Urinary Tract Infection Flashcards
What is a UTI
A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra.
What is infection in the bladder called
Cystitis
What is infection of the Kidney called
Pyelonephritis
What are 4 general predisposing factors to acquiring UTI
Immunosuppresion
Steroids
Malnutrition
Diabetes
What are more specific causes of UTI (x8)
Female sex (short urethra)
Sexual intercourse and poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies eg catheters, stones
Oestrogen deficiency in postmenopausal women creates a dry perineum (down below)
Neurological problems
- Multiple sclerosis
Fistula between bladder & bowel
What do you prescribe for Oestrogen deficiency in postmenopausal women
Oestrogen cream
What gram negative bacteria can cause UTI
E.coli - 70-95%
Proteus miribilis
Klebsiella species
What gram positive bacteria can cause UTI
Coagulase negative staphlycocci – 5-20%
-Enterococci
What the most common way bacteria get into the body
Transurethral route
Perurethral area contaminated
Recurrent UTIs, diaphragms,
- Urethra to bladder
Intercourse, catheterisation
- Bladder (and up ureters)
What other ways can bacteria get into the body
bloodstream
lymphatics
What are the presenting symtpoms of UTI in children
Diarrhoea Excessive crying Fever Nausea and vomiting Not eating
What are the presenting symtpoms of UTI in adults
Flank pain Dysuria (“like passing broken glass”) Cloudy offensive urine Urgency Chills Strangury pass Confusion (very old people)
How would you describe the pain in UTI
Renal angle pain
NOT COLIC
Can be very painful and require opiate treatment
What is Stangury
- Patient complains of little urine passing but still feels like they have lots to pass
What investigations should you carry out for UTI
Mid-stream sample of urine.
Urinalysis in ward.
Microbiology in laboratory
Culture and sensitivity
If a child or man has a UTI what further investigations should you do
Ultrasound or IVU may be helpful
Isotope studies to rule our reflux and scarring
What are indicators of infection in a urine sample
Blood
Leucocytes
Protein
Nitrites
What is treatment for a normal mild/moderate UTI
Fluids Antibiotics: - Amoxicillin (3-5 day course or 3g x 2), - Cephalosporin - Trimethoprim
What is treatment for a severe UTI
Intravenous antibiotics
What is a long term complication of repeated UTI in an abnormal urinary tract.
Chronic pyelonephritis
What are the bacteriostatic properties of a normal urinary tract
Free flow of urine
Prostatic secretion are bacteriostatic
Anti-bacterial antibodies
If you culture a normal MSSU what will you find
Urethral flora diminshed but always present
the flora will ALWAYS GROW in culture
If a sample has 10^4 bacteria per ml what is the chance of infection
50% chance if not symptoms
If a sample has 10^5 bacteria per ml what is the chance of infection
99/100 is infected
If a sample has 10^3 bacteria per ml what is the chance of infection
Usually no infection
What are causes of obstruction in the urinary system
BPH
Uterine prolapse (women)
Tumours
Calculi
What is bilateral hydroureternephrosis
It involves the dilatation of the renal pelvis, calyces and ureter; it develops secondary to urinary tract obstruction and leads to a build-up of back pressure in the urinary tract, and it may lead to impairment of renal function and ultimately culminate in renal failure
What is hydroureter
Hydroureter refers to dilation of the ureter(s) and is most often caused by obstruction of urine outflow due to blockage of the ureter(s) by calculi, chronic inflammation, luminal or intramural neoplasia, or accidental ligation during surgery.
