Urinary tract infections Flashcards
Etiology
- E coli most common 2. Staphylococcus saprophyticus 3. Proteus mirabilis and Klebsiella species, enterococci, group B streptococci, Pseudomonas aeruginosa, and Citrobacter species.
Risk factors
- Sexual activity 2. Spermicide use 3. Post-menopausal 4. Positive family history 5. History of recurrent UTI 6. Foreign body 7. Stasis and obstruction PUV, reflux, medication, BPH, urethral stricture, cystocele, neurogenic bladder 8. Trauma, anatomic abnormalities Insulin DM, recent antibiotics, poor bladder emptying, +age
Presenting complaints in women
Dysuria Frequency Hematuria Back/flank pain CVT Uncommonly fever Urgency Supra-pubic pain and tendeness
Investigations in women
- Urine MCS only required in: a. pregnant b. men c. aged care facility d. recent antibiotic use/treatment failure e. recurrent infection f. international travel in last 6 months Other tests to consider when ++++ and abnormal presentation 1. Post void residual 2. Renal USS->stone, hydroneprhosis, renal abscess 3. Abdominal/pelvic CT->stone/abscess 4. Cystoscopy->tumor, stone, foreign body
Uncomplicated UTI
- nonpregnant women who do not have a functional or anatomical abnormality of the urinary tract. 2. Acute uncomplicated cystitis and pyelonephritis is most commonly caused by Escherichia coli (70% to 95% of cases) and Staphylococcus saprophyticus (5% to 10% of cases).
Complicated UTI
- Anatomical or functional abnormalities->neurogenic bladder, nephrolithiasis, diabetes 2. +risk of serious complications or treatment failure
- E. coli most common, but associated with others including Proteus, Klebsiella, enterococci faecalis, streptococcal agalactaie
Treatment in non-pregnant women
- Trimethoprim 300mg orally, daily for 3 days
- Cephalexin 500mg BD 5 days
Treatment in pregnant women
- Cephalexin 500mg PO BD 5 days OR 1. Nitrofurantoin 100mg PO BD for 5 days
Treatment in men
- Trimethoprim 300mg PO for 7 days
Treatment mild pyeloneprhitis
1 amoxycillin+clavulanate 875+125 mg orally, 12-hourly for 10 to 14 days OR 1 cephalexin 500 mg orally, 6-hourly for 10 to 14 days OR 1 trimethoprim 300 mg orally, daily for 10 to 14 days.
Treatment for severe pyelonephritis
- Gentamycin IV + amoxy/ampicillin IV
Indications for investigations
- Pyeloneprhitis 2. Persistent symptoms/pyuria despite treatment 3. Severe infection with +in Cr 4. Atypical pathogen (urea splitting) 5. Hx of structural abnormality/decreased flow
Indications for investigations
- Pyeloneprhitis 2. Persistent symptoms/pyuria despite treatment 3. Severe infection with +in Cr 4. Atypical pathogen (urea splitting) 5. Hx of structural abnormality/decreased flow
Management of recurrent/chronic cystitis
- Lifestyle Limit caffeine Increase fluid 2. Continuous vs post coital antibiotics 3. Topical estrogen? 4. No treatment for asymptomatic bacteruria except in pregnant women/women undergoing urinary tract instrumentation
- Antibiotics->trimethopri 300md OD for 10 days or cephalexin 500mg BD for 10 days
Management of recurrent/chronic cystitis
- Lifestyle Limit caffeine Increase fluid 2. Continuous vs post coital antibiotics 3. Topical estrogen? 4. No treatment for asymptomatic bacteruria except in pregnant women/women undergoing urinary tract instrumentation
What is painful bladder syndrome
- Chronic urgency, frequency and pain without other reasonable causation
Etiology of painful bladder
• unknown a. theories: increased epithelial permeability, autoimmune, neurogenic, defective glycosaminoglycan (GAG) layer overlying mucosa b. associations: severe allergies, IBS, fibromyalgia
Etiology of painful bladder
• unknown theories: increased epithelial permeability, autoimmune, neurogenic, defective glycosaminoglycan (GAG) layer overlying mucosa associations: severe allergies, IBS, fibromyalgia
Management of painful bladder syndrome
- first-line: patient empowerment (diet, lifestyle, stress management), pain management 2. second-line: oral: pentosan polysulfate sodium, amitriptyline, cimetidine, hydroxyzine intravesical: dimethylsulfoxide (DMSO), heparin, lidocaine 3. third-line: cystoscopy with bladder hydrodistention (traditionally diagnostic) under GA, treat Hunner’s ulcers if present 4. other: neuromodulation, cyclosporine A, intradetrusor botulinum toxin 5. surgery (last resort): augmentation cystoplasty, or urinary diversion ± cystectomy
When is a urine sample for culture required prior to antibiotic therapy
- Pregnant
- Men
- Aged care facility
- Recent antibiotics/treatment failure
- Recurrent infection
- Travel internationally in last 6 months
Clinical features of pyeloneprhitis
- Flank pain
- Fever
- Dysuria
Chills, NVD
