Lecture 27 - UTI Flashcards
Which term describes inflammation of the kidney?
Chronic/acute pyelonephritis
Which term describes inflammation of the bladder?
Cystitis
Which term describes inflammation of the urethra?
Urethritis
Which term describes inflammation of the prostate?
Prostatitis
Which term describes inflammation of the epididymis/testis?
Epididymo-orchitis
How many times more likely is a woman to have a UTI than a man?
3x
What is the most common HAI?
UTI (38%)
What are some general predisposing factors to UTI?
Immunosuppression
Steroids
Malnutrition
Diabetes
What are some more specific predisposing factors to UTI?
Female sex
Sex + poor voiding habits
Congenital abnormalities, e.g. duplex kidney
Stasis of urine, e.g. due to poor bladder emptying
FBs, e.g. stones, catheters
Oestrogen deficiency in post-menopausal women
Fistula between bladder + bowel
Spermicide coated condoms/diaphragms
What is the most common organism causing UTIs?
E. coli
What are other organisms that can cause UTIs?
Usually proteus, klebsiella, enterococci
What are the different routes by which bacteria can spread and cause a UTI?
Transurethral - periurethral area contaminated
Urethra to bladder, e.g. intercourse, catheterisation
Bloodstream
Lymphatics
What part of the bacteria allows it to attach to bladder epithelial cells?
Fimbrae
What are features of UTIs in adults?
Flank pain Dysuria (like passing broken glass) Cloudy offensive urine Urgency Chills Strangury Confusion (elderly)
What are features of UTIs in kids?
Diarrhoea Excessive crying Fever NV Not eating
What are the clinical features of acute pyelonephritis?
Pyrexia Poor localisation Loin tenderness (renal angle) Signs of dehydration Turbid urine
What investigations shouldbe done for suspected UTI?
MSSU
Urinalysis
What is done to the MSSU in the lab?
Microscopy + gram staining
Culture + sensitivity
What do you tend to see on urine dipstick in UTI?
Blood
Leucocytes
Protein
Nitrates
What other investigations should be done for UTI in children, men or when UTI are frequent?
UV/IVU
Isotope studies to rule out reflux/scarring
What are the principles of managing UTIs?
Identify organism + start treatment
Identify predisposing factors + treat
What is the treatment of UTIs?
Amoxicillin (3-5d course)
Cephalosporin
Trimethoprim
Fluids
Severe - IV antibiotics
Who tends to get reflux nephropathy?
Kids
What is the damage in reflux nephropathy due to?
Reflux + infection
How should you investigate a suspected reflux nephropathy?
Micturating cystogram
Assess progression by US and biochemistry
How is reflux nephropathy treated?
Surgery
What advice should you give to people who are getting recurrent UTIs?
Fluid intake 2L/day
Void every 2-3 hours every day
Void before bed and before + after sex
How should you treat UTI with a catheter in situ?
Antibiotics if symptomatic + replace catheter
Define bacteriuria
> 10^5 CFU
How is chronic pyelonephritis diagnosed?
Radiologically
What can you see in the kidney of someone who has chronic pyelonephritis?
Scarring + clubbing
What can chronic pyelonephritis cause?
Chronic renal failure
HTN
What are the features of lower UTIs in adults?
Dysuria Urinary frequency Urinary urgency Cloudy/offensive smelling urine Lower abdominal pain Low grade fever Malaise
How do UTIs present in infants?
Poor feeding, vomiting, irritability
How do UTIs present in younger children?
Abdominal pain, fever, dysuria
How do UTIs present in older children?
Dysuria, frequency, haematuria
What features of UTIs in children may suggest an upper UTI?
Temperature >38
Loin tenderness/pain
When should you check a urine sample in a child?
Signs/symptoms suggestive of UTI
Unexplained ever of 38+
Alternative site of infection but who remains unwell
What is the preferable urine collection method in kids?
Clean catch
If not possible urine collection pads should be used
ONLY use in invasive methods like suprapubic aspiration if non-invasive methods not possible
How are UTIs in children managed?
<3 months –> refer immediately to paediatrician
>3 months + upper UTI –> refer to hospital or give cephalosporin/co-amoxiclav for 7-10 days
>3 months + lower UTI - 3 days trimethoprim, nitrofuratoin etc.
Ask parents to bring child back if still unwell after 24-48h
Should you investigate a UTI in a child?
Yes - you should try and find the underlying cause
What are the common organisms causing UTIs in kids?
E. coli (80%)
Proteus
Pseudomonas
What are predisposing factors to UTIs in kids?
Incomplete bladder emptying - infrequent voiding, hurried micturition, obstruction by full rectum due to constipation, neuropathic bladder
VUR
Poor hygeine
How are lower UTIs managed in non-pregnant women?
Trimethoprim/nitrofuratoin for 3 days
When should you send a urine culture for a non-pregnant women presenting with a lower UTI?
Only if age >65 or visible/nonvisible haematuria
How should a pregnant woman presenting with a UTI be managed?
Urine culture sent
Antibiotics for 7 days - nitrofuratoin (avoid near term), amoxicillin or cefalexin
How should asymptomatic bacteruria be treated in pregnancy?
Treat as UTI to prevent progression to acute pyelonephritis
Send off culture after treatment is finished as test of cure
Should you treat asymptomatic bacteruria in a catheterised patient?
No
Should should symptomatic UTI in a catheterised patient be managed?
7 day antibiotic course
How is acute pyelonephritis managed?
Hospital admission
Broad spectrum cephalosporin/quinolone for 10-14 days
What is the most common cause of acute pyelonephritis?
Ascending infection (usually E. coli) from lower urinary tract
Can also occur from bloodstream spread of infection
What clinical features are associated with acute pyelonephritis?
Fever, rigors
Loin pain
Vomiting
White cell casts in urine
