UTI Flashcards
What is UTI
Affects kidneys, ureters, bladder, urethra
Women at higher risk due to shorter urethra, more common in adults. UTIs in children more likely to be serious and should be investigated (may damage kidneys due to reflux)
What is upper UTI
Pyelonephritis
What is lower UTI
cystitis (inflammation of the bladder), urethritis, prostatitis
What are the organisms that cause UTI
Mainly Escherichia coli as it is in the gut, rarely fungi (candida) and viruses
Other:
Gram -: Klebseilla, Pseduomonas, Enterobacter, Proteus
Gram+: Staph, Strep, Enterococcus
What is the pathogenesis of UTI
Starts with contamination of the periurethral area with uropathogen from the gut. Bacteria can make biofilm to protect detection by neutrophils. Can cause epithelial damage by bacterial toxins and proteases. Can cause bacteraemia through colonisation of the kidneys
What are the symptoms of cystitis
dysuria, blood, discomfort in lower abdomen, pain in urination
What are the symptoms of urethritis
dysuria, urinary discharge
What are the symptoms of prostatitis
painful prostate on rectal examination
What are the symptoms of pyelonephritis
Fever, back pain, nausea or vomiting. In severe cases - sepsis
What is shown on urine dipstick
Dipstick: leucocytes, nitrite (gram negative bacteria), blood and protein
Microscopic examination to check for polymorphonuclear leucocytes (pus cells)
Urine culture to check for growth of pathogenic bacteria
What is required for bacterial culture to be confirmed
Confirmation: absence of prior abx therapy - 10^5 colony count
Contaminated specimens present with colony counts less than 10^4.
What is candiduria
Candiduria: frequently occurs in px with indwelling catheter. If grows in urine ,get rid of catheter. Treat only if symptomatic with fluconazole (amphotericin if resistant)
How to treat recurrent UTI
important to obtain urine culture and sensitivity to treat appropriately
Over 2 infections in 6 months. 3 UTIs in 12 months.
Reinfection: by different bacteria
Persistence: same organism from focus within the urinary tract
Causes: struvite stone (precipitates in alkaline urine), reflux (dysfunction of alves), ureteral stricture, obstruction
What are the causes of urethritis
Chlamydia trachomatis or Neisseria gonorrhoea
Chlamydia is frequently asymptomatic in female, but can present with dysuria, discharge or pelvic inflammatory disease
Send UA, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
Pelvic exam - send discharge from cervix or urethra for chlamydia PCR
What are the symptoms of prostatitis
Symptoms: pain in the perineum, lower abdomen, testicles, penis and with ejaculation, bladder irritation, bladder outlet obstruction and sometimes blood in the semen
