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Urinary tract infection

Definition
  • UTI: Infection that affects part of the urinary tract.
  • Lower UTI (cystitis): Affects the bladder.
  • Upper UTI (pyelonephritis): Affects the kidneys.
Epidemiology
  • More common in females due to shorter urethra.
  • Faecal incontinence (colonisation by faecal flora)
  • Occurs at all ages but increased incidence in the elderly and sexually active females.
Causes
  • Escherichia coli (E. coli): Most common pathogen.
  • Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella, Enterococcus spp. among others.
  • Risk factors: Catheterisation, pregnancy, diabetes, urinary stasis, sexual activity, postmenopausal status in women.
Clinical Presentation
  • Lower UTI: Dysuria, frequency, urgency, hematuria, cloudy urine, suprapubic pain.
  • Upper UTI: Flank pain, fever, chills, nausea, vomiting, malaise in addition to symptoms of lower UTI.
Investigations
  • Urine dipstick: Nitrates, leukocyte esterase.
  • Urine microscopy & culture: To identify pathogen and its sensitivities.
  • Ultrasound or CT if structural abnormalities are suspected or recurrent infections.
Management
  • Lower UTI: Short course (3 days) of antibiotics like Nitrofurantoin, Trimethoprim or Amoxicillin.
  • Upper UTI: Oral or IV antibiotics such as Co-amoxiclav or Ciprofloxacin, depending on severity. Typically, a longer course (7-14 days).
  • Address underlying risk factors and causes.
  • Adequate fluid intake.
Complications
  • Sepsis.
  • Renal abscess.
  • Recurrent infections.
  • Renal scarring and impairment.

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