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Urinary Tract Infections, Asymptomatic Bacteriuria - Coggle Diagram

- - - - Acute/chronic pyelonephritis
        
        Affects renal pelvis, calyx, and parenchyma
      - Pyelitis
        
        Affects pelvicalyceal system without parenchyma (cortical area)
        
        Upper UTI
        
        Uncomplicated = Normal urinary tract
        
        Complicated = functional/anatomical abnormality and altered host defence
        
        Functional abnormalities
        
        Neurogenic bladder
        
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        Vesicourethral reflex
        
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        Structural/anatomical abnormalities
        
        Strictures
        
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        Tumors
        
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        Calculi (kidney stones)
        
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        Prostatic obstruction
        
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        Indwelling urinary catheters
        
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        Altered host defence
        
        Diabetes mellitus
        
        Immunocompromised
        
        Renal transplant recipients
      - Renal/perinephric abscess
    - - Cystitis
    - - Urethritis
        
        Lower UTI
    - - Prostatitis
- - - - Increases urine pH
        
        Promotes stone formation
    - - Allows motility
    - - Breakdown IgA
        
        More likely to bind receptors
  - - - From distant infection
      - Uncommon
      - Staph. aureus bacteraemia
      - Candida fungaemia
    - - From GIT
        
        Colovesical fistula
        
        Enterovesical fistula
- - - - Not done anymore usually
    - - Mild
        
        No nausea/vomiting
        
        Oral Fluoroquinolone
        
        10-14 days
      - Severe
        
        Admit to hospital
        
        IV Fluoroquinolone OR 3rd gen Cephalosporin
        
        Clinical improvement
        
        Oral antibiotics
        
        14 days
  - - - 1st line therapy
        
        Nitrofurantoin
        
        5 days
        
        Contraindicated in late pregnancy
        
        Trimethoprim
        
        3 days
        
        Trimethoprim/Sulphamethoxazole
        
        3 days
      - 2nd line therapy
        
        Ciprofloxacin/Levofloxacin
        
        3 days
        
        DO NOT use in pregnancy
      - Alternative therapy
        
        Not as effective
        
        Tend to have recurrences
        
        Co-amoxiclav
        
        7 days
        
        Cefaclor
        
        7 days
    - - Nitrofurantoin
        
        5-7 days
        
        Contraindicated in late pregnancy
        
        Risk of haemolytic anaemia in baby
      - Co-amoxiclav
        
        5-7 days
      - Cephalexin
        
        3-5 days
  - - - 7-14 days
    - - 7-14 days
    - - 10-14 days
    - - 10-14 days
    - - 10-14 days
- - - - DO NOT collect from drainage bag
        
        Collect from sampling port
    - - High false positives
        
        Negative result rules out UTI
        
        Confirm positive with suprapubic aspiration
    - - Gold standard; least likely to be contaminated
      - Method of choice for infants with sepsis
      - Not routine in older children/adults
    - - For those unable to self collect "reliable" specimen
    - - If unable to, refrigerate
      - If delayed > 24 hours, use preservative vials/tubes
  - - - WBCs
        
        Pyuria if >5-10 WBC/hpf
      - Bacteria
      - RBCs
        
        Haematuria
      - White cell casts
        
        Indicates infection in kidney
      - Squamous epithelial cells
        
        Indicates contamination
    - - Dip stick coated with chemicals dipped in urine
        
        Compare reactions to color chart
      - Leukocyte esterase test
        
        Indirect test for pyuria
      - Nitrite test
        
        Test for bacteriuria
        
        Bacteria produce nitrate reductase
        
        Reduces urine nitrate to nitrite
    - - For significant bacteriuria
        
        ≥100,000 CFU per mL urine
        
        Indicates infection
        
        1000 CFU/mL urine seen in males, gram + bacteria, and yeast infections
        
        Suggest antibiotics for symptomatic patients with ≥1000 CFU/mL urine
      - Loop method
        
        0.001 mL urine in calibrated loop
        
        Inoculate onto media
        
        Incubate 37ºC 18 hrs
        
        Colonies identify/counted
        
        One colony = one bacteria
        
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      - Bacterial count to estimate number of bacteria per mL urine
    - - Indications
        
        Pyelonephritis
        
        Complicated UTI
        
        Recent hospitalization/catheterization
        
        Transplant patients
        
        Prostatitis
        
        Pregnancy
        
        Diabetes
        
        Uncomplicated cystitis
        
        Cultures not always necessary
        
        Dipstick urinalysis
        
        Send if female has reucurrent UTI or doesn't respond to treatment
- - - - Elderly
  - - - Sepsis
        
        Septic shock
      - Renal/perinephric abscess
      - Emphysematous pyelonephritis
        
        Gas in renal parenchyma
      - Emphysematous pyelitis
        
        Seen in hyperglycaemic diabetic patients
        
        Enterobacteria ferments glucose
        
        Produces gas
        
        Gas in renal pelvis
      - Papillary necrosis
      - Impaired renal function/renal failure
      - Preterm infants
      - Low birth weight infants
- - - - Reduced bladder/urethral tone
    - - Mechanical pressure