Urinary tract infections (UTI) Flashcards
What is inflammation of the kidney
Acute or chronic pyelonephritis
What is inflammation of the bladder
cystitis
what is inflammation of the urethra
urethritis
What is inflammation of the prostate
prostatitis
What is inflammation of the epididymis/testis
Epididymo-orchitis
Which gender are UTIs more common in
Females 3:1 Males
What general factors can make a person more susceptible to UTI and other infections
Immunosuppression
steroids
malnutrition
diabetes
What are predisposing factors specific to UTI
Female gender - due to short urethra
Sexual intercourse
Congenital abnormalities like duplex kidney
Stasis of urine
Obstructions
Catheters
Estrogen deficiency in postmenopausal women which can cause the vagina to be more dry and can increase risk of uti
What organisms most commonly cause UTI
E.coli is most common but staphylococcus and enterococcus are also common
Gram negatives are quite common
What are the clinical features of a UTI in children
Diarrhoea
Excessive crying
Fever
nausea and vomiting
not eating
Clinical features of UTI in adults
flank pain - cardinal symptom of pyelonephritis
Dysuria
Cloudy offensive urine
urgency
chills
strangury - voiding but feeling that the bladder is not empty
confusion in old people
What are the clinical features of acute pyelonephritis
Pyrexia
Poor localisation
loin tenderness at the renal angle
Signs of dehydration due to increased frequency
Turbid urine (cloudy)
What are the investigations done for UTI
MSSU
Urinalysis - looking for blood, leucocytes, protein and nitrites
Microbiology (culture)
Why are nitrites checked in urinalysis
Bacteria produces nitrites so if nitrites are present, UTI is probable
What investigations are done in children, men or when the UTIs are frequent
Ultrasound or intravenous urogram
Isotope studies for reflux
describe isotope studies for reflux
Ask patient to drink a lot of water and insert a dye, take pictures during micturition
How is a UTI managed
Identify the infecting organism and give the appropriate treatment
Identify any predisposing factor which caused the UTI and treat to prevent reoccurrence
What is the treatment of UTI
Fluids
Amoxicillin (3-5 day course 2x 3g doses)
Cephalosporin
trimethoprim - first line treatment
In severe infections - IV antibiotics
Why is trimethoprim sometimes avoided in treatment of UTI
It can sometimes cause acute pyelonephritis
What is the most common cause of UTI in children and how does it work
Reflux nephropathy - the reflux results in stasis of urine in ureters which can predispose to infection
What is the advice for people who have recurrent UTIs
Fluid intake of 2L
Void every 2-3 hours a day
Void before sleeping and after sexual intercourse
Avoid constipation
What is Purple urine bag syndrome
Rare occurrence when patients are catheterised too long
it is caused by the breakdown of tryptophan which breaks down into a mix of a blue and red compound which makes purple
When does UTI caused by catheter need treatment
When there are symptoms
Why does pregnancy result in higher risk of infection
Porgestogens are increased which cause smooth muscle relaxation which causes ureters to relax which can cause urinary reflux
