Urinary Tract Infections Flashcards
What organs are involved in an upper UTI?
kidney and ureter(s)
what organs are involved in a lower UTI?
bladder and urethra
how would you explain UTI to a pt?
it’s an infection in your urinary tract. Your urinary tract consists of your kidneys, ureters, bladder, and urethra.
when you have a UTI, one or multiple parts of your urinary tract have an infection
what factors make a UTI complicated?
- adult males
- elderly
- immunocompromised (cancer, active HIV, DM, immunosuppressive therapy)
- pregnancy
- stones
- indwelling catheters
- pts with structure abnormalities
what factors make a UTI uncomplicated?
- no structural or functional abnormalities
- young
- nonpregnant
- premenopausal women
- no comorbidities
- no stones
what is the criteria/number of episodes needed to dx recurrent UTI?
> = 3 episodes of symptomatic, culture-proven UTI in one year
OR
= 2 episodes in 6 months, culture-proven UTI
what is asymptomatic bacteriuria?
presence of bacteria in urine w/o s/s of UTI
what is a persistent/relapsed UTI?
persistence of s/s and positive cultures w/ same bacteria despite culture-adjusted antibiotic tx
what is one ddx for UTIs in male?
- urethritis/STI
what is one ddx for UTIs in general?
- interstitial cystitis/painful bladder syndrome
what is painful bladder syndrome?
pts with recurrent UTI s/s w/o an identifiable cause
basically chronic pain related to the bladder
in what sex is UTI more common?
females > males
tell me about the epidemiology of UTI in children
boys <7Y UTI is more common
UTI more common in uncircumcised infant boys, premature, young children w/severe constipation
what are some RF for developing UTI in adults?
- being female
- older age
- menopause
- incontinence
- FH of UTI
- catheterization
- kidney/bladder stones
- DM
- urinary tract procedures
- immunocompromised status
what are some RF for UTI in children/adolescents?
- structural abnormalities, vesicoureteral reflux
- prematurity
- indwelling urinary catheters
- lack of circumcision
- bladder and bowel dysfunction (constipation, Hirschsprung)
- DM
- Trauma/neglect (not changing diapers)
- sexual intercourse
whats the most common uropathogen for UTI?
E. coli
general pathophys of UTI
Retrograde movement of pathogen, urinary stasis, obstruction, vesicoureteral/vesicourethral reflux → infection and inflammation → S/S
what s/s would you see in adult bacterial cystitis?
frequency, urgency, dysuria, hematuria, pain, foul-smelling urine
what is the triad youd see in pyelonephritis?
fever, flank pain, and positive urine cultures
what is the most common sign in newborns >3M? and others?
fever!
crying while urinating, irritability, and vomiting
how would a pyelonephritis pt present? s/s?
classic triad: fever, flank pain, positive culture
general malaise, chills/sweats/rigors, N/V, DLOC, flushed, diaphoretic, sepsis
what bloodwork would you do for a suspected UTI?
- CBC
- creatinine and BUN
- electrolytes
- potential blood culture if sepsis s/s
what urine tests would you get for a suspected UTI? and what parts of them are important?
Urine culture and sensitivity ➔ academically good to get all the time, realistically done when suspected complicated
Urine dipstick
- nitrites
- leukocyte esterase activity
- microscopic blood
- protein
pregnancy test
when would you consider imaging for a UTI in adults?
for complicated pyelonephritis – CT
for pregnant and for sus of stones - u/s
could consider endoscopy for complicated w/stones ➔ urethrocystoscopy (lower) or ureterorenoscopy (upper)
why would you get imaging for a child with UTI?
determine if there are any structural abnormalties
what kind of imaging pipeline would you follow for child with UTI? and what age?
for 3M - 2Y, if >2Y only get imaging for recurrent UTI
- KUB U/S - looks for inflammation/dilation of ureter, obstruction and abnormalties, unlikely will see vesicourethral reflex
- voiding cystourethrogram - looks for the vesicourethral reflex, done after the UTI is resolved
- nuclear cystogram - looks for the vesicourethral reflex
tx for UTI?
abx!
supportive care: stay hydrated, discuss bathroom hygiene, NSAIDs/tylenol for pain
how manage recurrent UTI?
- consider low-dose prophylactic abx
- preemptive abx prescriptions to fill
what type of bacteria converts urinary nitrate to nitrite that we can see on dipstick?
gram negative
most common: E. coli
