Infection

Question 1

What organisms can cause UTI’s?

Answer 1

E-Coli

Proteus

Klebsiella

Enterococcus Faecalis

Pseudomonas

Staph Saprophyticus

Question 2

What sex are UTI’s more common?

Answer 2

F>M, affects 30% of women in their lifetime

Short urethra and proximity to the rectum allowing colonisation with bacteria from large bowel

Question 3

What pathogen is the most common cause of UTIs?

Answer 3

E-coli

Question 4

What are the risk factors for UTIs?

Answer 4

Immunosuppression

Steroids

Malnutrition

DM

Female

Sexual intercourse and poor voiding habits

Trauma

• Damage to the female urethra during childbirth and intercourse

Congenital abnormalities

• Duplex kidney
• Urethral valves
• Prostate enlargement

Renal cysts

Stasis of urine due to poor bladder emptying

Foreign bodies

• Catheters become colonized rapidly

Oestrogen deficiency/Postmenopausal women

Fistula between bladder and bowel

Pregnancy

Excessive exposure to detergents

Question 5

How do UTI’s present?

Answer 5

Fever

Flank or suprapubic pain

N&V

Dysuria

Cloudy, offensive urine

Urgency/incontinence

Frequency

Chills

Lethargy

Confusion in the elderly

Question 6

What investigations are used in UTI diagnosis?

Answer 6

Dipstick

• Blood, protein, nitrites, leucocytes

Mid Stream Urine Sample (MSSU)/Urinalysis

US/IVU for men and children

• Scarring and clubbing for chronic pyelonephritis and reflux

Isotope studies for men and children

• Reflux and scarring

Micturating Cystogram

• Assess reflux nephropathy in children

Question 7

What antibiotics are used in UTIs

Answer 7

Amoxicillin 3-5 day course

Cephalosporin

Trimethoprim

Ciprofloxacin 14 day course for men to cover possibility of prostatitis

Question 8

What is cystitis?

Answer 8

Inflammation of the bladder

Question 9

What is urethritis?

Answer 9

Inflammation of the urethra

Question 10

What is prostatitis?

Answer 10

Inflammation of the prostate

Question 11

What organisms are associated with balantitis?

Answer 11

Candida albicans

Staph aureus

Strep B

Question 12

What is balantitis?

Answer 12

Inflammation of the glans penis that sometimes extends to the underside of the foreskin which is known as balanoposthitis

Question 13

How is balantitis managed?

Answer 13

Gentile saline washes

1% Hydrocortisone

Topical clotrimazole for 2 weeks if candidiasis

Oral flucloxacillin or clarithromycin if staph aureus or strep B

Circumcision if recurrent

Question 14

What is pyelonephritis?

Answer 14

Inflammation/infection of the kidney which can lead to scarring and consequently reduced kidney function

Question 15

What is epididymo-orchitis?

Answer 15

Inflammation of the epididymis/testis

Question 16

What organisms cause epididymo-orchitis?

Answer 16

Chlamydia trachomatis, most likely in young sexually active patients

Neisseria gonorrhoeae

E coli, most likely in patients with low STI risk

Mumps

Question 17

How does epididymo-orchitis present?

Answer 17

Unilateral testicular pain and swelling

• Gradual over minutes/hours as opposed to rapid in torsion

Dragging heavy sensation

Urethral discharge may be present

Tender on palpation, particularly over epididymis

Erythema to scrotum

Question 18

How is epididymo-orchitis managed?

Answer 18

If the organism is unknown

• Ceftriaxone 500mg IM single dose
• Plus doxycycline 100mg orally twice daily for 10-14 days

Tight underwear for scrotal support during illness

Abstain from intercourse during illness

Question 19

What causes polyuria?

Answer 19

Diuretics

Alcohol

Caffeine

Lithium

HF

Hypercalcaemia

Hyperthyroidism

Chronic renal failure

Hypokalaemia

Diabetes insipidus

Question 20

What does persistent pyuria and negative urine culture suggest?

Answer 20

Renal TB

Question 21

How are UTIs managed in catheterised patients?

Answer 21

No treatment if asymptomatic

7 day rather than 3 day course if symptomatic