Introduction to urinary tract infections

Question 1

What is a UTI ?

Answer 1

presence of organisms in the urinary tract and signs and symptoms of inflammation. UTIS can be complicated and also uncomplicated.

UTIS in men, pregnancy and children are all complicated

Around 1 in 3 women have had a UTI by the age of 24

Question 2

Organisms

Answer 2

MAJORITY OF INFECTIONS
- E.COLI
- STAPHYLOCOCCUS SAPROPHYTICUS
- PROTEUS MIRABILIS

LESS COMMON
- KLEBSIELLA SPP
- PROTEUS VULGARIS
- CANDIDA ALBICANS
- PSEUODOMONAS SPP
- STAPH EPIDERMIS

Question 3

UTI’s

Answer 3

LOWER UTI - this is generally considered to be infection of the bladder or urethra

UPPER UTI - this involves ureters or kidneys

PYELONEPHRITIS - inflammation of the kidney substance

Question 4

Complicated UTI’s

Answer 4

• older age
• male gender
• pregnancy
• diabetes
• HIV
• immunosuppression
• antibiotic use
• resistant organisms
• incomplete bladder emptying
• fq sexual activity
• abnormalities of urinary tract

Question 5

Signs and symptoms

Answer 5

LOWER UTI
- dysuria
- urinary frequency
- urgency
- haematuria
- foul smelling or cloudy urine
- incontinence

UPPER UTI
- fever
- rigors
- back pain
- nausea and vomiting

Question 6

Investigations

Answer 6

• urine dipstick
• culture and sensitivity
• blood culture and sensitivity if systemic symptoms

Question 7

Urine dipstick

Answer 7

• if dipstick is positive for nitrite or leukocyte and red blood cells UTI is likely
• if urine dipstick is negative for nitrite and positive for leukocyte UTI is equally likely to other diagnosis
• if urine dipstick is negative for nitrite, leukocyte and RBC, UTI is less likely

Question 8

Management of UTIs

Answer 8

• patients with confirmed bacteriuria - 50% will resolve within 3 days without the need for drug treatment

Question 9

Antibiotic treatment of UTIs

Answer 9

• UTIS are the second most common reason for antibiotics
• resistance to routinely prescribed AB is common
• increased emphasis on use of nitrofurantoin as 1st line
• use renally excreted antibiotics
• start emperical treatment then review when=n C&S results available

Question 10

ACUTE PYELONEPHRITIS

Answer 10

can lead to septicaemia and consider whether hospital admission is indicated

IF ADMISSION IS NOT NECESSARY :
- ensure hydration is adequate
- treat pain with paracetamol
- start empirical oral antibiotic immediately
- follow local antibiotics policies
- review urine culture results and if necessary adjust treatment

IF THERE IS NO RESPONSE WITHIN 24 HRS CONSIDER HOSPITAL ADMISSION

Question 11

SELF CARE ADVICE

Answer 11

• hydration
• pain relief - OTC cystitis products
• wipe front to back
• is symptoms do not improve within 48 hrs, seek medical help