Urinary Tract Infection Flashcards
def in men
inflammatory reaction of urinary tract epithelium in response to pathogens (commonly bacteria)
how is UTI confirmed in men
symptomatic male demonstrates growth of a significant amount of organism
epi
very common in elderly
females>males
what is the most common cause of UTI in men and women
E.coli
aetiology in men
pathogens enter the urinary tract by ascending the urethra, indwelling catheters are often implicated
E.coli (most common)
Gram negative bacteria (klebsiella) + positive
enterococcus, staphylococcus, psuedomonas (hospital)
what disrupts the balance between host defence mechanisms and virulence of pathogens
immunodeficiency (HIV)
urine flow which normally washes out pathogens is disrupted (prostate disorders, renal stones)
who are complicated UTIs associated with
males
what are complicated UTIs
UTI with presence of factors which hinder efficacy
risk factors in men
benign prostatic hypertrophy
urinary tract stones
catheterisation
age
history in men
dysuria (difficult or painful urination)
increased urgency and frequency
suprapubic pain
hesitancy and nocturia is associated with BPH
examination in men
none
investigations in men
1 dipstick urinalysis -positive leukocyte esterase +/ nitrate 2 urine microscopy + culture -identifies leukocytes + bacteria ->10^2 colony-forming units indicates UTI in symptomatic men
a 59y/o man complains of urinary frequency, urgency and dysuria for several days/ NO haematuria or penile discharge but does have 3 episodes of nocturia most nights. PMH includes benign prostatic hyperplasia.
UTI
management of UTI in men
if asymptomatic or mild symptomatic
-oral antibiotic therapy with levofloxacin or ciprofloxacin
if symptomatic and severe
-IV antibiotics with levofloxacin or ciprofloxacin
complications in men
prostatitis
pyelonephritis
prognosis in men
prognosis decreases with age
def in women
infection of the kidneys, bladder, urethra
what is the most common type of UTI in women
infectious cystitis (bacterial infection of the bladder)
aetiology in women
commonly uncomplicated cases
1 e.coli (most common)
2 staphylococcus saprophyticus
what are uncomplicated UTIs
acute cystitis
risk factors in women
sexual activity (strongest factor)
spermicide use
post-menopause
FHx
history in women
dysuria, frequency, haematuria, back pain
patient may complain of urgency or supra-pubic pain and tenderness
examination in women
costovertebral angle tenderness (pain on percussion of the area on the back)
investigations in women
1 urine dipstick
-positive nitrate and leukocyte esterase
2 urine microscopy, culture + sensitivity
-bacteria, WBCs, possibly RBCs
-<10^5 colony-forming units per ml and pyuria is present (>20WBC/mm3) or symptomatic
what is the most specific and sensitive test for UTI in women
urine culture + sensitivity
A 27y/o healthy, sexually active woman presents with pain on urination and recent onset of urinary frequency and urgency
UTI
management of uncomplicated UTI in women (cystitis)
nitrofurantoin or trimethoprim
if resistance ciprofloxacin or levofloxacin
management of complicated UTI in women (pylonephritis)
oral ciprofloxacin or levofloxacin
management for recurrent UTIs in women
post-coital antibiotics (nitrofurantoin) in pre-menopausal women plus intra-vaginal oestrogen therapy (eastradiol vaginal)
prognosis in women
good
