Urinary Tract Infections Flashcards
What are different types of urinary tract infections?
- Kidney
- Acute pyelonephritis
- Chronic pyelonephritis
- Bladder
- Cystitis
- Urethra
- Urethritis
- Prostate
- Prostatitis
- Epididymis/testis
- Epididymo-orchitis
What is a kidney infection called?
- Acute pyelonephritis
- Chronic pyelonephritis
What is a bladder infection called?
- Cystitis
What is a urethral infection called?
- Urethritis
What is a prostate infection called?
- Prostatitis
What is a epididymis/testis infection called?
- Epididymo-orchitis
What is the M:F ratio of urinary tract infections?
1:3
What is the most common hospital acquired infection?
Urinary tract infection
What are some predisposing factors for a urinary tract infection?
- Immunosuppression
- Steroids
- Malnutrition
- Diabetes
Specific to urinary tract:
- Female sex (short urethra)
- Sexual intercourse and poor voiding habits
- Congenital abnormalities
- Such as duplex kidney
- Stasis of urine
- Such as due to poor bladder emptying
- Foreign bodies
- Such as catheters, stones
- Oestrogen deficiency in postmenopausal woman
- Fistula between bladder and bowel
What bacteria commonly causes urinary tract infections?
- E coli
- Proteus
- Klebsiella
- Enterococcus
What form of transfer occurs for urinary tract infections?
- Transurethral route
- Periurethral area contaminated
- Urethra to bladder
- Bladder (and up ureter)
- Bloodstream
- Lymphatics
Describe the natural history of urinary tract infections?
- Single episode 90% of time
- Complicated vs uncomplicated
What is the clinical presentation of urinary tract infections in children?
- Diarrhoea
- Excessive crying
- Fever
- Nausea and vomiting
- Not eating
What is the clinical presentation of urinary tract infections 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 are done for acute pyelonephritis?
- Mid-stream sample of urine
- Urinalysis in ward
- Blood
- Leucocytes
- Protein
- Nitrates
- Microbiology in laboratory
- Microscopy and gram staining
- Bacteriuria > 105 CFU/ml
- Culture and sensitivity
What additional investigations are done for acute pyelonephritis in children, men or when UTIs are frequent?
- USS or IVU may be helpful
- Isotope studies to rule out reflux and scarring
What are the principles for management of urinary tract infections?
- Identify the infecting organism and institute appropriate treatment
- Identify predisposing factors and treat if possible
What is the treatment of urinary tract infections?
- Fluids
- Antibiotics
- Amoxicillin
- Cephalosporin
- Trimethoprim
- IV antibiotics for severe infections
What are examples of abnormal urinary tracts?
Includes:
- Anatomical/neurological abnormalities
- Stones
- Diabetes
All may cause infections and sometimes lead to renal impairment
Do repeated UTIs result in renal damage?
Even repeated/persistent UTIs rarely result in renal damage
How do UTIs in children lead to renal damage?
UTIs in children, damage is caused by reflux and infection
What investigations are done for UTIs in children?
- Micturating cystogram
- Assess progression by USS and biochemistry
What is the treatment for UTIs in children?
Surgery
What advice is given to avoid recurrent UTIs?
- Fluid intake 2L/day
- Void every 2-3 hours by day
- Void before bedtime and before and after intercourse
What is indwelling urinary catheter?
Is a catheter that is left in your bladder
What is inevitable with an indwelling urinary catheter?
Aseptic technique but colonisation is inevitable
Antibiotics only if patient is symptomatic:
- Replace catheter
When does bacteriuria occur?
When >= 105
But depends on clinical symptoms
How is chronic pyelonephritis diagnosed?
Radiological diagnosis
What is the clinical presentation of chronic pyelonephritis?
- Scarring and clubbing
- Hypertension/CRF
- Reflex
What percentage of chronic pyelonephritis leads to renal failure?
15%
