urinary tract infection ,ED care

1. Urinary tract infections
Dr Tess Jose
Intern
Emergency medicine

2. Lower urinary tract infections
 Cystitis
Urethritis
Prostatis

3. Symptoms
• Fever with chills
• Suprapubic pain
• Dysuria
• Urgency
• Frequency

4. UTI terminonology
• Uncomplicated UTI :without underlying renal
neurological diseases
• Complicated UTI: with underlying structural ,
medical or neurological diseases

5. Diagnosis
• Urine analysis
• Urine culture
Presence of pus cells >8/ HPF
, WBCs, RBCs
Bacterial count >1lakh/ml
(significant bacteruria)
Mandatory in men with UTI

6. ED care
• Analgesics
• Uncomplicated UTI
• NITROFURATOIN 100 mg BD x 5days
Or
TMP-SMX 160/800 bd x 5 days
Second line : quinolones x 3 days
• Complicated UTI
depends on culture and sensitivity
Refer to urologist
Admit if fever , severe pain unable to eat
/ drink
In pregnancy contraindicated
TMP-SMX
QUINOLONES
Catheterised , start antibiotics
when symptoms present

7. Acute pyelonephritis (pyelum –nephros-itis)
• Acute pyelonephritis is diagnosed in a patient with a proven urinary
tract infection who has loin pain and/or fever picket fence fever
(Inflammation of kidney and upper urinary tract that result from
bacterial infection of bladder)

8. Causes of acute pyelonephritis
• Vesicoureteral reflux
• Normal urine flow obstruction incomplete bladder emptying
residual urine ascent of infection pyelonephritis
• BPH
Kidney stones
• Catheterisation
• DM
• Loss of neurological control of bladder and spincter

9. Indications for admission with acute
pyelonephritis
• Dehydrated or unable to take oral fluids.
• Evidence of sepsis.
• Pregnancy.
• Failure to improve after 24 hours of antibiotics.
• Abnormal renal tract anatomy or function.
• Pre-existing renal impairment.
• Evidence of renal stones.
• Immunocompromised.
• Diabetes. ● Nephrostomy or ureteric catheters

10. ED care
• Antibiotics — IV Antibiotics for 7-10 days (guided by local antibiotic
policy).
• Fluid rehydration — orally or intravenously.
• Analgesia.

11. Acute prostatitis
Inflammation and infection localized to the prostate causes urinary
tract infections and pelvic pain

12. Symptoms
• Fever.
• Dysuria, frequency, and/or urgency.
• Acute urinary retention.
• Suprapubic/perineal pain.
• Tender prostate

13. Investigation
• Urine analysis
• Urine culture
• Gram staining of urethral swab

14. ED Care
• Antibiotics — a quinolone for 28 days is recommended.
• Analgesia.
• Laxatives if defecation is painful.
• Suprapubic catheterization if in urinary retention (uretheral
catheterization is not recommended due to the risk of disseminating
the infection).

15. Epididymo-orchitis
• Epididymitis is inflammation of the epididymis causing pain and
swelling,
• If testis is involved in the inflammatory process (epididymo-orchitis)

16. Symptoms
• Progressive testicular ache and swelling of the epididymis and testis.
• Low lying testis.
• Tender epididymis.
• Urethral discharge.
• Fever.

17. Investigation
• Urinalysis and culture.
• Chlamydia testing — urethral swab or urinary.

18. ED Care
• Antibiotics — quinolone (e.g. ciprofloxacin for 10 days), add in
doxycyline if Chlamydia is suspected.
• Patients should be followed up by genito-urinary medicine, if a sexual
transmitted cause is suspected,
• Urology

19. REFERENCES
• Tintinalli ‘s emergency medicine manual 8 th edition
• Medscape . Com