Urinary tract infection

Question 1

Define Urinary tract infection

Answer 1

Infection of the kidney, bladder or urethra
cystitis is the most common (bladder) but pylonephritis the worse. Urethritis..is
much more common in women

Question 2

Aetiology and risk factors of Urinary tract infection

Answer 2

In men, UTI is rare under 50, and mainly caused by catheters-e.coli, but also kleb

Women-usually from proximity to anus/sexual encounters
E.coli in 75%
staph saphropyrus in 20%
Kleb is more complicated
main cause is ascending 

risk factors:
Diabetes/
Female
Age 
sexual acitivity
Recurrent UTI
FHx

Question 3

Epidiemology of Urinary tract infection

Answer 3

Female UTI are very common-over 60% will have them during life
prevalence increases with age
Among the most common thing seen in primary care
men are about 20% of UTI’s
mainly catheters related, and age

Question 4

Signs and Sx of Urinary tract infection

Answer 4

Always suspect sepsis if there are any signs

Key Sx under 65 women-Dysuria, new nocturia, urgency, feeling on non emptying, pain urinating, cloudy looking urine, fever
heamturia, frequency, suprapubic pain
(main 3-dysuria, nocturia, cloudy urine-if all 3 90% UTI)
Over 65-dysuria and anything more suggesting UTI/infection (confusion)

If flank pain-think pylonephritis-dangerous

Men-same as women-
urethral discharge
Hx of catheters, BPH, kidney stones

Question 5

Investigations of Urinary tract infection

Answer 5

Urine dipstick-presence of leukocytes and/or nitrites always
can have heamaturia
Urine culture-grow and sensitive

if men-can ct in case BPH causing Sx

Question 6

Management of Urinary tract infection

Answer 6

Pregnant women-always Abx
Other-depends how severe/how risk
old-alwyas
catheter-always
young-nearly always
Trimeth or nitrofurantoin (in that order)-Amox if sensitive back and its a gram neg
then change depending on sensitivities if needed

Question 7

Complications of Urinary tract infection

Answer 7

acute pylonephritis-flank pain, fever chills, more sepsis like, myalgia, nausea, vom-need IV abs

sepsis-death

renal and peri renal absecc

AKI

Question 8

Prognosis of Urinary tract infection

Answer 8

Uncomplicated-totally excellent
complicated-good-rare cases of renal impairment

old men often have complicated
Catheter have worse prognosis