UTI Lecture Notes PDF

Urinary Tract infections Dr Vasundra  Lecture outline Definition Risk factors Causative organisms UTI – types Clinical features Complications Diagnosis Management Prophylactic measures UTI in dialysis patients ...

Urinary Tract infections Dr Vasundra  Lecture outline Definition Risk factors Causative organisms UTI – types Clinical features Complications Diagnosis Management Prophylactic measures UTI in dialysis patients  Definition A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Presence of 100,000 organisms /ml of mid-stream urine sample (MSU) is significant Women are greater risk of developing UTI Women are prone for cystitis and pyelonephritis Men are prone for urethritis and prostatis  Risk factors Female – short urethra – Urethral damage – sexual trauma Systemic diseases – Immunodeficiency states – Diabetes  Risk factors Abnormal drainage of urine (Residual urine left after micturition) – Renal calculi /BPH /obstruction – Pelviureteric Junction obstruction – VUR – Instrumentation – UV prolapse – Neurologic bladder Pregnancy  Causative organisms Most of them are ascending infections Gram negative 75% caused by E coli from faecal reservoir Other organisms include klebsiella Proteus, Pseudomonas, Gram positive Streptococci, Staphylococci  UTI- Types Location: Upper urinary infection – Pyelonephritis – Ureteritis Lower urinary infection – Cystitis – Prostatitis – Urethritis  UTI- Types Nature of the disease Complicated UTI - Is considered to be present when there are underlying factors that predispose to ascending bacterial infection. E.g recurrent UTI in patient with BPH Uncomplicated UTI -Occurs without underlying abnormality or impairment of urine flow. E.g UTI in a young adult for first time  UTI- Types UTI in pregnancy : Asymptomatic bacteriuria - patient is asymptomatic Both symptomatic bacteriuria and asymptomatic bacteriuria must be treated Amoxicillin is ideal antibiotics  UTI- Types UTI in Male: Mainly due to structure/ functional anomaly Antibiotics given depends on the co- exiting organ affected (epididymis/ prostrate) -Cipro preferred  UTI- Types UTI in catheterised patient: Sudden fever, flank pain, haematuria, altered mental status may be indicative of UTI in catheterised patient  Clinical features Urethritis: Pyelonephritis: – Dysuria – Fever with/without chills – Strangury – Upper back pain Cystitis: – Nausea/ vomiting – Hematuria, pyuria – Dysuria – Frequency – Low abdomen pain – Back pain – Smelly cloudy urine  Complications Recurrent infections Renal damage In pregnancy – risk of preterm labour, LBW Sepsis Urethral stricture in male  Diagnosis Urine (clean, mid catch sample) – Dipstick – albumin, WBC, nitrites – Microscope – WBC, pus, RBCs – Cultures  Diagnosis Imaging – Xary – KUB USG- KUB, CT- KUB – voiding cystography - for visualizing a person's urethra and urinary bladder while the person urinates. Cystoscopy Renal function test  Management Antibiotics – Oral/ parenteral – Course depends on the disease 1 week for mild; 2 week for moderate to severe – Ciprofloxacin, Amoxiclav, Norfloxacin, Cephalosporins. Alkaliniser – Potassium citrate mixture 10ml in a glass of water three times a day, It alkalinizes the urine and relieves dysuria. Pain relief – Bladder relaxants (Flavoxate 200 mg TID) Hospitalisation  Prophylactic measures Plenty of fluid intake Frequent emptying of bladder – Double micturition at bedtime – Emptying bladder before & after intercourse Application of 0.5% cetrimide cream to preurethral area before intercourse Antibiotic prophylaxis Estrogen cream for postmenopausal women  UTI in dialysis patients UTI increases the risk of complications in CKD patients. Factors affecting the treatment: – compromised immune system – inability to completely void the bladder – chronic comorbidities High range antibiotics are required – vanco ertapenem. Why the antibiotics are given during last 30 min or after the dialysis?