Urinary tract infection Flashcards
what are the different types of UTI and where do they occur
kidney
- acute pyelonephritis
- chronic pyelonephritis
bladder
- cystitis
urethra
- urethritis
prostate
- prostatitis
epididymis/testis
- epididymo-orchitis
what are general factors that predispose to UTI
immunosuppression
steroids
malnutrition
diabetes
what are more specific predisposing factors to UTI
Female sex (short urethra)
Sexual intercourse and poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies eg catheters, stones
Oestrogen deficiency in postmenopausal women
Fistula between bladder & bowel
Spermicide coated condoms and diaphragms
what are the most common organisms that cause UTI
usually bowel organisms E.COLI proteus klebsiella enterococcus
how are organisms transferred into the urinary tract
Transurethral route: - Perurethral area contaminated (Recurrent UTIs, diaphragms, ? bubble baths) - Urethra to bladder Intercourse, catheterisation - Bladder (and up ureters)
Bloodstream
Lymphatics
what are the 5 stages of UTI that can lead to acute kidney injury
- colonisation
- uroepithelial penetration
- ascention
- pyelonephritis
- acute kidney injury
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 (“like passing broken glass”) Cloudy offensive urine Urgency Chills Strangury Confusion (very old people)
what are the clinical features of acute pyelonephritis
Pyrexia Poor localisation Loin tenderness (renal angle) Signs of dehydration Turbid urine
what investigations should be carried out for suspected UTI
mid-stream sample urine
urinalysis in ward
-blood, leukocytes, protein, nitrates
microbiology in lab
- Microscopy and Gram staining, Bacteruria >105 CFU /ml, Culture and sensitivity
what radiological investigations may be useful in children, men or patients with multiple UTIs
US or IVU
isotope studies to rule out reflux and scarring
what are the 2 main principles of UTI management
- identify the infecting organism and institute appropriate treatment
- identify predisposing factors and treat if possible
what are the treatments for UTI
fluids antibiotics - amoxicillin (3-5 day course or 3g x 2) - cephalosporin - trimethoprim
severe infections:
IV antibiotics
what are the consequences of functionally normal UTI i adults
normal anatomy on imagine so even repeated/persistent UTIs seldom result in renal damage
what are the consequences of abnormal urinary tract UTIs
anatomical/neurological abdnormalities can lead to stones and diabetes which may all cause infections and can lead to renal impairment
what is reflux nephropathy
UTIs in children
damage caused by reflux and infection
micturating cystogram - assess progression by US and biochemistry
surgery ultimately needed
what can you do to reduce risk of recurrent infections
fluid intake 2L/day
void every 2-3 hours by day
void before bedtime and before and after intercourse
how would you manage a patient with an indwelling urinary catheter
use aseptic techniques
increase fluid intake
colonisation inevitable so antibiotics only if patient symptomatic
replace catheter
how is chronic pyelonephritis diagnosed
radiologically
what is chronic pyelonephritis characterised by
scarring and clubbing of the calyces
what can chronic pyelonephritis lead to
hypertension
chronic renal failure
?reflux
SUMMARY: list 3 common causative organisms
e coli
klebsiella
proteus
SUMMARY: List four general systemic factors that might predispose an individual to a UTI
immunosuppression
steroids
malnutrition
diabetes
SUMMARY: What specific urological problems might lead to an increased risk of UTI?
Female sex (short urethra)
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies eg catheters, stones
Oestrogen deficiency in postmenopausal women
Fistula between bladder & bowel
SUMMARY: Describe the typical symptoms & signs of a UTI
Flank pain Dysuria (“like passing broken glass”) Cloudy offensive urine Urgency Chills Strangury Confusion (very old people)
SUMMARY: How are UTIs managed?
fluids antibiotics - amoxicillin (3-5 day course or 3g x 2) - cephalosporin - trimethoprim
severe infections:
IV antibiotics
SUMMARY: What advice would you give for recurrent UTI in young women?
fluid intake 2L/day
void every 2-3 hours by day
void before bedtime and before and after intercourse
