URINARY TRACT INFECTIONS

GOSBELL WEEK 7

DEFINITIONS
Cystitis: (acute or recurrent) clinical syndrome with inflammation of bladder and urethral epithelium. o Most common UTI o Usually females o Frequent and painful urination o Small amounts of turbid and sometimes smelly urine o Males: obstructive symptoms o Ddx: Chlamydia, gonorrhoea, HSV o Fever uncommon, but not impossible Pyelonephritis: Kidney infection causing flank pain, fever and chills. Sometimes difficult to distinguish from lower UTI Renal abscess: Usually a complication of Pyelonephritis. Fever, chills, flank/ abdo pain; urinary symptoms may not be present. Recurrent UTI: can be caused by re-infection or relapse. Difficult to differentiate. Can be treated by constant prophylactic antibiotics. o Reinfection is common in women o Relapsed UTI common in men with underlying anatomical disease or chronic prostatitis Acute bacterial prostatitis: High fever, chills, perineal back pain, UTI symptoms. DRE shows tender/ painful prostate. Bacteriuria almost always present. Treat with quinolones for 4 6 weeks (other antibiotics are either resistant or do not penetrate the prostate) Chronic bacterial prostatitis: difficult to cure. Episodes of recurrent bacteriuria with the same pathogen between prolonged asymptomatic periods. Non-bacterial prostatitis: most common type. No history of bacteriuria. Asymptomatic bacteriuria: significance depends on age and sex of patient. Not always treated. Predisposes to UTI.

CLINICAL PRESENTATIONS
Children with undifferentiated fever with no obvious focus Confused elderly patient with or without fever Anyone presenting with dysurial frequency Fever with loin/ back pain

DYSURIA
Important to take a sexual history to check for STIs, especially in young sexually active patients Tested by PCR of the urine Females: consider pelvic exam for STIs or any masses Males: Rectal examination to ascertain prostatic tenderness

PREDISPOSITION TO UTIS
Urinary tract abnormalities o Obstruction, calculi, congenital abnormalities, intrinsic compression, urethral obstruction, prostatic enlargement, intrarenal obstruction Vesicoureteric reflux less angulation in the ureter when it enters the bladder, causing reflux of urine during mictuition. Incomplete bladder emptying o Foreign bodies, calculi, indwelling catheter Systemic illness (e.g. T2DM)

TESTING MCS (MICROSCOPY, CULTURE & SENSITIVITY) PRETEST CONSIDERATIONS

MSU In-out catheter Bladder tap Bag urine Urodome specimens Catheter urines Refrigerate to 4C if unable to take straight to lab

DIPSTICKS
Check that they are not out of date! Be sure to wait the appropriate time to reaction Pyuria: WBC in the urine. Suggests UTI (inflammatory process). Shown as leukocytes on the dipstick.

BLOOD CULTURE
Important diagnostic test in pyelonephritis Essential to do blood cultures in evaluating febrile patients with suspected sepsis

IMAGING
Particularly for looking for obstruction (U/S or CT) Diagnosis of pyelonephritis

SERUM
Pyelonephritis is characterised by neutrophilia (high neutrophils); thrombocytosis (high platelets) makes abscess likely

UTI TREATMENT
Hydration Antibiotics (draw blood cultures and urine specimen first) Drainage of pus Relieving of obstruction