Pyelonephritis

Question 1

What are pathogens that are the most common?

Answer 1

E coli > Staph saprophyticus > Klebsiella > Enterobacter > Proteus

Question 2

What are the risk factor for acquiring UTI?

Answer 2

o Older adults
o Diabetes (DM) or immunosuppression
o Sexual intercourse, a new sex partner
o Personal history of UTI or family history of UTI in a first-degree female relative
o Pregnant women
o Urinary obstruction e.g. tumour, kidney stone, or an enlarged prostate
o Those who use a contraceptive diaphragm or spermicide
o Renal insufficiency
o Catheter use
o Men who engage in anal intercourse, who have HIV infection, or who have never been circumcised
o Conditions that affect the bladder’s nerve supply (including DM, multiple sclerosis, Parkinson’s disease, and spinal cord injuries [SCI])

Question 3

What are the clinical features of lower UTI?

Answer 3

• Dysuria, frequency (with small volumes), urgency (FUN/irritative symptoms)
• Haematuria, foul-smelling urine, suprapubic pain
• +/- incontinence, fever

Question 4

What are the clinical features of upper UTI?

Answer 4

• Flank pain, N&V, fever
• Costovertebral-angle tenderness, renal punch positive
• +/- symptoms of lower UTI that might have preceded pyelonephritis

Question 5

What are the investigations for UTI?

Answer 5

• Urinalysis (urine dipstick) for evaluation of pyuria and bacteriuria
• Urine microscopy for evaluation of haematuria
• Urine culture to determine causative organisms and antimicrobial sensitivity

Question 6

In which patients do you treat asymptomatic bacteriuria?

Answer 6

1. Instrumentation of urinary tract that may breach mucosa (i.e. prior to urological surgery)
2. Pregnant women, to reduce the risk of Pre-term prelabour rupture of membranes (PPROM)

Question 7

what is considered complicated uti?

Answer 7

• ureteric stone (structural)
• neurologic bladder secondary to spina bifida (functional)
• male
• pregnant woman
• IDC
• concomitant immunocompromised disease e.g. DM

Question 8

what is recurrent UTI?

Answer 8

3 or more in 1 year (or 2 or more in 6 months), with complete clinical resolution in between

Question 9

What is the treatment for acute uncomplicated cystitis?

Answer 9

• trimethoprim
• nitrofuratoin
• fosfomcyin if allergy to sulfur containing drugs or renal impairment
• avoid aminopenicillins because of ecologic effects, resistance and selection of ESBL
• avoid quinolones (resistance