UTIs Flashcards
What is the difference between lower urinary tract infections (UTIs) and pyelonephritis?
Lower UTIs: Infections limited to the bladder causing cystitis.
Pyelonephritis: Inflammation of the kidney due to bacterial infection, affecting both the kidney tissue and renal pelvis.
Why are women more prone to urinary tract infections?
Women have a shorter urethra, making it easier for bacteria (typically from feces) to reach the bladder.
What are the common sources of bacteria for UTIs?
- Fecal bacteria, particularly E. coli, travel from the anus to the urethral opening.
- Sexual activity and poor hygiene can also contribute.
- Urinary catheters are a possible source, leading to more serious and harder-to-treat infections.
What are the classic symptoms of a lower urinary tract infection (cystitis)?
- Dysuria (pain or burning when passing urine)
- Suprapubic pain
- Frequency and urgency
- Incontinence
- Haematuria (blood in urine)
- Cloudy or foul-smelling urine
- Confusion in older patients
What are the additional symptoms of pyelonephritis?
- Fever
- Loin or back pain (unilateral or bilateral)
- Nausea or vomiting
- Systemic illness (general malaise)
- Renal angle tenderness on examination
What are the key signs to distinguish between lower UTIs and pyelonephritis?
- Pyelonephritis has additional symptoms like fever, loin pain, nausea/vomiting, and renal angle tenderness.
- Lower UTIs typically lack these features and are less severe.
What is the significance of nitrites on a urine dipstick test?
Nitrites suggest the presence of gram-negative bacteria (e.g., E. coli), which reduce nitrates to nitrites. It indicates a UTI.
What does the presence of leukocytes and leukocyte esterase on a urine dipstick test indicate?
Leukocytes and leukocyte esterase indicate white blood cells, suggesting an infection or inflammation, typically from a UTI.
What is the difference between microscopic and macroscopic haematuria?
- Microscopic haematuria: Blood is only seen on a dipstick or under a microscope.
- Macroscopic haematuria: Blood is visible to the naked eye in the urine.
When should a midstream urine (MSU) sample be sent for culture and sensitivity testing?
- In pregnant patients
- For recurrent UTIs
- In cases of atypical symptoms
- If symptoms don’t improve with antibiotics
What are the most common causes of UTIs?
- E. coli (most common)
- Klebsiella pneumoniae
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
What is the first-line antibiotic treatment for lower UTIs in the community?
- Nitrofurantoin (avoid if eGFR <45)
- Trimethoprim (watch for resistance)
- Alternatives: Pivmecillinam, Amoxicillin, Cefalexin
What is the typical duration of antibiotic treatment for lower urinary tract infections?
- 3 days for uncomplicated UTIs in women
- 5-10 days for women with immunosuppression, abnormal anatomy, or impaired kidney function
- 7 days for men, pregnant women, or catheter-related UTIs
How is pyelonephritis treated?
- Community treatment (7-10 days): Cefalexin, Co-amoxiclav (if culture results available), Ciprofloxacin (with caution for tendon damage)
- Hospital treatment: Sepsis management, including sepsis six, IV antibiotics, and fluids
What are some potential complications of pyelonephritis?
- Renal abscess
- Kidney stones obstructing the ureter, causing further infection
What should be considered when treating UTIs during pregnancy?
- Antibiotics: Nitrofurantoin (avoid in third trimester), Cefalexin, Amoxicillin (only after sensitivities)
- Trimethoprim should be avoided in the first trimester due to the risk of neural tube defects.
Why should nitrofurantoin be avoided in the third trimester of pregnancy?
Nitrofurantoin can cause neonatal haemolysis (destruction of the baby’s red blood cells), and should be avoided in the third trimester.
What are the risks of trimethoprim in early pregnancy?
Trimethoprim is a folate antagonist, which can lead to congenital malformations like neural tube defects (e.g., spina bifida), especially in the first trimester.
