urinary infections Flashcards
how is a urinary tract infection defined?
symptoms + bacteruria
how does asymptomatic bacteruria differ from a UTI in terms of management?
asymptomatic bacteria isn’t treated unless
- pregnant
- prior to urological surgery
don’t treat as it replaces low virulence organisms with something worse
how are UTI’s treated acutely?
- typical symptoms + nitrates/leucocytes on dip = start treatment
- 3 days of oral antibiotics is adequate for an uncomplicated UTI in the female
- in a male or structural abnormality in urinary tract = 7-10 day course
antibiotic was trimethoprim, but now is Nitrofurantoin
how does trimethoprim affect your GFR?
increases GFR as affects ability to secrete creatinine
why wouldn’t you give trimethoprim in the first trimester of pregnancy?
its a folate synthesis inhibitor and folate is needed in the first trimester for the formation of the neural tube
what is the use of nitrofurantoin in urology?
- active in urine (useless for pyelonephritis and renal failure)
- cannot use in final trimester of pregnancy as can affect lung development
what is a multi drug resistant gram negative organism (MGNO)?
more common, partly due to overtreatment of asymptomatic bacteruria
difficult to treat in UTI’s
some can be treated with trimethoprim/nitrofuratoin if sensitive. Oral fosfomycin can also be an option.
otherwise IV meropenem
how can recurrent UTI’s be managed in women, non antibiotic based?
- exclude structural cause with USS, residual volume estimation and potentially a cystoscopy
- topical oesteogens if post menopausal
- cranberry capsules = weak evidence
- D mannose - not prescribable. expensive.
how can recurrent UTIs be treated antibiotic based?
- post coital dose of abx
- self start at first sign of symptoms
- low dose continuous prophylaxis
how does pyelonephritis present clinically and how can you distinguish it from pyonephorisis?
pyonephorisis = infected, obstructed kidney. Can identify with a CT KUB
pyelonephritis usually in women triad of N+v, fever and loin pain. May also have symptoms of lower UTI. If not too unwell can be managed with antibiotics in primary care.
if very unwell, can differentiate using a USS to look for obstruction and give antibiotics as patient will be unwell.
what is the difference between acute and chronic prostatitis?
- acute is rare, patients are unwell and usually hospitalised on IV antibiotics.
- chronic, get pelvic/perineal pain with or without any urinary and sexual dysfunction in men. 6 week course of antibiotics used. Referred to as chronic pelvic pain syndrome due to uncertain aetiology of bacteria.
what is epididymo orchitis?
acute inflammation of the testis/epididymis
younger men = chlamydia
older men = coliforms
what features distinguish epididymis-orchitis from testicular torsion?
age
- torsion occurs more commonly in under 40s
speed of onset/duration
- torsion = rapid onset
- history >24hrs, unlikely to be torsion and exploration is probably of little benefit
exam findings
- high lying, laterally orientated testis indicate torsion
- cremasteric reflex absent suggests torsion
how is testicular torsion managed?
- emergency scrotal exploration
- reduction and orchidopexy of testis if viable
- if non viable, orchidectomy
- if alternative diagnosis e.g epididymo-orchitis found instead, no fixation needed
how is epididymo - orchitis managed?
- first void urine for chlaymdial PCR
- Mid stream urine sample
- USS
- oral ciprofloxacin
- IV antibiotics if septic or unwell
10-14 day course of antibiotics needed. may stay swollen for 6 weeks.
