Infectious diseases - UTIs

Question 1

What are the main bacterial causes of UTIs?

Answer 1

E-coli (main one)

Klebsiella pneumoniae (gram-negative anaerobic rod)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)

Question 2

Lower urinary tract infection presentation

Answer 2

Dysuria (pain, stinging or burning when passing urine)

Suprapubic pain or discomfort

Frequency

Urgency

Incontinence

Confusion is commonly the only symptom in older more frail patients

Question 3

Pyelonephritis presentation

Answer 3

Fever - more prominent feature than in UTI

Loin, suprapubic or back pain

General malaise

Vomiting

Loss of appetite

Haematuria

Renal angle tenderness on examination

Question 4

How to test for renal angle tenderness?

Answer 4

Hand on back over the kidney - thump hand with other first

Renal angle tenderness may be present in pyelonephritis

Question 5

Investigations in suspected UTI/pyelonephritis

Answer 5

Urine dipstick:

• Nitrites positive
• Leukocytes positive (There are normally a small number of leukocytes in the urine but a significant rise can be the result of an infection or other cause of inflammation)
• Nitrites are a better indication of infection than leukocytes

Midstream urine for C+S

Question 6

Management of UTI

Answer 6

Trimethoprim or Nitrofurantoin

3 days for simple LUTI in women

7 days of antibiotics for men, pregnant women or catheter related UTIs

Question 7

Alternative antibiotics for UTI

Answer 7

Pivmecillinam
Amoxicillin
Cefalexin

Question 8

Management of pyelonephritis

Answer 8

NICE recommend the following first line antibiotics for 7-10 days when treating pyelonephritis in the community:

Cefalexin
Co-amoxiclav
Trimethoprim
Ciprofloxacin