Urinary Tract Infection Flashcards
What is the name for infection of the: Kidney Bladder Urethra Prostate Epididymis/testis?
Kidney - acute or chronic pyelonephritis Bladder - cystitis Urethra - urethritis Prostate - prostatitis Epididymis/testis - epididymo-orchitis
What percentage of GP consultations are due to UTI?
6%
What is the incidence of UTI in females vs in males?
Female : male
3: 1
Affects 30% of women at some point in their life
Why is UTI important in children?
Less common, but it is an important cause of kidney failure
What is the incidence of pyelonephritis in women?
3 per 1000 women per year
What is the incidence of symptomatic UTI in men?
5 per 10,000 per year
What is the incidence of cystitis in young, sexually active women?
0.5 per year
What percentage of hospital acquired infections do UTIs constitute?
38%
What are the general predisposing factors to infection?
Immunosuppression
Steroids
Malnutrition
Diabetes - glucose in urine can act as a culture medium
What are the predisposing factors specific to the urinary tract?
Female sex - shorter urethra
Sexual intercourse and poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine
Foreign bodies e.g. catheter, stones
Oestrogen deficiency in post-menopausal women, usually presents as recurrent cystitis
Fistula between bladder and bowel
What are the common causative organisms of UTI?
Usually bowel organisms e.g. E. coli, proteus, klebsiella, enterococcus
Usually gram-negative, rarely gram-positive
Usually E. coli
How is bacteria transferred, resulting in UTI?
Transurethral route;
Periurethral area contaminated - recurrent UTIs, diaphragms
Urethra to bladder - intercourse, catheterisation, spread to bladder and up ureters
Bloodstream
Lymphatics
What is the natural history of UTI?
Single episode in 90%
Complicated vs uncomplicated
Mostly uncomplicated, single episodes
What are the clinical features of UTI in children?
Diarrhoea Excessive crying Fever Nausea and vomiting Not eating
What are the clinical features of UTI in adults?
Flank pain Dysuria Cloudy, offensive urine Urgency Chills/rigors Strangury Confusion
What are the clinical features of acute pyelonephritis?
Pyrexia Poor localisation Loin tenderness Signs of dehydration Turbid urine
What are the investigations for UTI?
MSSU
Urinalysis in ward - blood, leukocytes, proteins and nitrites
Microbiology in lab - microscopy and gram staining, bacteruria
In children, men or frequent UTIs, ultrasound or IVU may be useful, plus isotope studies to rule out reflux and scarring
What is the management of UTI?
Identify infecting organism and give appropriate antibiotics
Identify any predisposing factors and treat if possible
Fluids
Antibiotics - amoxicillin, cephalosporin, trimethoprim
IV antibiotics for severe infections
In functionally normal urinary tracts in adults, they should have a normal IVU and repeated/persistent UTIs seldom result in renal damage. What happens in abnormal urinary tracts?
Anatomical/neurological abnormalities, stones and diabetes may all cause infection and lead to renal impairment
What are the features of reflux nephropathy?
UTIs in children
Damage caused by reflux and infection
What investigations can be done for reflux nephropathy?
Micturating cystogram
Assess progression by US scan and biochemistry
What general measures can be taken for recurrent infections?
Fluid intake 2lday
Void every 2-3 hours by day
Void before bedtime and after intercourse
Avoid bubble baths and constipation
What is inevitable in indwelling urinary catheters?
Colonisation
When should antibiotics be given for colonisation of indwelling urinary catheters?
Only if patient is symptomatic
