UTI Flashcards
Which organisms commonly cause UTIs?
E. coli Proteus mirabilis Klebsiella Enterococcus Staph sprophyticus S. epidermis
What are the risk factors for UTI?
Women
Post-menopausal women
New sexual activity, particularly in young women
Indwelling urinary catheter or instrumentation of the urinary tract
Urinary tract stones
Urinary tract stasis (incomplete bladder emptying)
Diabetes mellitus or immunosuppression.
What is acute pyelonephritis?
Neutrophil infiltration of the renal parenchyma
Acute deterioration in renal function
What is reflux nephropathy?
Chronic pyelonephritis
Arises from childhood UTI and vesicoureteric reflux
Renal scarring, hypertension, CKD in later life
How are UTIs treated?
Trimethoprim twice daily for 3-7 days
Nitrofurantoin twice daily 5-7 days
Men with uncomplicated treated as above for 7-14 days A high 2 L daily fluid intake
How is pyelonephritis treated?
IV aztreonam, cefuroxime, ciprofloxacin or gentamicin
Switching to a further 7 days treatment with oral therapy when symptoms improve
What can occur in UTI in pregnancy?
If untreated 20% will develop acute pyelonephritis
Risk of septic shock, low birthweight and prematurity
What does sterile pyuria suggest?
Urethritis Gonorrhoea Chlamydia Recently treated UTI Appendicitis TB Bladder cancer
What are complications of pyelonephritis?
Renal abscess
Recurrent infections
Chronic pyelonephritis
Papillary necrosis
What are causes fo chronic obstruction that can lead to chronic pyelonephritis?
Bilateral obstruction: Congenital malformation (posterior urethral valve) Benign prostatic hyperplasia Cervical carcinoma Unilateral: Renal calculi
What are the investigations for UTI?
MSU dipstick (double +ve nitrites & leucocytes)
Midstream urine MCS
Ask if vaginal discharge (GUM pathology?)
Sepsis 6 if systemically unwell
Further investigations (male, children, treatment-resistant, recurrent, pyelonephritis):
USS - renal scarring/hydronephrosis
CT/IV urography - exclude stones, tumours, diverticula
