Cystitis Flashcards
what is the definition of cystitis?
Acute cystitis is an infection of the urinary bladder most commonly affecting young, sexually active women. It can be classified as complicated or uncomplicated based on the presence of patient characteristics that would indicate a probable poor response to a short course of therapy
Asymptomatic bacteriuria
Uncomplicated - non-pregnant women
Complicated - everyone else
what is the epidemiology of cystitis?
Women most common More common in female children but can happen in all Rare in men High rate of asymptotic in elderly High rates in hospitals
what is the aetiology of cystitis?
Mainly e.coli (>50% of cases)
Proteus (renal stones)
Klebsiella (hospital / catheter associated)
Enterococci (low grade pathogen)
Staph.saprophyticus (young women)
S.aureus (deep seated infection)
Pseudomonas aeruginosa (recurrent UTI or other underlying pathology)
what are the risk factors for cystitis?
Frequent sexual intercourse History of UTIs Congenital abnormality Urinary catheter Asymptomatic bacteriuria Diabetes Spinal cord injuries Pregnancy Immunodeficiency Older age Lack of circumcision
what is the pathophysiology of cystitis?
Catheter allowing colonisation
Bowel flora - female shorter urethra so more common, sexual intercourse or poor hygiene
Prostatic hypertrophy, bladder stones or ureteric stones causing obstruction
Low urinary volume (dehydration) means less urine being flushed through bladder
Stasis during pregnancy
Strains of e.coli adhere more easily
what are the key presentations of cystitis?
Presence of risk factors Dysuria Urgency Frequency Suprapubic pain Prior history of UTI and treatment
what are the signs of cystitis?
Presence of risk factors
Recent UT instrumentation
what are the symptoms of cystitis?
Lower urinary tract - increased frequency, dysuria
Upper urinary tract - fever, haematuria
what are the first line and gold standard investigations for cystitis?
Urine sample - MSU (midstream urine), CSU (catheter urine sample), bag urine (more with infants), catch urine (children), superpubic aspirate, early morning urine (used for TB)
Dipstick - blood, protein, pH, ketones, glucose, nitrates, leucocytes
Microscopy - WBC (>10^4mbc/ml = pyuria), RBC, cast (can indicate renal infection or damage to kidney epithelium so glomerulonephritis), bacteria (>10^5cfu/ml show infection), epithelial cells (poorly taken specimen)
Cultures - can be used to tell what the organism is (cannot pick up TB, candida etc.)
what are the differential diagnoses for cystitis?
Pyelonephritis
Vaginitis
Interstitial cystitis
Chlamydia urethritis
how is cystitis managed?
Asymptomatic bacteriuria - don’t treat over 65 yrs, but treat others
Uncomplicated - treat empirically, 3 days of antibiotics (nitrofurantoin), don’t usually need sample, antibiotics adjusted if sample given, advice of fluid intake, hygiene
Complicated - send for culture, 7 days of antibiotics (levofloxacin)
Susceptibility testing - testing to find best antibiotics
Antibiotics:
Avoid broad spectrum, nitrofurantoin (don’t use in 3rd trimester, renal failure)
how is cystitis monitored?
In treating patients with uncomplicated acute cystitis, no follow-up monitoring is necessary. When treating patients with complicated acute cystitis, it is often useful to repeat a urinalysis and urine culture to be certain that the infection has resolved
what are the complications of cystitis?
Pyelonephritis, preterm delivery, urinary retention, recurrent UTI
what is the prognosis of cystitis?
Prognosis after treatment is excellent. As this condition is common, many patients will eventually have a recurrence. If the patient has a recurrence of the symptoms within 1 month of the treatment, urinalysis and cultures are indicated to verify the diagnosis and to guide therapy.
