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
State some potential complications of a UTI
- Pyelonephritis
- Sepsis
- Renal and/or peri-renal abscess
- AKI
What is pyelonephritis?
Infection of the renal pelvis and parenchyma- may be acute or chronic
Why does acute pyelonephritis occur/what does it often follow on from?
A UTI that has ascended. Most likley causative organisms: E-coli, Proteus or Klebsiella
What populations/groups does acute pyelonephritis commonly affect?
- Women
- Elderly
State some risk factors for acute pyelonephritis
- Structural & functional abnormalities of urinary tract
- Immunosupression
- Diabetes
- Catheter
- Renal stones
- Pregnancy
(same as for UTI)
State signs & symptoms of acute pyelonephritis
Classic triad of:
- Fevers/rigors
- Renal angle tenderness
- Loin pain
May also have:
- Nausea & vomitting
- Myalgia or flu-like symptoms
What investigations would you do if you suspect a pt has acute pyelonephritis, include:
- Bedside
- Bloods
- Imaging
Bedside
- Urine dipstick: may demonstrate haematuria, leucocytes and nitrites
- Urine sample for microscopy, culture & sensitivity: find out causative organism
Bloods
- FBC: raised WCC
- U&Es: check renal function
- CRP: inflammation/infection
- ESR: inflammation/infection
Imaging
- Ultrasound: look for renal stones
- ?CT scan: look for renal stones if suspsicion and can’t visualise on ultrasound
Discuss the management of acute pyelonephritis
- Empirical antibiotic therapy: ciprofloxacin or co-amoxiclav are reccommended. Give for 7 days. Oral for uncomplicated, IV for complicated
- Analgesia
- Fluids
- Anti-emetics
State some potential complications of acute pyelonephritis
- Sepsis
- Renal abscsess formation/pyonephrosis
- Renal failure/AKI
- Recurrent UTIs
What is chronic pyelonephritis?
What is the most common cause?
How do we treat it?
- Chronic inflammation of renal pelvis and parenchyma causing irreversible damage (hence it can cause ESRD). Will have history of vesicoureteric reflux, acute pyeloneprhitis or renal obstruction
- Vesicoureteric reflux
- No specific treatment as damage has already been done; however, treatment should be given to reduce further damage
What is pyonephrosis?
What is the treatment?
- Pus in collecting system of kidneys
- IV antibiotics and emergency surgical decompression
What is prostatitis?
Inflammation of the porstrate
How does prostatitis present?
- Pyrexia
- Dysuria
- Urgency or back pain
- Abdo or pelvic pain
- Pain on ejaculation
There are two major subtypes of prostatitis; state and describe each
Bacterial Prostatitis
- Most common form in younger men
- Largely caused by gram -ve organisms. May also be due to STIs
- Can be acute (presents as systemicllay unwell) or chronic (presents are recurrent UTIs)
Non-bacterial prostatitis/chornic prostrate pain syndrome
- No discernible cause
- Pelvic, perineal or genital pain lasting more than 3 months
- Pain on ejactulation is most commonly reported symptom
Discuss the management of bacterial prostatitis
Antibiotics (e.g. fluoroquinolones) over a prolonged period of time (up to 8 weeks) to allow antibiotics to reach prostrate
