Lower Urinary Tract Infection

Question 1

What is the main causes of UTI?

Answer 1

E coli (gram negative rod anaerobic) 
-from faceces that can easily spread to urethra due to being anatomically close 

Klebsiella pneumoniae (gram negative rod anaerobic)

Urinary catheters

Incontinence

Question 2

What 2 types of inflammation can UTI cause?

Answer 2

Cystitis= inflammation of bladder 
Pyelonephritis= when infection spread to kidneys

Question 3

How might someone with lower UTI present?

Answer 3

Dysuria

• pain/burning/stinging
• suprapubic pain + discomfort
• frequency
• urgency
• incontinence
• cloudy or foul smelling urine
• haematuria
• confusion in elderly

Question 4

What investigations can be done when LUTI suspected?
What would you expect if they had a UTI?
When would you treat for a UTI and when would you not based on the results?

Answer 4

URINE DIP
Nitrites
-gram -ve bacteria breakdown nitrates to nitrites
-better indication of infection than leukocytes

Leukocytes

• rise in WCC associated with infection
• urine dip tests for leukocyte esterase (product of leukocytes which can indicate the number)

RBC
-microscopic haematuria= when blood only present on dipstick

Both Nitrites + leukocytes= TREAT
Only nitrite= TREAT
Only leukocytes= DON’T TREAT

MSU (sent for microscopy, culture + sensitivity)

• if dip positive for either then should send for MSU for microscopy
• pregnant patients
• patients with current UTIs
• atypical symptoms
• symptoms not improving with antibiotics

Question 5

What is the management for UTI?

Answer 5

3 days Abx= simple LUTI in women

5-10 days Abx= immunosuppressed women, abnormal anatomy or impaired kidney function

7 days Abx= men, pregnant women or catheter related UTI

Initial Abx:

• trimethoprim
• nitrofurantoin

Question 6

How does the management of UTI change in pregnancy and why?
Why is trimethoprim avoided in 1st trimester?
Why is nitrofurantoin avoided in 3rd trimester?

Answer 6

Increased risk of pyelonephritis, premature ruputure of membranes and pre-term labour

7 days Abx (1st Nitrofurantoin + 2nd line Cefalexin/amoxicillin)
Urine culture + sensitivities

Has anti-folate effects= can effect development

Linked with haemolytic anaemic in newborn