urinary tract infection...................................................

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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 I nflammation 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