UTI Flashcards
Define UTI
Infection of the kidneys, bladder or urethra
Most common UTI
Infectious cystitis
Infection of the kidney
Pyelonephritis
Inflammation of the urethra
Urethritis
Epidemiology UTI
- 10% of females >18 annually
- 20-40% of women have recurrent UTI
- M < F
- Most common bacterial infection
Most common cause of UTI
Escherichia coli - 70-95% uncomplicated
Second most common cause of UTI
Staphylococcus saprophyticus (5-20%)
Common causes of uncomplicated UTI
- Enterobacteriaceae = Proteusmirabilis, Klebsiella
- Enterococci
- Group B strep
- P.aeruginosa
- Citrobacter
Bacteria causing complicated UTIs
Most resistance to antibiotics
- P.aeruginosa
- Enterobacter
- S.aureus
- Enterococci
MRSA is a rare cause of …
Uncomplicated cystitis and pyelonephritis
2 things that are considered complicated UTIs
- Pregnancy
- Kidney involvement
Complicated UTIs
- Increased colonisation
- Decreased efficacy of treatment
- Anatomical or functionally abnormal urinary tract
- Immunocompromised host
- Multi-drug resistant bacteria
Uncomplicated UTI
- Infection in a health person
- Anatomically and functionally normal urinary tract
Upper UTI structures
- Ureters and kidneys
Lower UTI structures
- Bladder and urethra
Upper compared to lower UTI
- Upper more rare than lower
- Upper generally more severe than lower
Most common route of infection (UTI)
Ascending pathway (colonise vagina then ascend)
Bladder stasis and UTI
- Impaired defence - no emptying
Define recurrent UTI
> 3 UTIs in 12 months
Signs and symptoms of UTIs
- Dysuria
- Urinary frequency
- Back pain
- Gross haematuria
UPPER
- Urgency
- Supra-pubic pain
- Fever
- Costovertebral tenderness
First diagnostic test in UTIs
Dipstick test
- Postive nitrates and leukocytes
Even if dipstick test is negative, if clinical picture fits, diagnosis is likely
Other tests for UTIs
- MCS - midstream urine - test if symptoms atypical
- Imaging - if treatment failed or persistent symptoms
- Renal US
- Abdominal pelvic CT
- Cystoscopy - rule out lower tract abnormalities
- Post-void residual
Post-void residual and UTIs
- PVR >100mL - not emptying bladder to completion
- Promote infection
UTI DDx
- Over-active bladder
- Urothelial carcinoma - upper UT or bladder
- Non-infectious urethritis
- Foreign body in bladder
- Vaginitis
- STI
- Interstitial cystitis
- Urethral diverticulum
Risk factors for UTIs
- Sexual activity
- Spermicide use
- Post-menopause
- Positive family history
- History of recurrent infections
- Presence of foreign body
- Insulin treated diabetes
- Many previous UTIs
- Recent AB use
- Poor bladder emptying
- Older age
Management of acute, uncomplicated UTI
- Oral antibiotics - Nitrofurantoin, Trimethoprim
Management acute UTI - with resistance
- Ciprofloxacin
- Levofloxacin
(Quinolones)
Management of acute, complicated UTI
- Pregnant = Cefalexin
- Not-pregnant = Ciprofloxacin
Longer treatment for complicated
Management for recurrent UTI - pre-menopause
- Nitrofurantoin
Management for recurrent UTI - menopause
- Intra-vaginal oestrogen therapy
Uncomplicated UTI treatment
Short course AB - 3-5 days
Why is Nitrofurantoin in no recommended as treatment for UTI in pregnancy
- Baby-haemolytic anaemia
Complications UTI
- Renal and peri-renal abscess
- Emphysematous polynephritis
- Xanthogranulomatous pyelonephritis
