Urinary Tract infection Flashcards
What is a lower UTI?
A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra
Lower UTI= bladder and urethra
What is an upper UTI?
A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra
Upper= Involvements of ureters and kidney
What are risk factors for UTIs?
- Female Sex
- Sexual activity
- Immunosuppressant therapy
- spermicide use
- Family/ PMHX of UTI
- post-menopause
What is classified as an uncomplicated UTI?
acute cystitis occurring in otherwise healthy, non-pregnant women without functional or anatomical urinary tract abnormalities.
What is a complicated UTI?
nfections in patients with functional or structural impairments that reduce the efficacy of antimicrobial therapy
What is the most common cause for UTIs in women?
Normally ascending UTI with eventual vaginal infection first
- Most uncomplicated UTIs due to E-coli
- Many others can cause complicated UTIs
What is the Epidemiology of UTIs in women?
50-60% of lifetime incidence
- increases with age (over 65)
What is the epidemiology of UTIs in men?
About 13%
- increases with Age
- mostly complicated UTIs
- 80% secondary to catheters
What are the causes of UTIs in men?
Also majority E-Coli
- bur more prone to complicated UTIs
- In men normally complicated: anatomical or function abnormalities
- prostate disorders, immunosupressant etc.
What are presenting symptoms of an UTI in men and women?
- fever (systemic involvement)
- cloudy looking urine
- dysuria
- new nocturia + increased urine frequency
- risk factors
- urgency
- haematuria
- suprapubic pain/tenderness (Lower UTI)
- flank and costo-vertebra angle tenderness (Upper UTI)
What are signs of a UTI?
- Fever
- Cloudy-looking urine/ smelly urine
*
Which investigations would you do in a woman with an UTI (upper +. lower)
Both
- urine dipstick
- urine culture and sentsitivity
further to be considered
- Renal ultrasound (to rule out urinary tract obstruction) (e.g. kidney stone; hydronephrosis; renal abscess; renal scarring)
- * non-routine: urine micoscropy
- post-void residual (if no full emptiing of bladder –> might cause recurrent UTI)
- Abdo/Pelvic CT (rule out stones, renal abscess)
What could you find in a Urine Dipstic from a Patient with UTI?
- Leukocytes
- Nitrites (nitrates are converted to nitrites by bacteria)
- Protein (if renal involvement)
What are the first line investigations for a UTI in men?
- Urine dipstick
- urinary micoscopy
- Urine culture
- Gram stain
How is a urine culture perfomed? What is being investigated?
Send a midstream, clean-catch urine specimen for culture (before giving antibiotics) if the patient:
(high risk of contamination in women)
What are possible differentials for a UTI?
- over-active bladder
- Carcinomas
- non-infectious urethritis
- Foreign body in bladder
How is an UTI managed?
- Exclude Sepsis
- Consider ABX (send of urine culture before)
- Nitrofurantoin
- Trimethoprim if low risk of resistance (normally for 3 days)
- If not better within 48hrs
- Urine culture and ABX change
What are possible complications from an UTI?
Generally in women low, in men higher
- sepsis
- renal and peri-renal abscesses
- AKI
In Men
- renal function impariment
- prostatisis
- polynephritis
What is the prognosis for patients with UTIs?
Yound men
- generally good prognosis
Oler men
- higher likelyhood of complicated infections
Women
- generally very good
When would you consider referral for a UTI?
In women
- if upper UTI with systemic symptoms –> consider referral for IV ABX
- in men be more suspicious
What is another name for an upper UTI?
Pyelonepthritis (if up the the pyleon of the kidney)
What is the clinical presentation of someone with an pyleonephritis?
Back pain
- fever
- nausea
- vomiting
