.
Discuss the management of UTIs in women
Management depends on if complicated or uncomplicated. All pts should be advised to drink more fluids and use paracetamol if needed.
Uncomplicated
- Antibiotics: trimethoprim or nitrofurantoin for 3 days
Complicated
- Antibiotics: consider prolonging antibiotic therapy for ~10 days
If after antibiotics, a pt is still experiencing symptoms of UTI what should you do?
Send a urine sample for microscopy, culture and sensitivities- see if can give more effective antibiotic
If a pregnant lady has asymptomatic bacteriuria what should you do?
Urine should be sent for culture and woman should be treated with antibiotics (nitrofurantoin) for 7 days
