Nephro: Urinary Tract Infections Flashcards
in which population are UTIs common
sexually-active women
what are UTIs in men and children associated with
abnormalities in the urinary tract
pathogenesis of UTI
colonic flora migrates into the perivaginal and perineal and transurethral regions, causing infection there
complications of UTIs
gram negative septicaemia and renal scarring
risk factors for UTIs
- changes in vaginal pH (more acidic)
- antibiotic prophylaxis
- recent/frequent intercourse
- highly concentrated urine
- urinary stasis or incomplete bladder emptying
- older age
- eradication of
- vaginal commensal organisms
- renal/bladder stones
what are the most common organisms to cause UTIs
- E.coli
- Staph sapro
- Klebsiella
- Enterococcus faecalis
- Proteus mirabilis
genetic predisposition to UTIs
some women have expressed receptors which aid the fimbriae of E.coli to stick to the urothelium
what is virulence?
how severe or harmful a disease is
how can you classify UTI
upper and lower urinary tract infections
signs and symptoms of lower urinary tract infection
- dysuria
- frequency
- urgency
- nocturia
- suprapubic pain/tenderness
- offensive urine/frank haematuria
what should you ask in a history of UTI
- sexual history
- new partners
- use of contraceptives and if so, which
- recent antibiotic use
- previous UTIs
signs and symptoms of a UTI in the elderly
- confusion
- incontinence
which symptoms make vaginitis more likely to be the case
- vaginal irritation
- discharge
signs and symptoms of an upper urinary tract infection
- fever
- chills
- rigors
- nightsweats
- N&V
- loin pain
- costovertebral angle tenderness
- septic shock
in which populations are symptoms of an upper urinary tract infection less likely to be present
immunocompromised and children
investigations for UTI
- urine dipstick
- microscopy
- culture and sensitivity
what to look out for in a urine dipstick
- positive leucocyte esterase
- positive nitrite reductase
- some proteinuria
what type of casts are suggestive of pyelonephritis?
WBC casts
what is the window of time where samples should be cultured?
there is a 2hr window; if you cannot culture by that time, refridgerate it, it will buy some time (around 2 days)
what to check from a clean catch MSU
- microscopy
- pyuria
- organisms
criteria for a positive diagnosis of a UTI
- culture of a urinary pathogen (10^5 units/mL is standard)
- lower in young women, men and pyelonephritis
what should you exclude if there are persistent symptoms despite treatment
- urethritis
- vaginitis
which populations need close attention?
- symptoms lasting more than 2 weeks
- recurrent UTis
- men
- children
- pregnant women
- diabetics
- immunocompromised
- associated stones
- known abnormal urinary tract
- indwelling catheter
radiological investigations for UTI
- plain AXR
- US kidneys
- CTKUB
- DMSA scanning
- prostate assessment
- cystoscopy
- CT scanning w/w/o contrast
which investigation should you use in a patient with recurrent UTIs
cystoscopy
general treatment of UTI
- antibiotics depending culture and sensitivity results (cipro, levafloxacin, seprin, cephalosporin)
- high-fluid uptake (>2L/day)
treatment of an uncomplicated UTI
- start with empirical therapy
- antibiotics for 3 days like cipro, levo and co-trimoxazole
- ampicillin and amoxicillin are less effective in eliminating vaginal and periurethral colonisation
- if symptoms persist, culture the urine and treat for 2 weeks
- 7 days treatment in pregnancy (do not use sulfonamides here)
what should you do in a suspected STD
- pelvic exam
- urine for GCgonococcus and Ctrachomatis
- treat with doxycycline for 7 days or azithromycin 1g single dose
how should you treat pyelonephritis
- admit the patient
- urine and blood cultures
14 days of IV and oral combined of antibiotics - treat IV until afebrile and 2-week oral antibiotics (cipro/levo)
- rehydration, pain relief, antiemetics
- rehydration with normal saline
what is empirical therapy?
treat depending on an educated guess rather than systematic things, until the C&S come back
how would you treat UTIs in immunocompromised?
additional single dose aminoglycoside eg gentamicin
which antibiotics are given IV for UTIs
- fluoroquinolone IV (cipro, levo)
- ampicillin + gentamicin
- 3rd gen cephalosporin
criteria for recurrent UTIs
more than 4 culture-proven UTIs per year
management of recurrent UTIs
- ask for a sexual history and whether it could have caused this
- increased fluid intake and frequent voiding
- discourages spermicides
- oestrogen creams PV in post-menopausal women
- prophylaxis for a year (and if there is no underlying cause identified)
lifestyle advice for recurrent UTIs
- wipe front to back
- voiding after intercourse
- personal hygiene
- panty-hose tights or synthetic fibres
which antibiotics are given for UTIs caused by sexual activity
co-trimoxizole or nitrofurantoin
how to give low-dose antibiotic prophylaxis
- rotation of 3 month cycles
- NF
- cephalexin
- co-trimoxazole
- amoxicillin
- trimethrophin
