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Urinary tract infection (Complications (Pyelonephritis/ prostatitis,…
Urinary tract infection
Definition
UTI
Infection of any part of the UT
(kidney, ureters, bladder, urethra)
Upper UTI
Kidney and ureters
Lower UTI
Bladder and ureters
Complicated UTI
Infection by unusual organism
and/or infection in patient with
unusual urinary anatomy or function
Epidemiology
F>>M
Risk factors
Elderly
Anatomical UT deformity
Female
Indwelling catheters
Institutional care
Aetiology
Infection
Bacteria - E. coli, S. saprophyticus, proteus
Candida (rare)
Pathophysiology
Dehydration and incomplete bladder emptying predispose
Bacteria adhere, ascend from the urethra and multiply;
may also enter from iatrogenic insertion (e.g. catheter)
or haematogenous from another site
More common in women due to shorter distance between anus and urethral meatus, and shorter urethra
Ascend to the bladder (cystitis), can ascend ureters to kidney to infiltrate the kidney (pyelonephritis)
Classification
Complexity
Complicated
Uncomplicated
Anatomical
Lower UTI - urethritis, cystitis, prostatitis
Upper UTI - pyelonephritis
Clinical
presentation
Urinary symptoms
Dysuria
Frequency
Urgency
Stranguary
Haematuria
Smelly urine
General symptoms
Fever
Rigors
Malaise
N+V
Abdominal
pain
Radiation
Nil
Associated symptoms
Urinary - frequency, urgency, dysuria,
haematuria, smelly urine, oligouria (if AKI)
General - fever, rigors, malaise, N+V
Character
Dull, constant
Timing
Constant, progressive
Onset
Insidious
Exacerbating/relieving factors
Nil
Site
Suprapubic (cystitis)
Flank (pyelonephritis)
Low back (prostatitis)
Severity
Severe if upper UTI
Atypical (elderly)
Confusion/delerium, incontinence
Diagnosis
Examination
Abdo - pain/tender abdo,
tender kidneys, distended bladder
PR - tender prostate
Investigations
Bedside
Standard obs - fever
Bloods
RBC (raised WCC), CRP (raised),
U+E (check if AKI), LFTs
Blood cultures
Urine
Dipstick
(haematuria, nitrates, leukocytes;
sterile pyuria could suggest TB, inadequate
tx of prev UTI, appendicitis, prostatitis, tumour,
PKD, pubulointerstitial nephritis, papillary necrosis,
chemical cystitis e.g. cyclophosphamide)
MCS
History
Management
Initial ABCDE
Definitive
Conservative
Hydration
Frequent urination
Medical
Analgesia
Paracetamol
Antibiotics
Lower UTI: trimethoprim, nitrofurantoin
(if normal GFR), cephalexin (GFR<40)
Upper UTI: IV broad spec e.g. c-amoxiclav
Consult specialist if
male or pregnant
Referral
Children, men, tx failures,
recurrent UTIs, unusual organism
Complications
Pyelonephritis/
prostatitis
Abscesses
(renal, prostatic)
Hydronephrosis
Renal failure
Sepsis
Urinary stones
(proteus)
Obstetric issues
(cerebral palsy,
dev delay, foetal death)
Prevention
Medical
Prophylactic abx if recurrent UTIs
(continuous or post coital)
Conservative
Hydration
Cranberry juice/tablets