UTI Flashcards
Define Urinary Tract Infection (UTI)?
The presence of a pure growth oif > 10^5 organisms per mL of fresh MSU
What is the sub-classification of UTI?
Lower UTI
Upper UTI
What does the Lower UTI affect?
Urethra (urethritis)
Bladder (cystitis)
Prostate (prostatitis)
What does the Upper UTI affect?
Renal Pelvis (pyelonephritis)
What’s important to remember about the lab classification of UTI?
1/3 of women with symptoms of UTI will have a negative MSU
What is the other classification of UTIs?
Uncomplicated UTI
Complicated UTI
What are the characteristics of Uncomplicated UTI?
Normal renal tract and funxtion
What are the characteristics of Complicated UTI?
Abnormal renal/genitourinary tract, voiding difficulty/obstruction, reduced renal function, impaired host defences, virulent organism (e.g. S. aureus)
What are more UTIs caused by?
Escherichia coli
What are the other causative organisms of UTIs?
Staphylococcus saprophyticus
Proteus mirabilis
Enterococci
What are the atypical organisms that can cause UTI?
(usually in immunocompromised individuals)
Klebsiella
Candida albicans
Pseudomonas aeruginosa
What are the risk factors for UTIs?
Female Sexual intercourse Exposure to spermicide Pregnancy Menopause Immunosuppression Catheterisation Urinary tract obstruction Urinary tract malformation
What is the epidemiology of UTIs?
Very common
1-3% of GP consultations
The majority of women will have a UTI in their lifetime
Much more common in FEMALES
What are the presenting symptoms of Cystitis?
Frequency Urgency Dysuria Haematuria Suprapubic pain
What are the presenting symptoms of Prostatitis?
Flu-like symptoms
Low backache
Few urinary symptoms
Swollen or tender prostate on PR
What are the presenting symptoms of Acute Pyelonephritis?
High fever Rigors Vomiting Loin pain and tenderness Oliguria (if AKI)
What are the signs of UTI on physical examination?
Fever Abdominal or loin tenderness Foul-smelling urine Distended bladder (occasionally) Enlarged prostate (if prostatitis)
What investigations do we do for UTIs?
Urine Dipstick Urine Microscopy Urine Culture Ultrasound Bloods
What do we see on a Urine Dipstick for UTIs?
Positive leucocyte esterase and nitrites
What do we see in Urine Microscopy for UTIs?
Presence of leucocytes indicates infection
Why do we do Urine Culture for UTIs?
To exclude diagnosis of it the patient failed to respond to empirical antibiotics
Why do we do US for UTIs?
Rule out obstruction
What bloods do we do for UTIs?
FBC
U&Es - check renal function
CRP
Blood cultures - if systemically unwell and risk of urosepsis
What is the Empirical treatment of uncomplicated UTI?
Trimethoprin or Nitrofurantoin
Treat for 3-6 days
Men with UTI may need a longer course of antibiotics
What are some alternative treatments of UTIs?
Co-amoxiclav
Cefalexin
What is the other treatment of UTIs?
Prophylactic antibiotics may be used in certain circumstances (e.g. recurrent cystitis associated with sexual intercourse)
What can ascending infection lead to in UTIs?
Pyelonephritis Perinephric and intrarenal abscess Hydronephrosis or pyonephrosis AKI Sepsis
What complication is common in men with UTIs?
Prostatic involement (e.g. prostatitis)
What is the prognosis for UTIs?
GOOD prognosis with appropriate treatment
