UTIs Flashcards
Definition of bacteriuria?
- Bacteria in the urine
- Not a disesase
Definition of a UTI?
- Acute urethritis and cystitis caused by a micro-organism
- Diagnosis based on symptoms and signs
- Mostly females affected
Definition of a lower UTI?
- Involves:
- Bladder (cystitis)
- Prostate (prostatitis)
Definition of an upper UTI?
- Pyelonephritis
- Infection of kidney/renal pelvis
Definition of Abacterial cystitis/urethral syndrome?
Diagnosis of exclusion in patients with dysuria and frequency, without being able to prove an infection
Describe the pathophysiology of UTIs?
- Urine is good medium for bacterial growth
- Women: shorter urethra, no bactericidal prostatic secretions
- Sexual intercourse can cause minor urethral trauma and transfer bacteria
Describe the classifications of a UTI?
- Uncomplicated
- Normal renal tract structure and function
- Complicated
- Structural/functional abnormality of the GUT
- eg obstruction, catheter, stones, neurogenic bladder
What are the risk factors for a UTI?
- Foreign bodies
- Lost of host defences
- Neurological problems
- Anatomical abnormalities
- Bladder outflow obstruction
What are the symptoms of Cystitis?
- Frequency
- Dysuria, Urgency
- Suprapubic pain
- Polyuria, Haematuria
What are the symptoms of Acute pyelonephritis?
- Fever, rigors, vomiting
- Pain: loin, costovertebral
- Associated cystitis symptoms
- Septic shock
What are the symptoms of Prostatitis?
- Pain:
- perineum, rectum, scrotum, penis, bladder, lower back
- Fever, malaise, nausea
- Urinary symptoms
- Swollen/tender prostate on PR
Clinical signs of all urinary tract infections?
- Fever, abdominal/loin tenderness
- Distended bladder, enlarged prostate
- If vaginal discharge, consider pelvis inflammatory disease
Describe the tests for a UTI?
- Dipstick (not for use in pregnant women)
- MSU culture
- FBC, U&Es, CRP,
- Imaging (for kidney/bladder involvement)
- USS, cytoscopy, CT
What are the organisms which can cause UTI?
- Usually anaerobes and gram negative
- E. coli (most common)
- Staphylococcus saprophyticus (skin commensal)
- Proteus mirabilis
- Klebsiella pneumonia
Describe E. coli?
Gram negative anaerobic coliform rod
Describe Proteus mirabilis?
- Gram negative anaerobic rod
- Gut commensal
- Stone formation due to urease production
- Breaks down urea to form ammonia
- Struvite stones then form in the presence of magnesiumm, calcium and phosphate
Describe Klebsiella pneumoniae?
- Gram negative encapsulated rod
- Colonizes skin, nasopharynx, GIT, hospitalized patients
- Association with antibiotic exposure, catheterization, immunosuppression
Causes of sterile pyuria?
(increased white cells but sterile on standard culture)
What should be ruled out as a cause?
TB should be ruled out
What is important to remember about the management of a UTI?
Antibitoics should not be used for the treatment of an asymptomatic bacteriuria in non-pregnant women, men and adults with catheters
Describe the treatment of non-pregnant women with a UTI?
- 1o: Trimethoprim (3 days)
- 2o Nitrofurantoin
- Trimethoprim/nitrofurantoin should not be used if GFR<30
- If first line fails then culture and treat according to sensitivity
Describe the treatment of a UTI in a pregnant woman?
- Seek expert help
- Refer to local guidelines
- Avoid
- 1st trimester: Ciprofloxacin, trimethoprim
- 3rd trimester: Nitrofurantoin
- Avoid
What is UTI in pregnancy associated with?
- Preterm delivery
- Intrauterine growth restriction
Describe the treatment of a UTI in men?
- Lower UTI:
- 7 days of trimethoprim/nitrofurantoin(eGFR>30)
- Prostatitis:
- 4 weeks of Fluoroquinolone (ciprofloxacin)
- Upper/recurrent UTI:
- Refer for urological investigation
Treatment for a UTI in someone who is catheterized?
- Send MSU only if symptomatic
- Symptoms: fever, pain, vomiting, confusion, sepsis
- Change catheter before starting anitbiotic
Describe Urinary tract TB?
- Cause of sterile pyuria
- Ask about malaise, night sweats, pain, visible haematuria
- Can cause interstitial nephritis and renal amyloidosis
Diagnosis of urinary tract TB?
- Microscopy with acid-fast techniques
- Mycobacterial culture of an early morning MSU
Treatment for Urinary tract TB?
- Rifampicin + isoniazid: 6 months
- Pyrazinamide + ethambutol: 2 months
Differentials for UTI?
- Urethritis from STI
- Urethritis associated with reactive arthritis
- Post-menopausal atropic vaginitis
Differentials for pyelonephritis?
- Acute appendicitis
- Diverticulitis
- Ectopic pregnancy
- Ruptured ovarian cyst
Prophylactic measures to be adopted by women with recurrent UTIs?
- Fluid intake of at least 2L/day
- Regular complete emptying of the bladder
- Emptying of bladder before and after sexual intercourse
- Cranberry juice may be effective
When does Asymptomatic bacteriuria require treatment?
- Infants
- Pregnant women
- Urinary tract abnormalities
Triad of Acute pyelonephritis?
- Fever
- Loin pain
- Tenderness over kidneys
Predisposing factors for Acute pyelonephritis?
- Cysts
- Renal scarring
Describe the treatment of Acute pyelonphritis?
- 1: Ciprofloxacin
- 2: Gentamicin
- IV fluids
- Renal tract US
- Exclude obstruction and perinephric collection
- If obstruction:
- Drainage by percutaneous nephrostomy
- Ureteric stent insertion
