Renal Infections

Question 1

When is imaging indicated in UTI?

Answer 1

Pyelonephritis not responding at 48hours (?abscess)

Urosepsis with shock (?infected stone/obstruction)

Dx unclear

Question 2

Antibiotics for UT without systemic symptoms:

Answer 2

CEPHALEXIN 500mg QID for 5 days
OR
NITROFURANTOIN 100mg BD
OR
TRIMETHOPRIM 300mg daily x3

Uncomplicated: 5 days
Complicated (incl men): 14 days

Question 3

Antibiotics for UTI with systemic symptoms:

Answer 3

AMOXICILLIN 2g IV QID
+
GENTAMICIN

If no pen: Gent only
If no gent: Ceftriaxone

Question 4

What is a ‘complicated’ UTI?

Answer 4

Anything other than cystitis, in a well, non-pregnant, female, with normal urinary tract anatomy.

So:
- Men
- Sepsis
- Pyelo
- IDC
- Stones
- Structural abn.
- Immunocompr.
etc.

……Treat for 14 days, not 5.

Question 5

Acute prostatitis:

Answer 5

STI or UTI organisms

• PR tenderness
• Painful ejaculation
• Blood in ejaculate

Gentle PR is indicated in ALL men with UTI presentations.

PSA not indicated: (high in simple UTI)

MANAGEMENT
- Test for UTIs and STIs
- Antibiotics 14 days (as per UTI)
- SPC if retention (IDC contraindicated)
- +- CT/USS for ?abscess

Question 6

Imaging options (and findings) in suspected pyelonephritis:

Answer 6

Ultrasound
- Not very sensitive! No good for diagnosing
- Underlying structural assessment
- Asses for Cx: hydro, asbcess

CT
- Can diagnose sensitively
- Look for stones
- Option of contrast (IV pyelogram) same time
–> Oedema, perinephric stranding, wedge-shaped reduced enhancement/s

MRI if preg.

Question 7

Management of S. Aureus urosepsis:

Answer 7

…. look for the primary source of staph bacteraemia! Almost certainly seeding from elsewhere (eg. endocarditis)