MI: Urinary Tract Infection Pt.2 Flashcards
List some patient groups in whom culture and sensitivities should be performed.
- Pregnancy
- Children
- Pyelonephritis
- Men
- Catheteristed
- Failed antibiotic treatment
- Abnormalities of the genitourinary tract
- Renal impairment
What does the presence of white cell in the urine (pyuria) suggest?
Infection
What does the presence of sqaumous epithelial cells in the urine suggest?
Contamination
What is the microbiological definition of UTI?
Culture of single organisms >10^5 colony forming units/mL with urinary symptoms
NOTE: this threshold may be reduced for organisms that are known to cause UTI (e.g. E. coli and S. saprophyticus)
What number of white cells in the urine represents inflammation of the urinary tract?
More than 10^4/mL
In which patient groups should screening of the urine for white cells for MC&S NOT be performed?
Immunocompromised patients, pregnant women and children
List some causes of sterile pyuria (white cells in urine but no culture growth).
- Prior antibiotic treament (MOST COMMON)
- STIs (e.g. chlamydia)
- TB
- Calculi
- Catheterisation
- Bladder cancer
What type of agar is used for urine culture? What do the colours suggest?
Chromogenic agar
- Pink = E. coli
- Blue = other coliforms
- Light blue = Gram-positives
List some methods of sampling urine for investigations.
- MSU
- Catheterisation
- Suprapubic aspiration (usually in young children)
What type of therapy may be needed for patients with UTIs caused by ESBL producing organisms?
Outpatient parenteral antibiotic therapy (OPAT)
(ESBL - Extended-spectrum beta-lactamases)
Outline the treatment options for:
- Uncomplicated UTI in women
- UTI in pregnant or breastfeeding women
- UTI in men
- Pyelonephritis or systemically unwell with a UTI
- Catheter-associated UTI
-
Uncomplicated UTI in women
- Cefalexin 500 mg BD PO for 3 days OR
- Nitrofurantoin 50 mg POQ QDS for 3 days (check renal function)
-
UTI in pregnant or breastfeeding women
- Cefalexin 500 mg BD PO for 7 days
- 2nd line: co-amoxiclav 625 mg TDS PO for 7 days
-
UTI in men
- Cefalexin 500 mg BD PO for 7 days OR
- Ciprofloxacin 500 mg BD PO for 14 days if suspicion of prostatitis
- Chronic prostatitis: ciprofloxacin 500 mg BD PO for 4-6 weeks
-
Pyelonephritis or systemically unwell with a UTI
- Co-amoxiclav 1.2 g IV TDS
- Consider adding IV amikacin or gentamicin
- Penicillin allergy: ciprofloxacin 400 mg IV BD
-
Catheter-associated UTI
- Remove catheter (but give stat doses before removal of infected catheter)
- Gentamicin 80 mg STAT IV/IM 30-60 mins before procedure
OR - Amikacin 140 mg STAT IV/IM 30-60 mins before procedure
In which groups of patients is a short course (3-days) of antibiotics not appropriate?
- Women with a history of UTI caused by antibiotic resistant organisms
- More than 7 days of symptoms
- Men
i.e. any complex UTI - short course only appropriate for women with uncomplicated UTI
In which patients do Candida UTIs tend to occur?
Patients with indwelling catheters
How should Candida infections due to catheters be treated?
Remove the catheter
There is no evidence of oral fluconazole being better than no intervention
In which exceptional cases should Candida UTI be actively treated?
- Renal transplant patients
- Patients waiting to undergo elective urinary tract surgery
