Urinary Tract Infections, UTIs

Notes
  • Urinary tract infections (UTIs) are considered to be the most common bacterial infection.
  • UTIs are classified into two categories: Lower Urinary Tract Infections (LUTIs) and Upper Urinary Tract Infections (UUTIs)
  • LUTIs involve infections of bladder, ureter, urethra, and prostate glands
  • UUTIs involve infections of parenchyma and pelvis of the kidney and it is known as acute pyelonephritis
  • Statistics: women are by far more likely to be affected by UTI than men; about 50% of all women will have one UTI episode in their lifetime; approximately 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years.

##Causes of UTIs include:

  • Normal bacteria flora of GIT: Coli (causes majority of cases), Strep faecalis and Klebsiella
  • Specific organisms that cause UTIs: Proteus vulgaris and Pseudomonas sp (they particularly cause UTIs where there are congenital urinary tract malformations)
  • Bacteria that rarely cause UTIs: Staphylococcus aureus

##Risk factors for UTIs

  • Catheterization of bladder (catheter-associated UTIs are the most common nosocomial infections)
  • Diabetes mellitus
  • Infants
  • Elderly
  • Patients with spinal cord injuries
  • Multiple sclerosis
  • HIV
  • Obstruction of the urinary tract in:

_Pregnancy

_Prostrate hyperplasia

_Calculi

_Cervical prolapse

_Cystocele

_Tumors

_Vesicoureteral reflux

Symptoms

##Symptoms of LUTIs

  • Dysuria (painful micturition)
  • Strangury (severe pain and a strong desire to urinate).
  • Cloudy and occasionally foul smelling urine
  • Increased frequency of urination

##Symptoms of UUTIs

  • Lumbar (loin) pain and tenderness
  • Dysuria (painful micturition)
  • Strangury (severe pain and a strong desire to urinate).
  • Cloudy and occasionally foul smelling urine
  • Increased frequency of urination
  • Fever
  • Vomiting
  • Palpable kidneys
Diagnosis
  • Urinalysis: the WBC >10WBC/mL for catheter specimen or uncentrifuged midstream urine (that should be tested within the 2 hours after collection or it should be refrigerated at 4 degrees C and tested within the next 24hrs )
  • Culture of urine specimen and bacteria colony count (>100,000 CFU is diagnostics
  • Urine culture and sensitivity in case of recurrent infections
  • Intravenous urography (an X-ray and a special dye to facilitate visualization of kidneys, ureters, bladder and urethra). For
  • Full Blood Count (FBC)
  • Urea and electrolyte
  • Ultrasound for perinephric abscess
Differential
  • Sexually Transmitted Diseases such as gonorrhea and chlamydia
  • Over-active bladder
  • Non-infectious urethritis
  • Interstitial cystitis or painful bladder syndrome
  • Urethral diverticulum
  • Urethral cancer
  • Atypical infections e.g. TB, adenovirus
  • Radiation cystitis
Prevention

##Advice the patient:

  • To be taking a lot of water
  • After using bathroom wipe from front to back to prevent bacteria in the anal region from spreading to the vagina and urethra
Management

##LUTIs

  • Tabs Ciprofloxacin 250mg BD x 5/7 OR
  • Tabs Cefuroxime 125-250mg BD x 7/7
  • In children, urinary tract surgery and pregnancy: Tabs Nitrofurantoin  50 – 100mg QID x 5/7
  • Increased fluid intake
  • Analgesics such as Paracetamol and Ibuprofen

##UUTIs

  • Increased fluid intake
  • Analgesics such as Paracetamol and Ibuprofen

For adults:

  • Caps Amoxicillin 500mg TID x 10 – 14 days OR
  • Tabs Cotrimoxazole 2 TABS BD x 10 – 14 days

If admitted, give the following:

  • IV Ciprofloxacin 200mg BD or Tabs 500mg BD x 2 – 4 weeks OR
  • IV Ceftriaxone 1-2 gm  OD  x 2 weeks

For Children:

  • Syr Amoxicillin
  • Tabs Cotrimoxazole 24mg/kg BD x 10 – 14 days
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