UTI Flashcards
What are complicated and uncomplicated UTIs?
- complicated: UURTI +/- systemic signs or catheter-associated UTI
- uncomplicated: lower UTI, normal structure and neurology
Define relapse and recurrent
- relapse = infection with the same organism
- recurrent = infection with same or different organism, 2+ episodes in 6 months or 3+ in a year
What are the risk factors of bacteriuria?
- female
- urinary catheterisation
- diabetes
- anatomical abnormalities of urinary tract
- pregnancy
What patients are treated for bacteriuria?
- preschool children
- pregnancy
- renal transplant
- immunocompromised
Describe ascending UTIs
- urethral colonisation
- female >male
- multiplication in bladder
- ureteric involvement
Describe descending/haemotgenous UTIs
- haematogenous spread
- involvement of renal parenchyma
What patients are at risk of poly-microbial or multi-drug resistant UTIs?
- multiple organisms: long-term catheters, recurrent infection, structural/neurological abnormalities
- multi-drug resistant: anatomical/neurological abnormalities, frequent infections, multiple antibiotic courses, prophylactic antibiotic use
What are the common organisms that cause UTIs?
- gram-negative bacilli: E.coli, klebsiella, proteus, pseudomonas
- gram-positive: strep, enterococcus, s. agalactiae, staph
- candida
- anaerobes (associated with bladder malignancies)
Describe the clinical features of UTI
- suprapubic discomfort
- dysuria
- frequency
- cloudy, blood stained, smelly urine
- low-grade fever
- sepsis
- failure to thrive, jaundice in neonates
- abdo pain and vomiting in children
- nocturne, incontinence and delirium in elderly
When is a culture indicated for suspected UTI?
Non-pregnant women:
- if no response to empirical treatment
- change to targeted treatment
Children and men: always
Describe the management of a UTI in pregnancy
- send urine for culture and treat each episode
- amoxicillin and cefalexin safe
- avoid trimethoprim in 1st trimester
- avoid nitrofurantoin near term
- hospital admission if severe
- risk of pyelonephritis
How would you manage recurrent UTIs?
- send sample from each episode
- emphasise importance of hygiene
- encourage hydration
- encourage urge initiated and post-coital voiding
- urology investigation
- intravaginal/oral oestrogen
- antibiotic therapy as per symptoms
How would you manage CAUTIs?
- send urine samples
- start empirical antibiotic therapy (look at previous microbiology)
- remove/replace catheter
What is pyelonephritis and describe the clinical presentation
- upper UTI
- moderate to severe infection
- flank pain +/- systemic infection
- enlarged kidney
- abscess on surface of kidney
Describe the management of acute pyelonephritis
- check previous microbiology results
- send urine and blood for culture
- imaging
- community: co-amoxiclav, ciprofloxacin, trimethoprim
- hospital: initial IV antibiotics
Describe renal abscesses
- complication of pyelonephritis (similar symptoms)
- positive urine and blood culture
- gram negative bacilli usually
- can become life threatening (eg. emphysematous pyelonephritis)
- poor response to antibiotics alone, surgical intervention needed
Describe perinephric abscess
- haemtogenous spread of infection (rare)
- common causes: gram negative bacilli (E.coli), gram-positive cocci (strep), candida spp.
What are the symptoms and management of perinephric abscesses?
- symptoms similar to pyelonephritis
- localised signs and symptoms
- local invasion
- urine and bloods sent for culture (pyuria and bacterial growth)
- treat empirically as complicated UTI
- poor response to antibiotic therapy and requires surgical management
What drugs are used for complicated UTI and any contraindications?
- amoxicillin, vancomycin
- contraindicated in renal failure
Describe acute bacterial prostatitis and its clinical presentation
- usually spontaneous but can follow urethral instrumentation
- causes diffuse oedema and microabscesses
- causes perineal/back pain, UTI symptom, urinary retention, pyrexia
- urology referral necessary
What are the complications of acute bacterial prostatitis?
- prostatic abscess
- spontaneous rupture (urethra, rectum)
- epididymitis
- ascending infection
- systemic sepsis
What investigations would you want to carry out if suspecting acute bacterial prostatitis?
- urine and blood cultures
- trans-rectal US
- CT/MRI
- no prostatic secretions
What are the likely causes and treatment for acute bacterial prostatitis?
- causes: gram-neg bacilli, S. aureus, n. gonorrhoea
- treatment: antibiotic management - empirical (ciprofloxacin/ofloxacin), check previous microbiology
Describe chronic prostatitis and common causative organisms
- rarely associated with acute prostatitis
- can follow chlamydia urethritis
- causes recurrent UTI symptoms, back pain, low grade fever
- relapse common
- causes: gram-neg bacilli, enterococcus, s. aureus
Describe epididymitis and the clinical features of it
- inflammatory reaction to epididymis
- caused by ascending infection from urethra or urethral instrumentation
- symptoms: UTI/urethritis symptoms, pain fever, swelling, penile discharge
Describe orchitis and the clinical features of it
- inflammation of 1 or both testicles
- testicular pain and swelling
- dysuria
- fever
- penile discharge
- can be associated with viral causes (mumps) and bacterial infections
Describe the complications of bacterial orchitis
- pyogenic infection: severe and requires urological review, IV antibiotics (as per complicated UTI)
- testicular infarction
- abscess formation
Describe Fournier’s gangrene
- form of necrotising fasciitis
- > 50y
- rapid onset and spread
- systemic sepsis
What are the risk factors for Fournier’s gangrene?
- UTI
- complications of IBD
- truma
- recent surgery
What are the causes and management of Fournier’s gangrene?
- causes: mixed, mainly gram-neg bacilli and anaerobes
- blood and urine cultures
- tissue/pus sample
- surgical debridement (1st line)
- broad spectrum antibiotics (pip-tazobactam + gentamicin + metronidazole +/- clindamycin)
