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
Conservative management options for recurrent UTI
good hygiene - wipe back to front, clean with water only
drink plenty
voiding after sex
timed voiding
Medical management options for recurrent UTI
cranberry capsules
D-mannose
topical oestrogen
Hiprex with vitamin C
intravesical GAG replacement
Pyelonephritis presentation
pyrexia
loin pain
rigors
urinary symptoms - dysuria, frequency, offensive smelling urine, haematuria
What investigations should be done in suspected pyelonephritis?
bloods - FBC, UE, CRP
urine dip/MSU/blood cultures
US KUB
Pyelonephritis initial management
IV gentamicin (5mg/kg)
IV fluids
Infected obstructed kidney causes
stone
tumour
stricture
external compression
Infected obstructed kidney management
urological emergency
needs urgent decompression - ureteric stent or nephrostomy
Complication of epididymoorchitis
scrotal abscess
What needs to be ruled out in suspected epididymoorchitis?
testicular torsion
STIs
Signs/symptoms of prostatitis
pelvic pain
mixed urinary and sexual symptoms
DRE - tender prostate
Fournier’s gangrene risk factors
DM
hypertension
immunosuppression
poor nutrition
Causative organisms of Fournier’s gangrene
staphylococcus
streptococcus
clostridium perfringens
How is urinary TB diagnosed?
dipstick - blood, WBC, no nitrites
EMU - AAFB
CXR + sputum
imaging (US, CT cystoscopy)
skin test
