Urinary Tract Infection

Question 1

Define Urinary Tract Infection

Answer 1

Infection of the kidneys, bladder or urethra

Question 2

Aetiology of Urinary Tract Infections

Answer 2

E. coli is the most common cause

Female: E. Coli (70-95% of uncomplicated cases in females) | Staphylococcus saprophyticus (5-20%) | Klebsiella | group B streptococci | Pseudomonas aeruginosa
Male: Klebsiella | Proteus | providencia | Gram +ve

Indwelling catheters: pseudomonas, Candida, resistant organisms

Question 3

Risk factors for Urinary Tract Infections

Answer 3

Sexual activity 
Spermicide use
Post-menopause
Positive family history of UTIs
History of recurrent UTIs
Presence of a foreign body e.g. catheter, stone, suture, surgical material
BPH 
Urethral strictures

Question 4

Symptoms of Urinary Tract Infections

Answer 4

Dysuria (Burning pain when passing urine | 1/3 key diagnostic signs and symptoms in females <65)
New nocturia, Urgency and frequency 
Cloudy urine or visible haematuria
Fever
Suprapubic pain or tenderness, Flank pain 
Incontinence 
New or worsening delirium/debility 
Loss of diabetic control
Malaise 
Rigors

Question 5

Signs of Urinary Tract Infection on examination

Answer 5

Cloudy urine 
Haematuria 
Fever
Suprapubic tenderness
Enlarged prostate in males (BPH), tender prostate or rectal pain

Question 6

Investigations for Urinary Tract Infections

Answer 6

Urine dipstick: leukocytes + Nitrites +
Midstream urine MC&S: diagnostic confirmation (not necessary in those with typical features + not pregnant)
Urine microscopy: bacteria, WBCs, possible RBCs

Renal USS: kidney stone, hydronephrosis, renal abscess, renal scarring
Abdominal/pelvic CT: kidney or bladder stone, renal abscess

Question 7

Management for Urinary Tract Infections in females

Answer 7

1. Antibiotics - nitrofurantoin PO OR trimethoprim PO
   => If no improvement -> pivmecillinam
2. Fluids and paracetamol
3. Pathogen target antibiotics

*trimethoprim CI in pregnancy

Question 8

Management for Urinary Tract Infections in males

Answer 8

IM diclofenac for any renal colic

1. Levofloxacin PO
2. Trimethoprim PO

Question 9

Complications for Urinary Tract Infections

Answer 9

Sepsis 
Renal and peri-anal abscess
Acute Kidney injury 
Emphysematous pyelonephritis 
Xanthogranulomatous pyelonephritis
Prostatitis

Question 10

Prognosis for Urinary Tract Infections

Answer 10

Prognosis for uncomplicated UTI is excellent
Unlikely to be long-term sequelae with appropriate antimicrobial treatment and resolution
Older man more often have complicated UTIs and eradication may be more difficult