urinary tract infections Flashcards
what is an UTI?
an infection of any part of your urinary system
what is an infection?
an infection is the invasion of body tissues by a pathogenic organism
what are the predisposing factors to UTIs?
o female sex
o urinary stasis
- pregnancy
- prostatic hypertrophy
- stones
- strictures
- neoplasia
- residual urine
o urological instrumentation (including catheters)
o sexual intercourse
o Fistulae
o congenital abnormalities
- vesicle-uteric reflux VUR
what are the normal bacteria in the urinary tract?
the ureter and kidney is sterile.
the urethra is colonised, perineal flora is found there.
what makes up the perineal flora?
skin flora
- mainly coagulase negative staphylococci
Lower GI tract flora
- colonising bacteria are often found on the skin around the relevant oriface
- anaerobic bacteria
- aerobic bacteria
Enterobacterales (aka coliforms, enteric Gram negative bacilli)
Gram positive Cocci
-enterococcus spp.
where do the invading bacteria come from?
Endogenous
- most infections are caused by gut bacteria
+ Perineum
- movement of bacteria along a lumen
+ Fistulae
- Movement of bacteria from the Genital/GI tract to the urinary tract
Haematogenous Spread
- seeding of bacteria to the urinary tract via the blood
so, what are the organisms that cause UTIs?
E.coli - 70/80% general practice, 50% hospital
CNS - 10/15% general practice
enterococcus spp. 10/20% hospital
where does cystitis occur?
lower UTI
what are the signs and symptoms of Cystitis?
Dysuria Frequency Urgency Supra-pubic pain or tenderness polyuria, nocturne, haematuria
what is pyelonephritis?
infection of the kidney/or renal pelvis
what are the signs and symptoms of pyelonephritis?
symptoms of lower UTI
loin/abdominal pain or tenderness
fever
what is catheter associated UTI?
indwelling catheterisation results in bacteriuria
what are the signs and symptoms for Urosepsis?
- fever
- rigors
- nausea, vomiting, diarrhoea
- +/- haemodynamic compromise
- raised inflammatory markers
what is prostatitis?
inflammation of prostate
what are the signs and symptoms of acute bacterial prostatitis?
lower urinary tract symptoms
fever
tender tense prostate
acute retention
what are the typical pathogens of acute bacterial prostatitis?
typically the normal urinary pathogens e.g. E.coli
S. aureus
what are the risk factors of prostatitis?
procedures involving the prostate
- TURP
- TRUS biopsy
Indwelling urinary catheter
what are the signs and symptoms of chronic prostatitis?
- 90% due to chronic pelvic pain syndrome
- pain in and around the perineum and genitalia
- lower urinary tract symptoms (LUTS)
- enlarged or tender prostate on examination
what is sterile pyuria?
pus cells (raised WCC) in the urine no organisms grown
why does sterile pyuria occur?
- inhibition of bacterial growth
- fastidious organisms
- urinary tract inflammation
- urethritis
what is the non-antimicrobial management?
- fluid intake
- anti-inflammatories
- device removal
- drainage if obstruction
- recurrent UTIs
what makes a good UTI antibiotic?
- gets into the urine
- minimally toxic
- effective against likely organisms
- easily administered
- cheap
how to treat female cystitis?
- treatment often pre-empts microbiology results
- short course of antibiotics. 3days
how to treat male cystitis?
-longer course, 7 days
