9 - Infection in Urinary System

ท้องน้อยภาษาอังกฤษ

Suprapubic

Why do females get UTIs more often than men?

Shorter urethra = easier path for bacteria to get to bladder

Cystitis definition, symptoms + reasons for them

Inflammation of the bladder wall

• Suprapubic/lower abdominal pain: Physically where the bladder is

• Frequency/urgency: Inflammation triggers stretch receptors even if the bladder isn’t full

• Dysuria: Urine passing an inflammed lining causes pain

• Hematuria: Blood vessels lining the bladder are damaged, causing bleeding into urine

Pyelonephritis definition, symptoms + reasons for them

Kidney infection

• Flank/upper back pain: Kidneys sit at the flanks, and inflammation will cause pain there, but it can radiate to the upper back

• High fever/chills/nausea/vomiting: Systemic symptoms due to bacteria going from kidney to the bloodstream, causing a systemic response

Urethritis definition, symptoms + reasons for them

Inflammation of ท่อปัสสาวะ

• Burning with urination: Similar logic to cystitis

• Discharge: Any pus made due to infection will drain out

ASB

• Stands for

• What is it?

• Asymptomatic bacteriuria

• A condition where there is a high amount of bacteria in urinary tract(>= 10^5 CFU/mL), but no symptoms are present

In a potential UTI case why do we prefer a culture over direct examination

1. Direct examination only tells bacteria presence, not number

2. Direct examination isn’t compatible with a further antibiotic sensitivity test

How fast do we have to test a urine sample?

1. If kept at RT, within an hour

2. If kept at 4 degrees celcius, within 6 hrs

Why do females need 2 positive samples for ASB diagnosis?

Because the shorter urethra in females makes it easier for the sample to be contaminated by things like vagina and anus

What are the conditions for a UTI to be a CAUTI?

1. Catheter has to be in place for 2 or more calendar days

2. Infection has to appear on the day of or the day after removal

Not only that, we need a urine culture with no more than 2 organisms present, and also one symptom of UTI

Main ascending, gut flora uropathogenic bacteria

1. E. Coli(UPEC)

2. Enterobacteriaceae(K. pneumoniae)

3. Enterococci

Other possible uropathogenic bacteria

• S. aureus: Can get to the kidney via the bloodstream

• S. saprophyticus: Ascends too, but from skin of genital/perineal region, found in young, sexually active women

• P. aeruginosa + A. baum: Healthcare associated infection

Lactobacili, gardenerella, viridans strep, corynebacterium, and bacillus are all…

Non-uropathogens, or contaminants

Main risk factor of UTI

• Urine stasis

Complicated vs uncomplicated UTI

• Complicated: Men, pregnant women, catheter associated cases, people with anomalies of the urogenital tract

• Uncomplicated: Healthy, non-pregnant woman w a normal urinary tract

Based on the anatomy/physio, NOT symptom severity

ASB treatment

• No treatment unless the patient is pregnant(Growing uterus can compress urinary tract and boost stasis), or about to undergo prostate surgery(Can lead to sepsis)

Do we treat uncomplicated UTIs with ATBs?

Yes

UTI antibiotics

• Nitrofurantoin or fosfomycin, best for cystitis

• Ceftriaxone for pyelonephritis