Classification
Uncomplicated
An infection of the urinary tract by a usual pathogen in a person with a normal urinary tract + normal kidney function.
Predisposing Factors
Females, Sexual Activity, Instrumentation, Pregnancy, Incomplete bladder emptying, Immunocompromise, Diabetes, Anatomical Abnormalities
General Area for referral of pain in those suffering from Cystitis
Suprapubic area
Organisms commonly found to have colonised the distal urethra and thus very rarely cause UTIs.
S.epidermidis, Corynebacteria, Lactobacilli, Anaerobes
First and Second Line for Lower UTI in Pregnant Women
1st) Nitrofurantoin
2nd) Amoxicillin (if culture is susceptible), or Cefalexin. (Microbiology to be consulted for alternative)
Complicated
Patient Demographics
Pregnancy, Women, Infants, The Elderly
Rare presenting symptom of Cystitis from a typical bacteria
Haematuria
Most common causative bacterial pathogen
GI tract Uropathogens i.e., E.coli
First and Second Line for Lower UTI in Non-Pregnant Women
1st) Nitrofurantoin, or Trimethoprim
2nd) Nitrofuranotin (if not used first line), Fosfomycin, or Amoxicillin (Only if culture is susceptible)
Relapse
UTI of the same causative strain inside 2 weeks of one another.
Comorbities
Diabetes Mellitus, Immunosuppression, Renal Failure, Renal Transplant
Collection of specifically urinary symptoms commonly present in UTI
Dysuria, Frequency (Nocturia), Urgency, Cloudy urine
Most common causative fungal pathogen
Candida
Oral and IV First Line for Pyelonephritis in Non-pregnant Women and Men
Oral) Cefalexin, or Ciprofloxacin. Co-Amoxiclav or trimethoprim if sensitivity known.
IV) Amikacin, Ceftriaxone, Cefuroxime, Ciprofloxacin, or Gentamicin. Co-Amoxiclav can be used in combination.
Reinfection
Further UTI >2 weeks post complete treatment of initial infection.
Infection Characteristics
Hospital Acquired Infection, Broad Antibiotic resistance, Prolonged symptomatic period before seeking care, Recent Abx use, Recent UTI
Chyluria
Cloudy urine
What causative organisms are most commonly found to be the cause for Haematogenous seeding to the Urinary Tract?
- S.aureus
- P.aeruginosa
- Salmonella Sp
Asymptomatic Bacteriuria in Pregnant Women
Amoxicillin, Cefalexin, or Nitrofurantoin
Recurrent
>/= 2 in 6 months or >/= 3 in 12 months.
Functional/Anatomical Abnormalities
Urinary Tract Obstruction, Prostatic Hypertrophy, Urethral Stricture, Presence of an indwelling (e.g.,Catheter)
Collection of symptoms not seen in Cystitis that enables differentiation between it and Pyelonephritis
- Pyrexia - Rigors - Flank Pain - Renal Angle Tenderness - Nausea and Vomiting
Causative pathogens most commonly involved in Catheter related UTI
- E.coli
- Enterobacteriaceae Proteus
- P.aeruginosa
- Candida
Oral and IV First Line for Catheter-associated UTI in Pregnant Women
Oral) Cefalexin
IV) Cefuroxime