Urinary Tract Infections Flashcards
Define:
Pure growth of > 10^5 organisms per mL of fresh mid-stream urine (not always needed)
Lower UTI- Bladder, urethra and prostate
Upper UTI- pyelonephritis
Aetiology:
MOST UTIS ARE DUE TO E.COLI
other causes = staph sapprphyicus, proteus microbilus and enterocci
If immunocompromised:
-Klebsiella, candida albicans and pseudonomas aerginosa
Risk factors
Female Sexual intercourse Menopause Pregnancy Spermicide UT obstruction Catheterisation Immunosuppression UT malformation
Epidemiology:
Very common
1-3% of GP consultations
Most women will get one and more common in women than men due to the short urethra (Bacteria is ascending and usually travels from the rectum up the urethra)
Symptoms of cystitis:
Increased frequency Urgency Dysuria Haematuria Suprapubic pain
Symptoms of prostatitis:
flu like symptoms
lower backache
Urinary problems
Swollen or tender prostate on PR
Symptoms of acute pyelonephritis:
High fever Rigor Nausea Vomiting Loin pain and tenderness Oliguria
Signs:
Fever
Abdo or loin tenderness
Distended bladder
Enlarged prostate
Investigations:
1st Line = urine dip (+ve for leucocytes and nitrates –> treat empirically till MSU)
MSU (MC&S) - if male, pregnant, child, ill or immunocompromised
Bloods - FBC, U + Es (renal functions), CRP and blood cultures
USS to rule out an obstructive cause
If urine culture shows sterile pyruia then this a an STD
Management:
If uncomplicated or in normally healthy woman:
-Trimerthoprim or Nitrofuratoin (3-6 days This will be longer in a male)
Alternatively:
-Co-amxoiclav or cefalexin
Non-pregnant + upper UTI post urin culture give Co-amox iv and then oral when afebrile for 7 days
Complications:
Pyelonephritis Sepsis AKI Prostatitis Perinephric or intrarenal abscesses Hyrdop/pyenopneohrosis
Prognosis:
Good with treatment
