Urinary Tract Infection Flashcards
Bacteriuria - definition
Bacteria in the urine (not in itself a disease) can be symptomatic or asymptomatic
Urinary Tract Infection - definition
A diagnosis based on signs and symptoms and assisted by testing for bacteriuria
Urinary Tract Infection - lower vs upper
Lower
- involves the bladder and prostate
Upper (a.k.a. pyelonephritis)
- infection of the kidney or renal pelvis
Abacterial Cystitis - definition
Diagnosis of exclusion in patients with dyuria amd frequecy
- no demonstrable infection
Urinary Tract Infection - incidence
10-20% annual in women
0.3% annual pyelonephritis
Urinary Tract Infection - classifications
Uncomplicated - normal renal tract structure and function
Complicated - structural abnormalities of the genito-urinary tract
e.g. obstruction, catheter, stones, neurogenic bladder or renal transplant
Urinary Tract Infection - risk factors
Bacterial inoculation
- sex, urinary incontinence, faecal incontinence and constipation
Decreased urine flow
- dehydration, obstructed urinary tract
Bacterial growth
- diabetes, immunosuppression, obstruction, stones, catheter, pregnancy and renal tract malformation
Urinary Tract Infection - clinical features of cystitis
Dysuria Urgency Subrapubic pain Frequency Haematuria (frank or microscopic)
Urinary Tract Infection - clinical features of acute pyelonephritis
Fever Rigor Vomiting Loin pain/tenderness Sepsis Costovertebral pain
Urinary Tract Infection - clinical features of prostatitis
Pain - perineum, rectum, scrotum, penis and lower back Fever Malaise Nausea Urinary symptoms (cystitis) Swollen/enlarged prostate on PR
Urinary Tract Infection - differentials
PID - associated with vaginal discharge
Urinary Tract Infection - investigations
Dipstick (not in pregnancy) - nitrates and leukocytes MSU culture (if unsure or failure to respond to treatment) Bloods (if systemically unwell) - FBC, U&Es, CRP Blood cultures (if systemically unwell) Imaging - ultrasound
Urinary Tract Infection - indications for USS
Men with pyelonephritis Failure to respond to treatment Recurrent UTI (more than 2/year) Pyelonephritis Unusual organisms Persistent haematuria
Urinary Tract Infection - common organisms
Anaerobes or gram negative bacteria are common - from bowel or vagina E.Coli (75-95%) S.Saprophyticus (5-10%) Proteus mirabilis Klebsiella Pneumonia
Sterile pyuria - causes
Defined as increased white cells, but sterile on culture Infection related - TB - recurrent UTI (recently/poorly treated) - appendicitis, prostatitis, chlamydia Non-infection related - polycystic Kidney Disease - SLE - steroids - calculi - renal tract tumour - papillary necrosis - tubulointerstitial nephritis - recent catheter - pregnancy
Urinary Tract Infection - management in non-pregnancy women
Drink lots of water and urinate often to clear the bacteria out of the urine
Lower UTI
- trimethoprim or nitrofurantoin for 3 days
- if this fails, MSU culture and treat as per sensitivities
Pyelonephritis
- MSU culture
- treat empirically as per local guidelines while waiting for sensitivities
Urinary Tract Infection - management of recurrent infection
Establish whether relapse or reinfection
Relapse
- identify and treat the cause (e.g. stones or scarred kidneys)
- IV antibiotics for 7 days followed by oral antibiotics for 4-6 weeks
- consider long-term therapy is another relapse
Reinfection
- implies poor bladder defence mechanism
- review contraceptive practice (avoid use of spermicidal gels or diaphragms)
- preventative measures and drink lots of water
Urinary Tract Infection - management of pregnant women
Expert help - UTI associated with increased risk of preterm delivery and IUGR
Antibiotics as per empirical local guidelines
- 1st trimester: avoid trimethoprim and ciprofloxacin
- 3rd trimester: avoid nitrofurantoin
Treat even if asymptomatic bacteriuria
Confirm eradication
Urinary Tract Infection - management in men
Lower UTI
- trimethoprim or nitrofurantoin for 7 days
Prostatitis
- consider 4 weeks of a fluoroquinolone
- ciprofloxacin (penetrates the prostatic fluid)
Pyelonephritis/recurrent UTI
- refer for urological investigations
Urinary Tract Infection - management in catheterised patients
All catheterised patients have bacteriuria
Symptomatic
- MSU culture
- change long-term catheter before starting on antibiotic
- prescribe empirically based on local guidelines
- once sensitivities known: narrow spectrum based on culture (best to eliminate recurrence)
Urinary Tract Infection - clinical features in catheterised patients
More likely to be atypical or non-specific Flank pain Suprapubic pain Fever Change in voiding pattern Confusion Vomiting Sepsis
