UTI

• What is the difference between lower & upper UTIs?

  Lower -> bladder infections (cystitis)

  Upper -> kidney infections (pyelonephritis)
• What are the RFs for lower UTIs?

  Sexual activity

  Female

  Postmenopausal women

  Pregnancy

  Catheterisation

  Males w/prostatic hypertrophy or prostatitis

  Dysfunctional voiding

  Anatomical abnormalities

  Immunosuppression
• What are the common causative pathogens of lower UTIs?

  E.coli (80%)

  Klebsiella pneumoniae

  Proteus mirabilis

  Staphylococcus saprophyticus

  Enterococcus faecalis
• What are the signs & symptoms of lower UTIs?

  Dysuria

  Urinary frequency

  Urinary urgency

  Incontinence

  Haematuria

  Cloudy/offensive smelling urine

  Lower abdo (suprapubic) pain

  Fever (typically loew grade)

  Malaise

  Acute confusion (in elderly pts)
• What are the Inx for lower UTIs?

  Obs

  Full Hx & examination

  Urine dip

  MSU culture & microscopy

  Bloods (if systemic upset -> VBG, FBC, CRP, U&Es)

  USS of urinary tract (if recurrent)

  Cystoscopy (if recurrent)
• What are the DDx of lower UTIs?

  Interstitial cystitis

  STIs (gonorrhoea, chlamydia)

  Urolithiasis

  Urethral carcinoma
• What is the management of lower UTIs?

  Non-pregnant women

  • Trimethoprim or nitrofurantoin for 3 days
  • urine culture if > 65 yrs or haematuria

  Men/catheterised

  • trimethoprim or nitrofurantoin for 7 days

  Pregnant women

  • send for culture
  • Abx for 7 days (1st line = nitrofurantoin (avoid in 3rd trimester), 2nd line = amoxicillin or cefalexin, also avoid trimethoprim in 1st trimester)
• What are the possible complications of lower UTIs?

  Pyelonephritis

  Sepsis

  Renal abscesses

  Urosepsis
• What are the RFs of pyelonephritis?

  Female

  Diabetes mellitus

  Factors that reduce flow of urine (stones, benign prostatic hyperplasia, tract abnormalities, spinal cord injuries)

  Catheter use

  Pregnancy

  Immunosuppression
• What are the signs & symptoms of pyelonephritis?

  Fever

  Loin/back pain

  Nausea

  Vomiting

  Costovertebral angle tenderness
• What are the Inx of pyelonephritis?

  Obs

  Full Hx & examination

  Urine dip

  MSU for culture & sensitivity

  Bloods (FBC, CRP, U&Es, cultures (if septic))

  Renal USS
• What are the DDx of pyelonephritis?

  Cystitis

  Acute prostatitis

  Urethritis

  Pelvic inflammatory disease

  Pelvic pain syndrome

  Lower lobe pneumonia

  AAA

  Ectopic pregnancy
• What is the management of pyelonephritis?

  Abx (7-10 days)

  IV fluids

  Analgesia

  Antiemetics (if needed)

  Surgery (to drain renal abscess (rare))
• When does pyelonephritis require hospital admission?

  Pregnant women

  Pts not improving despite 48 hrs of treatment

  Severe pain

  Pts with signs of severe illness (tachycardia, hypotension, reduced urine output, tachypnoea, confusion)

  Pts unable to tolerate oral fluids/meds

  Pts at risks of complications (diabetes, < 3 months, > 65 yrs, known GU abnormality)
• What are the possible complications of pyelonephritis?

  AKI

  Urosepsis

  Perirenal abscess

  Premature labour in pregnancy

  Chronic pyelonephritis