Theme 4 Lecture 5: Urinary Tract Infections Flashcards
What is a UTI?
- An infection of any part of your urinary system
- an immune response, gibing rise to symptoms. if there are no symptoms, the bacteria are not causing harm
What are the risk factors for UTIs?
- female sex –> 10:1 female: male ratio to short urethra
- anything that leads to urinary stasis - pregnancy, prostatic hypertrophy, stones, strictures, neoplasia
- urological instrumentation e.g catheters
- sexual intercourse
- fistulae
- congenital abnormalities e.g VUR
Which parts of the urinary tract should have bacteria, and which shouldnt?
- kidney, ureter shouldn’t have any bacteria
- urethra, perineum will have bacteria
- bladder is debatable (as you get older it is more common to have asymptomatic bacteria)
- essentially, the further you go up the urinary tract, the less you should have any bacteria
What makes up perineal flora? (found in the urethra)
- skin flora (mainly coagulase negative staphylococci)
- lower GI tract flora
- enterobacterales (coliforms - usually enteric gram -ve bacilli)
- gram +ve cocci - enterococcus spp
Where are the two places invading bacteria in the perineum can come from?
- endogenous
- most infections are caused by gut bacteria - haematogenous spread (rare)
- seeding of bacteria to the urinary tract via the blood
What are the organisms that commonly cause UTIs?
- E.coli
- staphylococcus saprophyticus (CNS)
- proteus mirabilis
- enterococcus spp
- klebsiella spp
- pseudomonas aeruginosa
How do you know if you should treat UTIs?
- clinical signs and SYMPTOMS
- and microbiology results guide you to the culprit and appropriate, directed treatment
What are the symptoms of UTIs? (14)
- urgency
- systemic - fever, pain
- retention
- loin
- rigors
- fevers
- back pain
- frequency
- pus
- polyuria
- dysuria
- supra-pubic pain
- haematuria
- nocturia
What are the symptoms of cystitis (lower UTI)?
- dysuria
- frequency
- urgency
- supra-pubic pain or tenderness
- polyuria, nocturia, haematuria
What is pyelonephritis?
- swollen kidney and ureter also filled with pus
- infection of kidney/renal pelvis
What are the symptoms of pyelonephritis?
- symptoms of lower UTI
- loin/abdominal pain or tenderness
- fever
- other signs of systemic infection: rigors, nausea, vomiting, diarrhoea
- elevated CRP, WBC
what features make a UTI a ‘complicated’ UTI?
- underlying abnormalitity e.g stone
- urinary stasis
- presence of ‘foreign body’
- catheter
- biofilm
- children < 10-12
- men < 65
What is a CA-UTI?
Catheter associated UTIs:
indwelling catheterisation results in bacteriuria - they should be removed the moment they are not needed
biofilm formation (bacteria forming around the catheter) –> colonisation
In what patient groups is antibiotic prophylaxis indicated?
- previous symptomatic CA-UTI with catheter change/removal
- traumatic catheterisation (if t has taken two or more attempts to insert a catheter)
- purulent/ urethral suprapubic catheter exit site discharge
- colonisation with staph aureus inc MRSA
What is a urinary ‘ostomies’
holes we make to get urine out other than catheters
What are the two types of urinary ‘ostomies’?
- nephrostomy - percutanoeus straight into kidney
- ileal conduit/ urostomy - short section of ileum removed and used to drain ureters directly into a stoma on the anterior abdominal wall after cystectomy
What is urosepsis and what are the symptoms?
Systemic signs of infection related to any underlying urinary source of infection:
- urinary
- rigors
- nausea, vomiting, diarrhoea
- +/- haemodynamic compromise
- raised inflammatory markers (CRP, WCC)
what is ‘urethral syndrome’
symptoms of lower UTI without any demonstrable infection
What is a perinephric urinary tract abscess?
- uncommon condition
- renal stones and/or diabetes
- secondary to obstruction of infected kidney
- normally gram -ve bacilli
What is a intrarenal urinary tract abscess?
- haematogenous spread
- staph aureus common
What is prostatitis?
inflammation of the prostate
What are the signs and symptoms of acute bacterial prostatitis?
- LUT symptoms
- fever
- tender, tense prostate on PR palpitation
- acute retention
What are the risk factors for acute bacterial prostatitis?
- procedures involving the prostate
- trans-urethral resection of prostate (TURP)
- trans-rectal ultra-sound guided (TRUS)
- indwelling urinary catheter
What is chronic bacterial prostatitis
recurrent UTIs with the same organism
asymptomatic in between
