Urinary Tract Infections Flashcards
How are urinary tract infections classified?
Uncomplicated
Complicated:
- Male
- Functional/structural abnormalities
- Children
- Pregnant women
- Hospitalised patients
What is the most common causative organism in a urinary tract infection?
E. coli
Name some causative organisms (and their likely clinical pictures) for a UTI
E. coli
- Uncomplicated, normal UTI
Staphylococcus saprophyticus
- Young women
Proteus, Klebsiella
- Abnormal renal tract
Staphylococcus aureus
- Haematogenous spread
What is the epidemiology surrounding urinary tract infections?
- 1-3% of young women will have bacteruria
- 40-50% of all women will have a UTI at least once in their lifetime
- 95% of all cases are caused by a single organism
What is the aetiology of a UTI?
Usually an ascending infection from the urethra, and contamination from the vulva/perianal area
What are the presenting features of a UTI across different age groups?
Children <2:
- Failure to thrive
- Vomiting
Children >2:
- Frequency
- Dysuria
- Abdominal pain
Adults:
- Suprapubic heaviness
- Dysuria
- Fever may be absent
What are the presenting features of pyelonephritis?
- Flank pain
- Rigors
- Fever
- Preceding lower UTI symptoms
What investigations are performed in a UTI? What results may be indicative?
Urine dip:
- Nitrites
- Leucocytes
MSU MC&S:
- Colony forming units of >10^4/L
- WCC of >10^7/L
- Mixed/epithelial growth show a bad sample
What are the diagnostic criteria for a UTI?
> 3 symptoms:
- UTI, treat without urine dip
<3 symptoms:
- +ve nitrites: treat
- +ve leucocytes: check cultures
- +ve blood only: not UTI
What further investigations can be performed in a UTI case? Why would they be performed?
- Renal USS
- Intravenous urogram
They should be performed in complicated cases of UTI (male, children), or pyelonephritis
What is the treatment algorithm for a UTI? For pyelonephritis?
Follow local guidelines
Female, uncomplicated:
- Trimethoprim/cefalexin for 3 days
Male/pregnant female:
- Trimethoprim/cefalexin for 7 days
Males with prostatitis:
- Add ciprofloxacin
Pyelonephritis:
- Co-amoxiclav + gentamicin for 1-2 days IV
- Treat for 14 days
What fungal infections are common? How are they caused? How are they treated?
Candida infections can be common, as a result of catheters, or a post UTI abx treatment.
Treatment is removal of catheter, no antifungal treatment is necessary
Only treat fungal infection if due to have renal operation, to reduce risk of surgical site infection.
What are the complications of pyelonephritis?
- Abscess
- Scarring tissue
