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What is severe sepsis?

sepsis and end organ damage, hypotension with SBP2mmol


What is septic shock?

severe sepsis with perisitant hypotension


Management of urosepsis?

diagnose with screening sepsis tool, treat with sepsis 6, manage systemic factors, relieve pressure with catheter and nephrostomy


What is the sepsis 6 treatment?

high flow o2, blood cultures, iv antibiotics, iv fluid resuscitation, check lactate, monitor hourly urine output

must do this within one hour then critical care support to complete early goal directed therapy


What is asymptomatic bacteriuria?

normal urine is sterile but is coming increasing common and may need treatment in pregnancy and children, bacteria ispresent in all catheterised patients


Why should you not treat asymptomatic bacteriuria?

increases antibiotic resistant organisms and does no sterilise the system or reduce the number of bacterial species, should only be done if symptoms occur


Why are intermittent self catheters preferred?

lowest risk of catheter related complications, and provides max protection for kidneys and better QoL


What is a UTI?

inflammatory response of urothelium to bacterial invasion associated with bacteruria and pyuria


What is the main organism to cause UTIs?


coagulated proteus sp., enterococci, Kiebsiella sp.


What is bacteriuria?

prescence or bacteria in the urine that can be asmyptomatic or symptomatic


When does bacteriuria need treating?

in pregnancy due to the risk of pyelonephritis and preterm labour risk


What is the difference between pathogenic and contaminant bacteriuria?

pathogenic is single isolate and contaminant is mixed growth


In who is bacteriuria most common?

over 70s, females, catheters, less common in those who have been circumcised


What is pyruria?

prescence of leukocytes in urine, appearing as pus in the urine, associated with infection as it is the hosts tissue response


Causes of pyruria?

treated UTI, appendicitis, calculi, bladder tumour, papillary necrosis, PKD, chemical cystisis, tubulointerstitial nephritis


Symptoms of cystisis?

dysuria, frequency, urgency, pain, haematuria, cloudy, smell


Treatment of cystisis?

hydration, cranberry, ibuprofen, antibiotics


Diagnosis of cystisis?

urine multistix dipstick

nitrates and leucocytes means UTI in 98.5% of cases as nitrates are a product of bacteria
pH >8 in urea splitting infections
S9 raised in concentrated/protein rich urine
glucose - DM increases UTI risk
ketones - raised in catabolic states

MC+S, clean catch


What is classed as a complicated UTI?

males, pregnant, children, reucrrent infection, immunocompromised, nasocomial infection, structural/functional abnormality, SIRS, urosepsis, associated disease


Treatment of uncomplicated UTI?

antibiotics e.g. trimethoprim, nitrofuratoin
increased fluids, void pre and post sex


Causes of antibiotic resistance?

extended spectrum B lactamase production reduces effectiveness of penicillins and cephalosporins

DNA changes e.g. plasma mediated, altered binding sires, altered permeability

repeated antibiotic course or not finished antibiotics


What is classed as a recurrent UTI?

>2 episodes in 6 months or >3 in 12 months
caused by reinfection, bacterial persistance or unresolved infection
can be same or different organism >2 weeks after stopping antibiotics


What is a UTI relapse?

recurrance of bacteriuria with the same organism within 7 days of completing treatment


Treatment of complicated UTI?

MSU needed, longer antibiotics course, USS scan, avoid spemicides and perfumed soaps, vaginal oestrogen replacement, prosnthrocyadins (cranberry), prophylaxis, GAG replacement, urovaxom for Ecoli infection


How many pregnant women will develop pyelonephritis?



What complications can complicated UTIs lead to?

renal papillary necrosis, renal or perinephric abscess with gram negative septicaemia


Who is most likely to get prostatitis?

men of all ages, most common one in men


What is the NIDDK/NIH classification for prostatitis?

1 - acute bacterial with s.faecalis and ecoli and chlamydia, presents with systemically unwell, fevers, rigors, significant voiding, pelvic pain, swollen prostate, treat with analgesia and levofloxacin

2 - chronic bacterial or non bacterial, symptoms >3 months, recurrent, pelvic pain, voiding LUTS, uropathogens and blood in urine, treat with anti inflammatorys and a blockers

3 - chronic pelvic pain syndrome and can be inflammatory or non inflammatory

4 - asymptomatic inflammatory prostatitis


Treatment of prostatitis?

1 - antibiotics e.g. gentamicin and co-amoxycillin
once well, 2-4 weeks quinolone
IRUSS guided abscess drainage if >1cm

2 - 4-6 weeks quinolone and a blocker and NSAIDs


What causes urethritis and the symptoms?

Neisseria gonorrhoea - urethral pus, dysuria, tenesmus, proctitis, discharge
nongonococcal urethritis - thinner discharge caused by c.trachomatis
non infective urethritis - traumatic, chemical, cancer