Urinary Tract Infection Flashcards
What organism causes 70% of all UTIs?
Escherichia coli (gram negative, anaerobe) = 70%
Proteus spp (gram negative) = 12%
Staphylococcus saprophyticus / epidermis = 10%
Enterococcus faecalis = 6%
Pseudomonas spp = 5%
Klebsiella spp. = 4%
What organisim causes 12% of all UTIs?
Proteus spp (gram negative) = 12%
Escherichia coli = 70%
Staphylococcus saprophyticus / epidermis = 10%
Enterococcus faecalis = 6%
Pseudomonas spp = 5%
Klebsiella spp = 4%
How common is UTI?
1-2% presentations to GP is UTI
Who does UTI affect?
Mainly women.
newborn males, older men due to prostate probs
What are the symptoms of cystitis (lower UTI)?
- increased frequency
- urgency
- nocturia
- dysuria / burning
- Haematuria
- Suprapubic pain
What are the symptoms of acute pyelonephritis?
- fever + rigors
- vomiting
- loin pain
- tenderness
- oliguria (in renal failure)
What are the symptoms of prostitis?
- flu like
- backache
- swollen, tender prostate on PR
- few urinary symptoms
How may UTIs present in elderly?
confusion
What are the risk factors for UTI?
- female
- sex
- pregnancy
- menopause (low oestrogen makes it easier for bacteria to adhere)
- immunosuppression
- urinary tract obstruction from stones, stricture leads to statis so increased bacteria.
- long term catheters
- Diabetes
How is a relapse of UTI diagnosed?
- recurrence of bacteriuria with same organism within 7 days of complete antibacterial treatment.
(failure to eradicate infection)
What conditions are more likely to have a UTI relapse?
- Urinary tract stone
- scarred kidneys
- polycystic kidneys
- bacterial prostatitis
What is the definition of a UTI reinfection?
When bacteriuria is absent after treatment for at least 14 days, then followed by recurrence of UTI. (reinvasion of urinary tract by infective organisms)
What investigations are done for suspected UTI?
1) Urine Dipstick (If UTI shows +ve nitrites or +ve leucocytes)
2) Mid stream urine (if pt symptomatic but dipstick -ve. growth of >10^5organism/L is diagnostic of UTI
MSU Microscopy:
- WBC >3 = pyuria
- RBC > 2 = microscopic haematuria
3) Bloods
- FBC (raised WCC?)
- U&E (AKI?)
- CRP
- blood cultures (urosepsis?)
- fasting glucose (diabetes?)
- PSA (after 6 months for enlarged prostate)
3) USS for suspected pyelonephritis, stones, obstruction, incomplete emptying)
Why is a routine urine dipstick done in pregnant patients?
In pregnancy UTIs are common and can be asymptomatic until they cause serious pyelonephritis —–> fetal death.
What 4 organisms cause UTIs?
- E.coli
- Proteus Mirabilis
- Klebsiella pneumonia
- Staph saprophyticus
UTIs can be class as complicated or uncomplicated - describe each.
Uncomplicated UTI = normal renal tract and function
Complicated = Abnormal renal / genitourinary tract, passing urine difficult/obstruction, decreased renal function, impaired host defence, virulent organisms e.g. staph aureus.)
What is the treatment for a single isolated attack of UTI?
1) Abx for 3-5days with amoxicillin, nitrofurantoin, trimethoprim or an oral cephalosporin.
(if resistant to Abx give co-amoxiclav or ciprofloxacin)
2) drink plenty of fluid
3) If suspected pyelonephritis give IV aztreonam, cefuroxime, ciprofloaxacin or gentamicin) —-> then switch to oral abx.
What is the treatment for relapse of UTI?
- find cause e.g. stone or scarred kidney and eradicate
What is the treatment for reinfection of UTI?
prophylactic measurements:
- increased fluid intake (cranberry juice)
- passing urine every 2-3hrs, before sleep, after sex.
- avoid constipation (can impair bladder emptying)
What are the causes of sterile pyuria?
TB
appendicitis
stones
bladder tumour
