UTI and pyelonephritis

Question 1

Define UTI and pyelonephritis

Answer 1

A UTI is an infection within the urethra or bladder (lower), and pyelonephritis is an infection in the kidneys.

Question 2

What is the difference between uncomplicated and complicated UTI, and urosepsis?

Answer 2

Uncomplicated: lower UTI with normal structure and neurology

Complicated: upper UTI +/- systemic signs and symptoms

Urosepsis: complicated UTI with SIRS

Question 3

What are clinical features of UTI?

Answer 3

• Suprapubic discomfort
  
  • Dysuria
  • Urgency
  • Frequency
  • Cloudy, blood stained, smelly urine
  • Low-grade fever
  • Sepsis
  • Failure to thrive, jaundice; in neonates
  • Abdominal pain and vomiting in children
    Nocturia, incontinence, confusion in the elderly

Question 4

What organisms cause UTI?

Answer 4

Anaerobes:

- E coli
- Klebsiella
- Proteus
- Pseudomonas 

Gram positive

- Strep e.g. strep agalactiae 
- Enterococcus 
- Staph 

Candida

Question 5

What investigations for UTI?

Answer 5

Urine dipstick
Urine culture and microscopy

Post-void residual: done in women to see if incomplete bladder emptying is cause of UTI

CT/US: if suspected anatomical cause

Question 6

How long should you give Abx for in UTI>

Answer 6

Non-pregnant women: 3 days

Children/menpregnant women: 7 days

Pregnancy: avoid trimethoprim in 1st trimester, Avoid nitrofurantoin near term)

Question 7

What defines a recurrent UTI?

Answer 7

> 2 episodes in 6 months or >3 episodes in 1 year.

Question 8

What are complications of catheters?

Answer 8

CAUTI
Obstruction hydronephrosis
renal stones
Longer term risk of bladder cancer

Question 9

What investigations and treatment for suspected pyelonephritis?

Answer 9

Urine and blood culture

imaging: can show abscesses
- If uncomplicated, treat for 7-14 days
- If complicated, treat for over 14 days.