Bacterial causes of UTI
- E Coli (most common)
- Staph saprophyticus
- Klebsiella
Risk factors for UTI
- Female
- Sex
- Diabetes
- Immunocompromise eg HIV, IVDU
- Old people
- BPH in men
- Neuropathic bladder, horseshoe kidney
- Urine catheters
- Kidney stones
How much bacteria in urine is considered UTI
> 10^5 organisms per mL of fresh MSU
What is classified as upper UTI
kidney and ureters (pyelonephritis)
What is classified as lower UTI
bladder and urethra (cystitis, prostitis, urethritis)
Who gets treated for asymptomatic bacteruria
pregnant women
urology procedure patients with expected mucosal bleeding (making cuts)
Definition of short term catheter
<28 days
When should USS be done in UTI
- everyone with pyelonephritis
- first simple UTI in males (to exclude structural abnormality)
What might be seen on a suprapubic USS
- dilated ureter (lots of back pressure from reflux)
- stones
- enlarged kidney
- hydronephrosis (secondary to stone obstruction)
What blood test should be done if a patient has renal stones
Calcium levels in blood
Why is it important to exclude hydronephrosis on USS
If left untreated, may lead to chronic renal failure
Definition of catheter associated infection
Infection in anyone who has had catheter removed in last 48h
How to diagnose UTI in a patient with a catheter
Diagnosis of exclusion from fever
Do NOT use dipstick testing (not reliable)
Definition of AKI
- increased serum creatinine to 1.5x baseline in last 7 days
* Urine volume <0.5ml/kg/hour for 6h
Definition of CKD
eGFR <60 for 3 months, with or w/o kidney damage
How long should females be treated in an uncomplicated UTI
3 days
How long should males be treated in an uncomplicated UTI
5 days
In which groups of people is urine collected prior to commencing therapy
- Men
- Pregnant women
- Children <3 yr
- Suspected pyelonephritis
- Recurrent infection
- Suspected resistant organisms
- Single positive on urine dipstick (Leucocyte or Nitrite)
- Clinical symptoms not in keeping with urine dipstick testing
Cancers that can present with haematuria
- Endometrial cancer
- Prostate cancer
- Renal cancer/ Wilm’s tumour (nephroblastoma in children)
- Bladder cancer
- Urethral cancer
Infections that can present with haematuria
- UTI
- TB
- Schistosomiasis
- Infective endocarditis
Drugs that can cause haematuria
- NSAIDs
- sulfonamides
- cyclophosphamide
7 Causes of sterile pyuria
- Urinary stones
- Urinary tract tumours
- Drug reaction
- Chlamydia
- Brucellosis
- TB
- UTI partially suppressed by a/b
In UTIs, what do elevated PCT levels correspond with
Associated bacteraemia
