Lower Urinary Tract Infection Flashcards
1
Q
ESSENCE
A
Infection in the bladder causing cystitis, can spread up to kidneys and cause pyelonephritis
2
Q
EPIDEMIOLOGY
Men or woman more affected
A
Far more common in woman due to shorter urethra
3
Q
Common sources of infection
A
- Primary source from faeces, usually E. Coli
- Sexual activity allows bacteria to spread around perineum
- Urinary catheters
4
Q
AETIOLOGY
Risk factors
A
- Catheterisation
- Urinary tract stones
- Urethral strictures
- Urological surgery
- Previous UTI
- Sexual activity in woman
5
Q
CLINICAL FEATURES
Presentation
A
- Dysuria (pain when passing urine - stinging or burning)
- Suprapubic pain
- Lower urinary tract symptoms
- Frequency
- Urgency
- Incontinence
- Haematuria
- Cloudy or foul smelling urine
- Confusion in older/frail patients
6
Q
When should pyelonephritis be suspected instead of lower urinary tract infection
A
- Fever
- Loin/back pain
- Nausea/vomiting
- Renal angle tenderness on examination
7
Q
AETIOLOGY
Organisms
A
- E.Coli (most common)
- Klebsiella pneumoniae
- Enterococcus
- Staphylococcus saprophyticus
- Candida albicans (fungal)
8
Q
INVESTIGATIONS
First choice
A
- Dipstick urinalysis - nitrates indicate bacteria
- Midstream urine (MSU) for microscopy, culture and sensitivity testing to determine organism
- Not all require
9
Q
INVESTIGATIONS
What patients should get MSU
A
- Pregnant patients
- Recurrent UTI
- Atypical symptoms
- Symptoms do not improve with antibiotics
10
Q
MANAGEMENT
General principles
A
- Initiate antibiotics
11
Q
MANAGEMENT
Antibiotic choice
A
- Trimethoprim or nitrofuratoin
- Alternatives
- Pivmecillam
- Amoxicillin
- Cefalexin
12
Q
When should nitrofurantoin be avoided
A
Patients with eGFT of <45
13
Q
MANAGEMENT
Duration of antibiotics
A
- 3 days in simple UTI in woman
- 5-10 days for immunosuppresed, abnormal anatomy or impaired kidney function
- 7 days for men, pregnant woman or catheter related
14
Q
What are complications of UTI in pregnancy
A
Increases risk of pyelonephritis, premature rupture of membranes and pre-term labour
15
Q
MANAGEMENT
Antibiotic options in prengnacy
A
- Required for 7 days
- Nitrofuratoin (avoid in 3rd trimester)
- Amoxicillin (only after sensitivies are known)
- Cefalexin
