Urinary Tract Infection Flashcards
What is the urinary tract?
urethra, bladder, ureters and kidneys.
Define acute pyelonephritis
Acute pyelonephritis is when the infection affects the tissue of the kidney. It can lead to scarring in the tissue and consequently a reduction in kidney function.
What is cystitis?
Cystitis means inflammation of the bladder, and can be the result of a bladder infection.
how do lower utis present?
Dysuria (pain, stinging or burning when passing urine)
•Suprapubic pain or discomfort
•Frequency
•Urgency
•Incontinence
•Confusion is commonly the only symptom in older more frail patients
How does pyelonephritis present?
Fever is a more prominent feature than lower urinary tract infections.
•Loin, suprapubic or back pain. This may be bilateral or unilateral.
•Looking and feeling generally unwell
•Vomiting
•Loss of appetite
•Haematuria
•Renal angle tenderness on examination
What may a urine dipstick find?
Nitrites – gram negative bacteria (such as E. coli) breakdown nitrates, a normal waste product in urine, into nitrites. The presence of nitrites suggest bacteria presence.
Leukocytes – this means white blood cells. There are normally a small number of leukocytes in the urine but a significant rise can be the result of an infection or other cause of inflammation. Urine dipsticks test for leukocyte esterase, a product of leukocytes that gives an indication to the number of leukocytes in the urine.
Nitrites are a better indication of infection than leukocytes. If both are present then the patient should be treated as a UTI. If only nitrites are present then it is worth treating as a UTI however if only leukocytes are present then the patient should not be treated as a UTI unless there is clinical evidence that they have a UTI.
What bacteria are causes of uti?
Most common cause is Escherichia coli (E. coli). This is a gram negative, anaerobic, rod shaped bacteria that is part of the normal lower intestinal microbiome. It is found in faeces and can easily spread to the bladder.
Other causes: •Klebsiella pneumoniae (gram negative anaerobic rod) •Enterococcus •Pseudomonas aeruginosa •Staphylococcus saprophyticus •Candida albicans (fungal)
How long should antibiotics be given?
3 days of antibiotics for a simple lower urinary tract infection in women
•5-10 days of antibiotics for women that are immunosuppressed, have abnormal anatomy or impaired kidney function
•7 days of antibiotics for men, pregnancy women or catheter related UTIs
What antibiotics are given?
An appropriate initial antibiotic in the community would be:
•Trimethoprim
•Nitrofurantoin
What can UTIs result in during pregnancy?
Urinary tract infections in pregnancy increase the risk of pyelonephritis, premature rupture of membranes and pre-term labour.
How to manage UTI in pregnancy
Management in pregnancy: •7 days of antibiotics (even with asymptomatic bacteruria) •Urine for culture and sensitivities •First line: nitrofurantoin •Second line: cefalexin or amoxicillin
Treating pyelonephritis
first line antibiotics for 7-10 days when treating pyelonephritis in the community: •Cefalexin •Co-amoxiclav •Trimethoprim •Ciprofloxacin
