Urinary System - Level 1 Flashcards
Definition of bacteriuria?
o presence of bacteria in the urine. This may be symptomatic or asymptomatic. Asymptomatic bacteriuria should be confirmed by two consecutive urine samples
Definition of UTI?
o presence of characteristic symptoms and significant bacteriuria from kidneys to bladder
o >105 (cfu/ml)
Types of UTI?
o Lower UTI = infection of the bladder (cystitis)
o Upper UTI = infection of kidney and ureters (acute pyelonephritis)
Classifications of UTI?
o Uncomplicated – normal renal tract/function
o Complicated – abnormal renal tract, obstruction, decreased renal function, immunocompromised
Epidemiology of UTIs?
- Incidence is 5% in UK
- More common in females due to short urethra
- 40% have genitourinary anomalies
Risk factors of UTIs?
o Women o Sexual intercourse o Catheter o Abnormality of renal tract o Antibiotic use o Pregnancy o Immunocompromise o Diabetes Mellitus o Spermide
Causative organisms of UTIs?
o E. coli in 90% of cases
o Proteus (present under prepuce)
o Klebsiella
o Enterococcus faecalis
o Saprophytic staphylococci (young women)
o Pseudomonas (may indicate structural damage in urinary tract)
Symptoms of lower UTIs?
o Dysuria o Frequency o Urgency o Haematuria o Suprapubic discomfort o Burning o Cloudy urine with offensive smell
Investigations in lower UTI?
- Urine dipstick MSU
o Leukocytes and nitrites, haematuria and proteinuria - Urine M, C&S
o Male, child under 16, pregnant, very ill
o May show leukocytes, RBC commonly seen, renal pathology if crystals or granular casts found - Renal USS (KUB)
o If recurrent or complicated - Bloods
o FBC, U&Es, CRP, cultures if unwell
Management of lower UTI - referral?
- Referral to hospital if sepsis suspected
Management of lower UTI - general advice?
o Paracetamol for pain
o Hygiene: clean perineum front to back
o Increase fluid intake
o Voiding after intercourse
Management of lower UTI - in non-pregnant women?
o Back-up antibiotic or immediate prescription, depending on clinical picture
Back-up prescription should be used if no improvement in 48 hours of taking antibiotic or worsens
Management of lower UTI - non-pregnant women - antibiotics - first & second choice?
First Choice
• Nitrofurantoin (if eGFR>45) 100mg MR BD for 3 days
• Trimethoprim 200mg BD for 3 days
Second Choice (worsening UTI on first choice for >48 hours) • Nitrofurantoin (if eGFR>45 and not first choice) 100mg MR BD for 3 days • Pivmecillinam 400mg initial dose then 200mg TDS for 3 days • Fosfomycin 3g single dose sachet
Management of lower UTI - pregnant women, men and children - investigations?
Midstream urine for M, C & S in pregnant women, men and children <16
Management of lower UTI - antibiotics children <16 years old - under 3 months?
• Under 3 months – refer to paediatric specialist
Management of lower UTI - antibiotics children <16 years old - over 3 months?
o First Choice
Nitrofurantoin (if eGFR>45) for 3 days
Trimethoprim for 3 days
o Second choice
Nitrofurantoin (if eGFR>45) for 3 days
Amoxicillin for 3 days
Cefalexin for 3 days
Management of lower UTI - antibiotics men first choice?
o Nitrofurantoin (if eGFR>45) 100mg MR BD for 7 days o Trimethoprim 200mg BD for 7 days
Follow up in 48 hours
If not working consider alternative diagnosis
Management of lower UTI - antibiotics - pregnant women - first & second choice?
• First choice o Nitrofurantoin (if eGFR >45) 100mg MR BDS for 7 days
Second choice
o Amoxicillin (only if cultures results available) 500mg TDS for 7 days
o Cefalexin 500mg BDS for 7 days
Management of lower UTI - antibiotics - in asymptomatic bacteriuria?
• Nitrofurantoin, amoxicillin or cefalexin
Management of lower UTI - catheterised patients - general management?
o Remove catheter or changing as soon as possible if been in place for >7 days
o Obtain urine sample via sampling port
Management of lower UTI - catheterised patients - non-pregnant women and men >16 - antibiotics if lower symptoms?
o First choice
Nitrofurantoin, trimethoprim, amoxicillin (only if cultures available)
o Second choice
Pivmecillinam
Management of lower UTI - catheterised patients - non-pregnant women and men >16 - antibiotics if upper symptoms?
o First choice
Cefalexin, ciprofloxacin, co-amoxiclav, trimethoprim
o First choice IV
Co-amoxiclav, cefuroxime, ceftriaxone, gentamicin, amikacin
Management of lower UTI - catheterised patients - pregnant women - antibiotics?
- First choice oral – cefalexin
* First choice IV - cefuroxime
Management of lower UTI - catheterised patients - children <16 - antibiotics?
Under 3 months – refer to paediatrics
Over 3 months
o First choice oral
Trimethoprim, amoxicillin, cefalexin, co-amoxiclav
o First choice IV
Co-amoxiclav, cefuroxime, ceftriaxone, gentamicin, amikacin