UTIs Flashcards
What are the main causes of obstruction to complete bladder emptying?
pregnancy
prostatic hypertrophy
renal calculi
tumours
strictures
What is the most common UTI pathogen?
Ecoli
What is the most common cause of someone developing a UTI?
ascending route from urethra to bladder
What is the difference between uncomplicated and complicated UTI?
uncomplicated = normal (anatomical and function) urinary tract
complicated = functional or anatomical abnormality (including catheters) - lower antibiotic threshold
What is an isolated UTI?
no previous UTI for 6mo
What is a recurrent UTI?
> 2 infections in 6mo or >3 in 12mo
What is relapsing UTI?
inadequate therapy
reinfection normally within same month (same organism)
Acute lower UTI symptoms
dysuria
urgency
frequency
Cystitis symptoms and signs
symptoms:
- frequency
- urgency
- suprapubic pain on postponing
- dysuria
- foul smelling, discoloured urine
- mild systemic upset
signs:
- temperature
- suprapubic tenderness
Cystitis investigations
urine dipstick
MSU for culture
Cystitis treatment
non-pharmacological (mild):
- fluids
- alkalinisation of urine (potassium citrate)
antibiotics:
- trimethoprim
- nitrofurantoin
- fosfomycin
- cefalexin
Uncomplicated UTI pathogens
Ecoli
other enterobacteriacae:
- proteus mirabilis
- K.pneumoniae
S.saprophyticus
What is the significance of S.saprophyticus infection?
only occur in urinary system
risk in pregnancy
Complicated UTI pathogens
Ecoli
other enterobacteriacae:
- proteus spp
- klebsiella spp
- citrobacter spp
- enterobacter spp
pseudomonas aeruginosa
enterococcus spp
Group B strep (if pregnant, need abx in labour)
candida spp
Where can UTIs come from?
ascending from perineum, vagina, large bowel
haematogenous: TB, Staph aureus
What antibiotics can be used for cystitis?
nitrofurantoin
trimethoprim
cephalexin
fosfomycin
What antibiotics are used for pyelonephritis/UTI sepsis?
IV gentamicin
b lactam/inhibitor
What antibiotics can be used for pseudomonas UTI?
IV gentamicin
IV piperacillin/tazobactam
IV aztreonam
IV meropenem
IV ceftazidime
IV/PO ciprofloxacin
Who should urine dipstick not be done on?
> 65y
catheterised
What would be positive on dipstick if UTI present?
leucocytes
nitrites
How are antibiotic sensitivities tested?
pellets of antibiotic placed on culture plate
bigger ring around pellet = infection sensitive to antibiotic
Symptoms of UTI in patient with a catheter
temperature
bladder pain
cloudy, smelly urine
single species on culture
How should catheter UTIs be treated?
replace catheter
treat as complicated UTI
Risk factors for recurrent UTI?
post menopausal
increased post void residual
urinary incontinence
vesical prolapse
