How to approach UTI?

Classification:

Uncomplicated UTI

Complicated UTI

1.The sites other than the bladder

2.Children

3.Most men

4.Pregnant women

5.Obstruction

6.Foreign body ( ex: catheter )

7.Elevated postvoiding residual volume

8.Renal transplant recipients

9.Surgical created ileal loop

Bacteriuria: Urine culture >10⁵ bacteria /ml

4 routes of bacterial entry to urinary tract.

1.Ascending infection

2.Blood borne spread

3.Lymphatogenous spread

4.Direct extension from other organs

Clinical presentation:

ü   Lower UTI- frequency, urgency, dysuria,haematuria

ü   Upper UTI- fever and chills, rigor and loin pain and symptoms of lower UTI.

Pyleonephritis:

ü   Fever and chills

ü   White blood cell casts in urine

ü   Back pain

ü   Nausea and vomiting

Elderly patients:

ü   Mostly asymptomatic

ü   Not diagnostic as the symptoms are common with age

DIAGNOSIS

Urinalysis

Urine culture

Imaging techniques – CT scan and MRI

Methods for urine collection:

1. Mid stream clean catch method

– preferred method

2. Catheterization

3. Suprapubic aspiration(SPA) –gold standard for urine collection

Treatment

ü   Symptomatic UTI- antibiotic therapy

ü   Asymptomatic UTI- no treatment required except in special situations

Non- specific therapy:

ü   More water intake

ü   Maintaining acidity of urine by fluids like cranberry juice

3 day therapy for Uncomplicated UTI

1. Quinolones

2. TMP-SMX

3. Beta-lactam antibiotics

Lower UTI

Trimethoprim, Nitrofurantion, ciprofloxacin, Co-amoxiclav

Acute pyelonephritis(for 10-14 days treatment)

Paranteral antibiotics

ü   Cefuroxime – 750mg i.v. Q8h

ü   Gentamycin - 80-120g i.v. Q12h（不建議使用，易導致AKI）

ü   Ciprofloxacin – 200mg i.v. Q12h

Ceftazimide, imipenam, ciprofloxacin – for hospital acquired pyelonephritis

Asymptomatic bacteriuria need antibiotic therapy for children, pregnant women, or patients who will undergo a traumatic genitourinary tract procedure.

Possible indications for treatment:

1.Renal transplant recipients

2.Neutropenic patients

3.Anatomic or functional anormalies of urinary tract

4.With indwelling catheterization

5.Diabetes mellitus

Perm-CATH infection

Reference

CMUH腎臟科教學內容