UTI Flashcards
Give examples of UTIs.
- Pyelonephritis
- Renal abscess
- Cystitis
- Urethritis
- Prostatitis
- Epididymo-orchitis
What is the incidence of UTI?
- Common
- Accounts for around 6% of GP consultations
Who is usually affected by UTI?
- F:M 3:1
- Affects 30% of women at some time
What is UTI an important cause of in children?
CRF
What is the incidence of pyelonephritis in women?
3 per 1,000 women per year
What is the incidence of symptomatic UTI in men?
5 per 10,000 men per year
How prevalent is UTI as an HAI?
Accounts for around 38% of HAI (the largest contributor)
General factors which make an individual
more susceptible to UTI (or other infection)
include:
- Immunosuppression
- Steroids
- Malnutrition
- Diabetes
What factors may predispose someone to UTI?
- Female sex (short urethra)
- Sexual intercourse and poor voiding habits
- Congenital abnormalities e.g. duplex kidney
- Stasis of urine e.g. due to poor bladder emptying
- Foreign bodies eg catheters, stones
- Oestrogen deficiency in postmenopausal women
- Fistula between bladder & bowel
Why can wiping from front to back after a bowel movement cause UTI?
It may force germs into the urethra
What organisms usually cause UTI?
Bowel Organisms
- E. coli
- Proteus
- Klebsiella
- Entercoccus
How can bowel bacteria be transferred to cause UTI?
- Transurethral route
- Bloodstream
- Lymphatics
How may bacteria be transferred from the urethra to the bladder?
- Intercourse
- Catheterisation
What events usually occur to result in UTI caused AKI?
- Colonisation
- Uroepithelium penetration
- Ascension
- Pyelonephritis
- AKI
How can UTI be classified?
- Single episode (90%) vs recurrent
- Complicated vs uncomplicated
What are the clinical features (signs and symptoms) of UTI in children?
- Diarrhoea
- Excessive crying
- Fever
- Nausea and vomiting
- Not eating
What are the clinical features (signs and symptoms) of UTI in adults?
- Flank pain
- Dysuria (“like passing broken glass”)
- Cloudy offensive urine
- Urgency
- Chills
- Strangury (desperate to pee but only small/nothing comes out)
- Confusion (very old people)
What are the clinical features of acute pyelonephritis?
- Pyrexia
- Poor localisation
- Loin tenderness (renal angle)
- Signs of dehydration
- Turbid urine
How should UTI be investigated?
- MSSU
- Urinalysis in ward
- Microbiology in lab (microscopy and gram staining)
What are you looking for in the urinalysis carried out on the ward?
- Blood
- Leucocytes
- Protein
- Nitrites
When should culture and sensitivity be carried out on urine samples?
Bacteruria >10^5 CFU/ml
What should be carried out on children, males or recurrent UTI patients?
- US or IVU may be helpful
- Isotope studies to rule out reflux and scarring
What are the principles of UTI management?
- Identify the infecting organism & institute appropriate treatment
- Identify predisposing factors and treat if possible
What is the treatment for UTI?
- Fluids
- Antibiotics
- IV antibiotics (for severe infections)
What antibiotics can be used in the treatment of UTI?
- Amoxicillin
- Cephalosporin
- Trimethoprim
What can abnormal urinary tracts causes?
Infections and sometimes lead to renal impairment
What can cause an abnormal urinary tract?
- Anatomical / neurological abnormalities
- Stones
- Diabetes
How can reflux nephropathy present?
As UTIs in children
What causes damage in reflux nephropathy?
Damage is caused by reflux and infection
How can reflux nephropathy be investigated?
- Micturating cystogram (radionuclide 99Tc techniques)
- Assess progression by ultrasound scan & biochemistry
How is reflux nephropathy treated?
Surgery
What advice should be given to those with recurrent infections?
- Fluid intake 2l / day
- Void every 2-3 hours by day
- Void before bedtime & before and after intercourse
When should someone with an indwelling catheter be given antibiotics?
Only is the patient is symptomatic and the catheter should be replaced
What is inevitable with indwelling catheters?
Colonisation
What type of technique must be carried out with indwelling catheters?
Aseptic
What is important to note with bacteruria?
30% will progress to symptomatic illness
How can chronic pyelonephritis present?
- Scarring and clubbing
- Hypertension/CRF
- ?Reflux
What can chronic pyelonephritis progress to?
15% progress to renal failure
How is chronic pyelonephritis diagnosed?
Radiological diagnosis
