Urology (3) (infection) Flashcards
lower urinary tract infection
involve infection in the bladder, causing cystitis (inflammation of the bladder). They can spread up to the kidneys and cause pyelonephritis
RF for uti
- Women (urethra is shorter)
- Sexual activity- bacteria spread around the perineum from the anus)
- Incontinence
- Poor hygiene
- Urinary catheters
causes of bacterial UTI
Causes
-
Bacteria- E.coli most common
- Klebsiella pneumonia
- Pseudomonas aeruginosa
- Primary sources faeces
presentation of lower urinary tract infection
- Dysuria (pain, stinging or burning when passing urine)
- Suprapubic pain or discomfort
- Frequency
- Urgency
- Incontinence
- Haematuria
- Cloudy or foul smelling urine
- Confusion is commonly the only symptom in older and frail patients
investigations for UTI
- dipstick
- MSU
Dipstick and UTI
- Nitrites (gram neg bacteria break down nitrates, a normal waste product in urines, into nitrites)
- Leukocytes
-
RBC
- Presence of leukocytes +RBC indicates likelihood of UTI
- If only leukocytes present do not treat
MSU
mid stream urine
- Microscopy, culture and sensitivity testing
- Asymptomatic bacteriuria- positive urine cultures without symptoms of UTI (common in elderly)
uncomplicated UTI
Uncomplicated UTIs are most common in young, sexually active women.
occurs in patients who have a normal, unobstructed genitourinary tract, who have no history of recent instrumentation, and whose symptoms are confined to the lower urinary tract.
complicated UTI
A complicated urinary tract infection (UTI) is a term to describe a UTI that doesn’t respond to traditional treatments. This may be due to underlying medical conditions or other risk factors, such as age and anatomical differences
- Pregnant patients
- Patients with recurrent UTIs
- Atypical symptoms
- When symptoms do not improve with antibiotics
- Men with UTI
management of uncomplicated UTI
- Trimethoprim for 3 days
- Nitrofurantoin for 3 days
side effects of trimethoprim and nitrofurantoin
- Side effects same for both:
- Itching
- D and V
- Stomach upset
- Loss of appetite
management of asymptomatic bacteriuria
- Offer antibiotics to pregnant women
- Usually doesn’t need to be treated in nonpregnant
management of UTI in pregnant patients
- Avoid nitrofurantoin in third trimester- risk of neonatal haemolysis
- Avoid trimethoprim in first trimester- works as a folate antagonist
- Congenital malformation e.g. neural tube defects such as spina bifida
duration of antibiotics of complicated UTI
- 5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
- 7 days of antibiotics for men, pregnant women or catheter-related UTIs
‘Multi-Drug Resistant Gran Negative Organism (MGNO)’
- Gram negative bacteria that are resistant to antibiotics that they have been sensitive to in the past
- MSU – to test for susceptibility
- Fosfomycin has been shown to retain some activity against MDR bacteria
Asymptomatic bacteriuria
is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a urinary tract infection. Asymptomatic bacteriuria is very common in clinical practice
pyelonephritis presentation
- Fever
- Vomiting
- Unilateral loin to groin pain
- N and V
- Co-existing lower UTI
- On examination
- Unilateral or bilateral costovertebral angle tenderness with or without suprapubic tenderness
- Assess for AAA as DD
pyelonephritis invesitgations
- Urinalysis and culture
- Routine bloods (FBC, CRP, U&Es)
- Renal US for evidence of obstruction
- If suspected- non-contrast CT imaging (KUB)
management of pyelonephritis
- Empirical antibiotics
- IV fluid is appropriate
- Analgesia
- Anti-emetics
- Non-responding cases- catherization and high dependency unit monitoring
complications of pyelnophritis
- Severe sepsis
- Multi-organ failure
- Renal scarring (CKD)
- Pynonephrosis
- Preterm labour
Epididymo-orchitis
Inflammation of the epididymis (orchitis is inflammation of the testicle). Usually result of infection.
risk factors for epididymitis or orchitis
- <35 usually
- sexually active
- UTI
causes of epididymo-orchitis
- 20-40/50- STI e.g. chlamydia, Neisseria gonorrhoea
- 40/50+ - UTI esp E.coli
- Often recent history of
- UTI
- Unprotected sex
- Catheter
- Check for mumps history (usually bilateral symptoms)- may present like this before glands in neck
presentation of Epididymo-orchitis
- Gradual onset
- Unilateral
- Testicular pain
- Dragging
- Swelling of testicle and epididymis
- Tenderness on palpation, particularly over epididymis
- Urethral discharge (more likely to be STI than E.coli)
- Fever and potentially sepsis
investigaitons for epidiymo-orchitis
- Bloods- FBC, UandEs, cultures
- Urine microscopy, culture and sensitivity (MC&S)
- Chlamydia and gonorrhoea NAAT testing on a first pass urine
- Charcoal swab of purulent urethral discharge for gonorrhoea culture and sensitivities
- Saliva swap for PCR testing for mumps, if suspected
- Serum antibodies for mumps, if suspected (IgM – acute infection, IgG – previous infection or vaccination)
- Ultrasound may be used to assess for torsion or tumours
management of epidiymo orchitis
- If very unwell or septic admit for IV antibiotics
- If risk of STI- refer to GUM
- If low risk of STI- ofloxacin for 14 days
- Analgesia, supportive underwear, reduce PA, abstain from intercourse
complications of Epididymo-orchitis
chronic pain, chronic epididymitis, testicular atrophy, sub-fertility, abscess
Epididymo- orchitis sometime confused with
testicular torsion
Epididymo- orchitis vs testicular torsion
- Testicular torsion
- Reactive hydrocele
- Scrotal wall erythema
- Decreased blood flow
- Epididymo-orchitis
- Epididymis is located posterolateral to the testis
- Tender, swollen and indurated
- Increased blood flow
