Urinary Tract Infection (UTI) Flashcards
What is infection of the epididymis/ testes called?
Epididymo-orchitis
What are the most common causes of HAI?
Urinary tract 38% Surgical wound 22% Lower Respiratory tract 15% Bloodstream 5% Others 20%
What general predisposing factors make an individual more susceptible to infection?
Immunosuppression
Steroids
Malnutrition
Diabetes
What specific predisposing factors make an individual more susceptible 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 e.g. catheters, stones
Oestrogen deficiency in postmenopausal women
Fistula between bladder and bowel
What are the most common bacterial aetiologies of UTI?
Gram negative:
- E. COLI
- PROTEUS mirabilis
- KLEBSIELLA species
Gram positive:
- S. saprophyticus
- ENTEROCOCCI
- Group B strep
- Staph aureus
What is strangury?
Characterized by painful, frequent urination of small volumes that are expelled slowly only by straining and despite a severe sense of urgency, usually with the residual feeling of incomplete emptying
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
- 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
Give a differential diagnosis for acute pyelonephritis
Renal/ ureteric calculi
What are the investigations in UTI?
MSSU
Urinalysis in ward
- Blood
- Leucocytes
- Protein
- Nitrites
Microbiology
- Microscopy and gram staining
- Bacteruria >10^5 CFU/ml
- Culture and sensitivity
What further investigations will you want to consider in children, men or when UTIs are frequent?
Ultrasound or IVU
Isotope studies to rule out reflux and scarring
What are the principles of UTI management?
Identify the infecting organism and institute appropriate treatment
Identify predisposing factors and treat if possible
How do you treat UTI?
Fluids
Antibiotics
- Amoxicillin (3-5 day course or 3g x 2)
- Cephalosporin
- Trimethoprim
Severe infections -> IV antibiotics
How do you diagnose reflux nephropathy?
Micturating cystogram (radionuclide 99Tc techniques)
Assess progression by ultrasound scan and biochemistry
