Urinary Tract Infections Flashcards
Define Pyuria
Pus cells present in the urine Sterile pyuria = pus cells but -ve on urine cultures
What can cause chronic pyelonephritis?
Recurrent UTI
Vesio-ureteric reflux (obstruction)
Diabetes
Define uncomplicated UTI
Young Sexual active women
Define complicated UTI
kids
men
abnormal tracts
immunosuppression
tumours
chronic retention
Bladder outlet obstruction
Management of men with UTI
14 days ciprofloxacin
7 days nitrofurantoin (if uncomplicated)
Management of women with UTI
3 days trimethoprim
nitrofurantoin if preganant
Common cause of UTI in men
STI (Younger men)
Prosthetitis (Older men)
How do you approach pregnant women re UTIs?
Screen with an MSSU culture at first antenatal appointment. Treat even if asymptomatic
Presentation of Lower UTI
Suprapubic Pain -
Dysuria -
Frequency -
Urgency -
Polyuria -
Haematuria
Presentation of Acute Pyelonephritis
Loin Pain
Fever - ~systemic unwellness -
Severe cases have bacteraemia (rigors, N&V etc)
Signs of dehydration
Management of Acute Pyelonephritis
7 days ciprofloxacin
Invesigation for suspected UTI in kids
Urine dipstick/MSSU
Screen for congenital vesicoureteric reflux
UTI presentation in kids
Often unspecific
Not eating
Crying
What extra investigation would you do for a patient with a proteus or Klebsiella UTI?
Non-contrast CT for stones. They’re produce a lot of stones
What are the important parts of the dipstick test for a UTI?
Nitrites (produced by bacteria)
Protein (inflammation or renal pathology)
Leucocytes
If all 3 are present its an indication for empirical Abx Also blood
What are the indications for a MSSU?
1) Women in which the dipstick is inconclusive
2) Men
3) Acute pyelonephritis
4) Pregnant (screening & Symptomatic)
5) Failed Abx or persistant symptoms
6) Recurrent UTIs
7) Children
How do you take a urine sample from a child?
Most kids can’t give a decent MSSU. So a clean catch urine sample is preferable. IF that fails: - Urine collection Pad - Catheter Sample - Suprapubic Aspiration
How do we tell if its contamination or infection on a urine culture?
10^4 organisms/ml indicates infection > contamination
(10^5 in asymptomatic bacteriuria)
Mixed organisms usually means contamination
Aetiology of UTI
- Urine stasis:
- Obstructuon (congenital/aquired)
- CNS problems = lack of voiding
- Bacteria entering urethra from anus
- Sexual activity
- Catheter
- General predispition
- Sexual active women
- Post menoposal women (due to low oestrogen)
- Diabetic (bacteria feed of GLC in urine)
- Pregnancy due to compression of urethra & progestrone dilating ureters
Investigations for UTI
MSSU:
- 10^5 colony= typically infection
- 10^3-10^4 = 50% infection- especially if they are symptomatic
- <10^3 usually no infection
Children & Elderly may have issues with complying to an MSSU
US
CT-KUB
WBC
Cystoscopy
Post-void bladder scan - Urinary Flow study
Common causative organisms of UTI
- E. Coli - most common
- Proteus Spp.
- Klebsiella Spp.
- Pseudomonas Aeruginosa
- Enterococci
What are the complications of a UTI?
- Sepsis and septic shock
- Chronic pyelonephritis
- Calculi –> Obstruction –> Hydronephrosis –> Hypertension & chronic renal failure
Whats the main cause of obstruction in children?
Vesicouretic reflux Its a loss of the angle of entry of ureter to bladder
What are the main causes of obstruction in adults?
- Benign Prostatic Hyperplasia (men) - Uterine Prolapse (Women) - Tumours & Calculi (both)
Why are women more at risk of UTIs?
- Short urethra
- No prostatic bacteriostatic secretion
- Close urethral orifice to rectum
- Sexual activity (vagina just behind urethra so pushes bacteria up)
- Pregnancy pressures the ureter & bladder
What other tests would we do in kids with UTIs?
A micturating Cystogram to check for vesico-ureteric reflux
How would we advise women with recurrent UTIs?
Drink plenty of fluids Urinate frequently, particularly bbed and before/after sex.
How do we handle UTIs due to indwelling catheters.
Only treat if the patients symptomatic.
What radiological signs (CT) may indicate pyelonephritis?
- Scarring
- Clubbing of Calyces
- Abscess
- Emphysematous (gaseous) pyelonephritis.
Lots of gas pockets within the kidney due to gas-forming bacteria.
