UTI (including Pyelonephritis)

Question 1

Define the following terms;

• Bacteriruia
• Urinary tract infection
• Urethritis
• Cystitis
• Prostatitis
• Pyelonephritis
• Abacterial cystitis/ urethral syndrome

Answer 1

Bacteriuria - bacteria in urine

Urinary tract infection - presence of a pure growth of >10⁵ organisms per mL of fresh MSU (midstream specimen of urine)

Urethritis - UTI of urethra

Cystitis - UTI of bladder

Prostatitis - UTI of prostate

Pyelonephritis - UTI of renal pelvis

Abacterial cystitis/ urethral syndrome - 1/3 of women with symptoms have bacteriuria, 2/3 have no bacteriuria but still have symptoms

Question 2

How do you classify UTIs?

Answer 2

Uncomplicated;

• Normal renal tract & function

Complicated;

• Abnormal renal/ GU tract
• Voiding difficulty/ outflow obstruction
• Low renal function
• Impaired host defence
• Virulent (severe) organism (staph aureus)

A relapse is a further infection with the same organism.

Question 3

What are risk factors for UTI?

Answer 3

Sexually active pregnant female using spermacide going through menopause with low immunity

Urinary tract;

• Obstuction, stones
• Catheter
• Malformation

Question 4

What are the main organisms in UTIs?

Answer 4

• E. coli (gram -ve rod, 70% community, 40% hospital)

Question 5

What is the danger with UTIs & pregnancy?

Answer 5

UTI is common & often asymptomatic, until serious pyelonephritis, premature delivery (+/- fetal death) supervenes.

DO routine dipstix in pregnancy!

Question 6

What are the symptoms of;

• Acute pyelonephritis
• Cystitis
• Prostatitis

What are the common signs for UTIs?

Answer 6

Symptoms

• General fever, malaise, nausea, vomiting
• Loin pain & tenderness (pylonephritis), suprapublic pain (cystitis)
• Frequency, dysuria, urgency, smell
• Strangury (painful, freq, straining)
• Haematuria

Prostatitis;

• Low backache
• Few urinary symptoms
• Swollen/ tender prostate on PR

Signs;

• Fever
• Abdo/ loin tenderness
• Foul-smelling urine
• Distended bladder/ enlarged prostate

Question 7

What investigations would you perform for suspected UTI?

Answer 7

• Urine dipstick
  
  • Nitrites (bacteria)
  • Leucocytes
• Midstream urine sample
  
  • Microscopy, culture & sensitivity
  • Diagnostic: pure growth >10⁵ organisms/mL
• Bloods; FBC, U&E, CRP, blood cultures (if systemic)
• USS; distended bladder

Question 8

What is pyruria, and what are causes of sterile pyuria?

Answer 8

Pyruia - urine + pus

Sterile pyuria - sterile urine (by standard techniques) which contains WBCs

• UTI
• Appendicitis, prostatitis, cystitis
• Tumour
• Nephritis, polycystic kidney

Question 9

How do you prevent a UTI?

Answer 9

• Drink more water
• Antibiotic prophylaxis
• Cranberry juice!