UTI - Learning Package Flashcards
What is cystitis?
Cystitis = inflammation of the bladder which can by due to infection (bacterial cystitis) or other cause
What is bacteruria?
Bacteruria = presence of bacteria in urine, note anterior urethra is not sterile and presence of urethral organisms washed out during micturition is not bacteriuria
What is pyuria?
Pyuria = presence of pus cells (neutrophil polymorphs) in significant quantities in urine
What is sterile pyuria?
Sterile pyuria = urine is negative on culture but significant numbers of pus cells present
What is acute pyelonephritis?
Acute pyelonephritis = infection of the upper urinary tract involving the kidneys
What is chronic pyelonephritis?
Chronic pyelonephritis = pathological condition with renal scarring and potentially loss of renal function
Describe the aetiology of UTI?
Aetiology in men:
- Prostatitis
- Infection of the prostate
- STIs
Aetiology in woman:
- Sex
What are some predisposing factors for UTI?
- In females, short urethra and its proximity to rectum
- Trauma to female urethra during coitus and childbirth
- In pregnancy due to stasis of urine allowing bacteria to flourish
- Anatomical abnormalities
- Congenital pelvi-ureteric junction obstruction, vesico-ureteric reflux, duplex kidneys, horseshoe kidney, urethral valves, prostatic enlargement etc
- Renal cysts
- Pre-existing renal parenchymal damage
- Such as from recurrent pyelonephritis
- Stones in urinary tract
- Immunosuppression including diabetes, prolonged steroid therapy, transplant rejection medication
- Instrumentation of urinary tract
- Presence of foreign body in urinary tract including catheter
How can UTI be classified?
- Complication
- Those which occur in situations other than young, sexually active woman
- Uncomplicated
- Occur in healthy, sexually active young woman
- Organisms usually E-coli or skin commensals such as staph saprophyticus
- Further investigations not required
What organisms are usually responsible for uncomplicated UTI?
- Organisms usually E-coli or skin commensals such as staph saprophyticus
In what situations should cultures be done to diagnose UTI?
There are many cases when clinical diagnosis of simple, uncomplicated UTI does not require lab confirmation and empirical antibiotics can be used
But, situations where cultures should be done:
- Woman with mild or limited symptoms for whom dipstick testing is inconclusive
- Suspected UTI in men
- Suspected acute pyelonephritis
- Pregnant woman with symptoms and for screening
- After failed antibiotic treatment or persistent symptoms
- Recurrent UTI
- Defined as >2 UTIs within 6 months or >3 in a year
- Children with suspected UTI
What is recurrent UTI defined as?
Defined as >2 UTIs within 6 months or >3 in a year
How is urine collected for culturing?
Urine collected with mid-stream urine (MSU), should be done early morning
Catheter specimens should be obtained from the catheter sampling port and not from the collection bag
What are some common organisms that cause UTI?
- E-coli most common cause
- Staph. Saprophyticus is a common cause in young sexually active woman
- Protease, Klebsiella and Pseudomonas are more often found in hospital patients
- Often associated with catheters
Other than culturing, what other investigation can help diagnosis?
Microscopy of unstained urine can also be carried out:
- To determine whether or not there are cells, casts or organism present
What are the classical symptoms of urinary tract infection?
- Dysuria
- Frequency of urination
- Suprapubic tenderness
- Urgency
- Polyuria
- Haematuria
Describe the general treatment for urinary tract infection?
- Antibiotics
- Drinking lots of fluid
- Alkalinising agents (OTC)
Describe the presentation of UTI in woman?
- Dysuria (pain on passing urine)
- Frequency (passing urine more often than usual in small amounts)
- Urgency (feeling that you need to pass urine)
- Suprapubic pain
- Polyuria (increased volume of urine)
- Haematuria (blood in the urine)
Describe the treatment for UTI in woman?
- If have 3 of above symptoms or severe symptoms should be treated with antibiotics without further investigation
- 3 day course
- If mild or only 2 symptoms or fever should have mid-stream urine (MSU) collected and dipstick test performed
- UTI unlikely if urine not cloudy
What can be detected in dipstick test?
- Nitrate (metabolic product of some bacteria)
- Protein (not normally detectable, sign of inflammation)
- Lecucocytes (leucocyte esterase is an enzyme found in leucocyte ie pus cells, marker of inflammatory response)
What is the commonest renal disease?
Acute pyelonephritis
Describe epidemiology of acute pyelonephritis?
(how common, age)
- Commonest renal disease
- Usually woman of child bearing age
Describe the presentation of acute pyelonephritis?
- Loin pain
- Fever
- Urinary symptoms less pronounced but possible
- Frequency and dysuria
- May be systemically unwell
- Bacteraemia in most severe cases
- Rigors, nausea and vomiting
What investigations are done for acute pyelonephritis?
- Urine cultured
- Blood culture if systemically unwell
Describe the epidemiology of catheter related infection?
(how common)
- Very common, 5% per day
Describe the epidemiology for asymptomatic bacteriria?
(who)
- Presence of bacteria in urine of asymptomatic woman and older men with prostatic hyperplasia is relatively common
What is asymptomatic bacteriruia associated with during pregnancy?
- Associated with increased risk of pyelonephritis and premature delivery
- Pregnant woman screened at booking by urine (MSU) culture and treated
Describe the aetiology of sterile pyuria?
- Usually renal tuberculosis
- Genito-urinary infections such as chlamydia trachomatis
- Non-infective pathology in bladder or kidney
What investigations should be done for sterile pyuria?
- Collect 3 early morning urine samples for a ZN strain and TB culture
Describe the treatment for simple cystitis in woman?
- Oral antibiotics to which organism is sensitive
- 3 day course of Trimethoprim or Nitrofurantoin
- Cultures taken if no response
Describe the treatment for suspected lower UTI in men?
- 14 days of quinolone such as ciprofloxacin to cover possible prostatitis
- 7 days of nitrofurantoin or trimethoprim if infection uncomplicated
Describe the treatment for acute pyelonephritis?
- 7 days of antibiotics guided by sensitivity testing
- Non-pregnant woman with ciprofloxacin
Describe the treatment for UTI during pregnancy?
- Nitrofurantoin
- Trimethoprim is not recommended during pregnancy
Describe the treatment for catheter related UTI?
- Only patients with symptoms treated
- Appropriate antibiotics preceded by changing the catheter
Describe the treatment for asymptomatic bacteriuria?
- No indication for treatment, other than in pregnancy or when operation procedure involving UTI is planned
Describe treatment for recurrent infections?
- Drink lots of fluids
- Emptying bladder after sexual intercourse
- Further investigations
- Gynaecological examination and IVP
- Long term antibiotic prophylaxis
- 1 tablet or nitrofurantoin or trimethoprim per night
