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Urinary tract infections
Dr Tess Jose
Intern
Emergency medicine
Lower urinary tract infections
 Cystitis
Urethritis
Prostatis
Symptoms
• Fever with chills
• Suprapubic pain
• Dysuria
• Urgency
• Frequency
UTI terminonology
• Uncomplicated UTI :without underlying renal
neurological diseases
• Complicated UTI: with underlying structural ,
medical or neurological diseases
Diagnosis
• Urine analysis
• Urine culture
Presence of pus cells >8/ HPF
, WBCs, RBCs
Bacterial count >1lakh/ml
(significant bacteruria)
Mandatory in men with UTI
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
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)
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
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
ED care
• Antibiotics — IV Antibiotics for 7-10 days (guided by local antibiotic
policy).
• Fluid rehydration — orally or intravenously.
• Analgesia.
Acute prostatitis
Inflammation and infection localized to the prostate causes urinary
tract infections and pelvic pain
Symptoms
• Fever.
• Dysuria, frequency, and/or urgency.
• Acute urinary retention.
• Suprapubic/perineal pain.
• Tender prostate
Investigation
• Urine analysis
• Urine culture
• Gram staining of urethral swab
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).
Epididymo-orchitis
• Epididymitis is inflammation of the epididymis causing pain and
swelling,
• If testis is involved in the inflammatory process (epididymo-orchitis)
Symptoms
• Progressive testicular ache and swelling of the epididymis and testis.
• Low lying testis.
• Tender epididymis.
• Urethral discharge.
• Fever.
Investigation
• Urinalysis and culture.
• Chlamydia testing — urethral swab or urinary.
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
REFERENCES
• Tintinalli ‘s emergency medicine manual 8 th edition
• Medscape . Com

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urinary tract infection

  • 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