Condition- UTI

Question 1

What is a UTI?

• what is the specific name for an infection of the Lower urinary tract (bladder)?
• what is the specific name for an infection of the Upper Urinary Tract (kidneys and ureter)?

Answer 1

An infection of any part of the urinary system…

Cystitis= lower urinary tract infection (bladder)

Pyelonephritis= upper urinary tract infection (kidneys-mainly renal pelvis)

Question 2

what is the difference between a complicated and uncomplicated UTI?

Answer 2

Complicated is one that causes abnormal genital/renal function (voiding difficulty/obstruction, reduced renal function, impaired host defences, virulent )

Uncomplicated- normal genitourinary tract function

Question 3

What are the two most common bacterial causes of UTIs?

Answer 3

1. E. coli
2. Staphylococcus saprophyticus

Question 4

List some risk factors which increase the risk of developing a UTI?

Answer 4

• FEMALE
• Sexual Intercourse
• Exposure to spermicide
• +ve FHx
• Post menopause- decreased Oestrogen increases UTI risk
• Immunosupression
• Cathetrisation
• Urinary tract obstruction (stones)

Question 5

List some of the presenting symptoms of UTIs

Answer 5

FOUR SYMPTOMS ONE SIGN

• Dysuria
• Increased urinary frequency
• Haematuria
• Lower back pain
• Costovertebral angle tenderness
• May also have supra-pubic pain and tenderness

Question 6

How would you identify a patient with pyelonephritis?

Answer 6

• s

Question 7

Which investigations would you order for a patient with a UTI?

Answer 7

1. Bedside: temperature, urine dip (+ve leucocyte esterase and nitrates=> MSU)
2. Urine Sample: Urine dip, MSU sample–> urine culture MC&S
3. Bloods: Blood culture, U+Es, ACR, eGFR, WCC, ESR/ CRP
4. Imaging: US of kidneys

Question 8

For which group of patients presenting with UTI symptoms would you always send an MSU off for?

Answer 8

• Male
• Child
• Pregnant
• Immunosupressed
• Ill

Question 9

Which antibiotics would you prescribe to a patient with a E.Coli lower UTI?

Answer 9

TRIMETHOPRIM
NITROFURANTOIN

Question 10

How would you manage a female with a symptoms of an Upper UTI with vomitting and high fever?

Answer 10

• Hospitalisation IV gentamycin/ ceftiaxone
• Then oral gentamycin when patient is afebrile

Question 11

List some of the possible complications of a patient with UTI…

Answer 11

• Pyelonephritis
• renal/ peri-renal abscess
• Sepsis
• AKI