Urinary Tract Infection Flashcards
Give the classic symptoms of urinary tract infection
Dysuria
- (burning) pain when urinating
Frequency of urination
- passing urine more frequently than usual (volume of
urine not necessarily increased)
Urgency
- sudden urge to urinate, due to involuntary
contractions of the bladder muscle
Polyuria
- too much urine being produced
Suprapubic tenderness
HaematuriaDefine cystitis and give its commonest cause
Inflammation of the bladder
Usually due to bacterial infection (bacterial cystitis)
Define bacteriuria
Presence of bacteria in the urine (not including urethral organisms which are washed out in the urine during micturition)
Define pyuria and describe its significance
Presence of pus cells (neutrophil polymorphs) in the urine
Represents and inflammatory response - supportive evidence of a UTI
What do neutrophil polymorphs look like down the microscope?
granulated cells with lobulated nuclei
What is meant by sterile pyuria?
when urine is negative on culture but significant numbers of pus cells (neutrophils) are present
Define acute pyelonephritis
Infection of the upper urinary tract involving the kidneys
Define chronic pyelonephritis. What causes it?
Pathological condition with renal scarring and potential loss of renal function.
Infection may contribute but is not necessarily ongoing for chronic pyelonephritis to be present.
Other contributory factors:
- diabetes
- vesico-ureteric reflux
- urinary obstruction
What is meant by uncomplicated UTI?
UTI occuring in healthy, sexually active young women
- clear correlation between sexual intercourse and episodes of UTI
What is meant by complicated UTI?
All types of UTI that are outwith the criteria for uncomplicated UTI, e.g.
- children
- men
- patients with renal tract abnormalities
- immunosuppression
- foreign body within the urinary tract (e.g. catheter, stent)
- bladder tumour
- chronic urinary retention
- abnormal bladder outflow tract
Give three examples of renal tract abnormalities that increase the risk of UTI (and would complicate a UTI)
pelvi-ureteric junction obstruction
vesico-ureteric reflux
renal tract stone
Give four examples of bladder outflow tract abnormalities that increase the risk of UTI (and would complicate a UTI)
benign prostatic enlargement
urethral stricture
meatal stenosis
phimosis (tight foreskin)
List six organisms that are known to cause UTIs
E.coli Proteus sp. Enterococcus faecalis Klebsiella sp. Psuedomonas sp. Staph. saprophyticus
Which two organisms are more likely to be the cause in uncomplicated UTI?
E.coli
Staph. saprophyticus
(most other organisms are more likely to be the cause cause in complicated UTI)
What is meant by empirical treatment in the context of UTI?
Treatment given before the exact cause is known, i.e. before the causative organism has been identified. In UTI, empirical treatment involves treating with broad-spectrum antibiotics, usually a 3-day course.
When is empirical treatment indicated in the management of uncomplicated UTI?
When the patient has 3 or more symptoms.
When symptoms are particularly severe.
When urine dipstick is positive for nitrate, protein AND leukocytes.
What should be done for women with mild or ≤2 symptoms of UTI?
Mid-stream sample of urine should be collected for inspection ± dipstick urinalysis
(dipstick urinalysis is only indicated if urine is cloudy)
What should be done for a man with suspected UTI?
MSSU should be collected and sent to the lab for culture and microscopy
In men, what is a potential underlying cause of recurrent UTI? What organisms are commonly involved in this condition?
Prostatitis and/or infection of the prostate (may be acute or chronic)
Older males - coliform organisms
Younger males - STIs e.g. Chlamydia trachomatis or Neisseria gonorrhoeae
Give the characteristic symptoms of acute pyelonephritis
Loin pain
Fever
(Urinary symptoms may be present but generally are less pronounced)
What is the biggest risk in patients with acute pyelonephritis? What symptoms may present in this condition?
Causative organism can spread to the bloodstream to cause bacteraemia, which can lead to sepsis.
Symptoms include rigors (uncontrolled shivering/shaking), nausea and vomiting
Describe the investigation/management for patients with suspected acute pyelonephritis
MSSU sent for culture and microscopy
Should be started on broad-spectrum antibiotics immediately, with the choice of antibiotic being reviewed once cultrue results are known.
If patient is systemically unwell, blood cultures should also be done.
Antibiotic treatment should be continued for at least 7 days.
Why is it important to screen pregnant women for bacteraemia?
Bacteraemia - including asymptomatic - in pregnant women is associated with an increased risk of pyelonephritis and premature delivery.
What is the “textbook” cause of sterile pyuria? How should this be investigated?
Renal tuberculosis
Collect three early morning urine samples for a ZN stain and TB culture
