UTI Flashcards
what bacteria are causes of UTI?
E. coli, proteus mirabilis, klebsiella pneumoniae, staphylococci’s saprophyticus
what is the most common bacterial cause of UTI?
E.oli
what are the bacterial causes of pyelonephriits?
o E. coli, pseudomonas, step faecalis, Proetus, Enterobacter
what are the haematogenous causes of pyelonephritis?
staphylococcus, E. coli (infective endocarditis, post-surgery, septicaemia
what are the risk factors to UTIs?
female, sexual intercourse, indwelling catheters, diabetes, obstruction, vesicoureteral reflux (due to failure of vesicoureteral orifice), pregnancy, constipation
what are the different types of UTI?
cystitis
prostatitis
pyelonephritis
what kind of symptoms does cystitis present with?
LUTS
what kind of symptoms does prostatitis present with?
LUTS
what kind of symptoms does pyelonephritis present with?
systemic symptoms
what are the virulence factors for bacteria in UTI?
o Flagella, aero bacterium , adhesions
o Urine pH and osmolarity – greater lower osmolarity and normal pH promote bacterial survival
o Commensals organisms prevent bacteria overgrowth
o Urine flow/micturition washes away bacteria – stasis promotes UTI
what is the pathway of infection in UTI?
- Enter through urethra – also blood, lymphatics or a fistula
- Ascending infection
what is the pathophysiology of pyelonephritis?
unilateral, bacteria adhere to renal epithelium of tubules, chemokines attract neutrophils to interstitial (normally glomeruli + vessels spread)
what are the clinical features of acute pyelonephritits?
high fever, rigors, vomiting, loin pain and tenderness, oliguria (if AKI)
what are the clinical features of cystitis?
frequency, dysuria, urgency, haematuria, suprapubic pain
what are the symptoms of prostatitis?
flu-like symptoms, low backache, few urinary symptoms, swollen or tender prostate on PR
what are the signs of UTI?
fever, abdominal or loin tenderness, foul smelling urine, occasionally distended bladder, enlarged prostate, pyuria
what investigations are done for UTI?
MSU
Urine Culture
Blood tests: FBC, U&E, CRP, culture
Imaging: USS, CTKUB, cystoscopy and urodynamics
when are MSUs done in UTI?
if symptomatic
Always send if male, child, pregnant, immunosuppressed or ill
how do MSU results guide management?
o +ve nitrites or leukocytes – treat empirically
o If -ve but symptomatic – MSU lab
what criteria of MSU results allow for diagnosis?
Bacteria of greater than 105
Bacteria of greater than 102 in the presence of pyuria
what is the management of UTI in catheterised patients?
o Do not use urinalysis. Do not treat unless clinical signs/symptoms of infection.
o If definite infection treat as per complicated uti.
what is the management of UTI in older patients?
o do not use urinalysis. Do not treat unless clinical signs/symptoms of infection.
o If definite infection treat as per guidance
what is the management of complicated uti/ pyelonephritis/ urosepsis ?
o iv amoxicillin + gentamicin (if penicillin allergic: iv co-trimoxazole + gentamicin)
o step down: po co-trimoxazole or as per sensitivities total iv/po 7 days
what is the management of uncomplicated female lower uti?
nitrofurantoin 100mg mr bd or 50mg qds or trimethoprim 200mg bd (3 days)
