Urinary Tract Infection

Question 1

What is the defintion of a UTI?

Answer 1

presence of a pure growth of >105 organisms per mL of fresh MSU

Question 2

What are the 3 types of UTI?

Answer 2

1. Urethritis – affects the urethra
2. Cystitis – affects the bladder
3. Pyelonephritis – affects the kidney

Question 3

What is the most common cause of UTI?

Answer 3

Escherichia coli

Question 4

What are RF for UTIs?

Answer 4

1. Sexual intercourse
2. Pregnancy
3. Immunosuppression
4. Catheterization
5. Urinary tract obstruction (BPH, calculi)
6. Female as shorter urethra and shorter distance between urethral + anal opening

Question 5

What are the storage symptoms of a UTI?

Answer 5

1. Increased frequency
2. Urgency
3. Dysuria
4. Foul-smelling

Question 6

What are the symptoms of acute pyelonephritis?

Answer 6

1. flank pain
2. fever
3. malaise

Question 7

What is the 1st line investigation for UTI?

Answer 7

urine dip

Question 8

What would the urine dip show for a UTI?

Answer 8

+ve leucocytes and nitrites

Question 9

What is the gold standard investigation for UTI?

Answer 9

MSU and MC&S – Gold standard:

1. Identify bacteria

Question 10

What would MSU and MC&S show in pyelonephritis?

Answer 10

white cell casts

Question 11

When do you do blood cultures in a UTI?

Answer 11

systemically unwell and risk or urosepsis

Question 12

What is the management for UTIs?

Answer 12

empirical antibiotics (nitrofurantoin)

Question 13

What is a UTI characterised by?

Answer 13

presence of >100,000 of colony-forming units per millilitre of urine. UTI may affect bladder (cystitis), kidney (pyelonephritis) or prostate (prostatitis).

Question 14

What is the aetiology of UTIs?

Answer 14

1. Escherichia coli (80%)
2. Staphylococcus saprophyticus
3. Klebsiella pneumoniae
4. Proteus mirabilis
5. Enterocci

Question 15

What are RF for UTIs?

Answer 15

1. Age >50 /Sex
2. Urine outflow obstruction (BPH, stones, strictures etc.)
3. Catheters (HAI)
4. Diabetes Mellitus
5. Pregnancy
6. Immunosupression

Question 16

What are white cell casts strong indicators of?

Answer 16

pyelonephritis

Question 17

What are upper UTIs?

Answer 17

1. Kidneys

2. Pyelonephritis

Question 18

What is the aeitology of upper UTIs?

Answer 18

Ascending faecal bacteria
OR
Descending bacteremia

Question 19

What is the presentation of an upper UTI?

Answer 19

1. Costo-vertebral angle tenderness
2. Flank pain
3. Fever
4. N&V
5. Urinary Sx
6. Acute confusion: elderly

Question 20

What is a lower UTI?

Answer 20

1. Bladder (cystitis)

2. Urethra (urethritis)

Question 21

What is the aeitology of lower UTIs?

Answer 21

faecal bacteria

E.Choli, Klebsiella Pneumoniae, Proteus mirabilis

Question 22

What is the presentation of a lower UTI?

Answer 22

1. Urgency
2. Dysuria
3. Frequency
4. Suprapubic pain
5. Foul smelling urine

Question 23

What are Ix for cystitis?

Answer 23

• If young woman with typical symptoms clinical Dx
• Clean catch
• Suprapubic aspiration

Question 24

What is clean catch?

Answer 24

1. Midstream urine sample

2. Avoids contamination with bacteria from outer meatus

Question 25

When is suprapubic aspiration indicated?

Answer 25

in patients with indwelling catheter (urine in bladder should have no bacteria)

Question 26

What bloods are done in pyelonephritis?

Answer 26

1. FBC (Leukocytosis w/ neutrophilia) 2. Renal function tests 3. Urinalysis (WBC casts on microscopy) 4. Urine culture

Question 27

What imaging is done in pyelonephritis?

Answer 27

1. Renal USS (Hypoechoic mass) | 2. Abdominal CT (Localised hypodense symptoms, signs of obstruction)

Question 28

What is abdo uss done?

Answer 28

exclude urinary tract obstruction or renal stones

Question 29

What are most causative organisms?

Answer 29

1. Gram-negative enteric organisms produce urinary nitrite and represent the most common uropathogens 2. Enterococcus, a less common uropathogen, does not produce nitrite and has a unique antibiotic resistance pattern.

Question 30

What makes a UTI complicated?

Answer 30

1. Men 2. pregnant women 3. indwelling catheters 4. uncontrolled diabetes mellitus 5. urethral strictures 6. recent urological procedures 7. immuno compromised

Question 31

What is the 1st line treatment for uncomplicated lower UTI?

Answer 31

1st line: Nitrofurantoin: 50mg x4/day for 3 days Trimethoprim: 200mg x2/day for 3 days

Question 32

What is important to remeber with Trimethoprim?

Answer 32

tetarogenic

Question 33

What is 2nd line for lower uncomplicated UTI?

Answer 33

- if no improvement in symptoms 1. Pivmecillinam 2. Fosfomycin

Question 34

What is the 1st line treatment for lower complicated UTI (men)?

Answer 34

Nitrofurantoin: 50mg x4/day for 7days Trimethoprim: 200mg x2/day for 7 days

Question 35

What is the 1st line treatment for lower complicated UTI (pregnant women)?

Answer 35

1st line: Nitrofurantoin: 50mg x4/day for 7days

Question 36

What is the 2nd line treatment for lower complicated UTI (pregnant)?

Answer 36

1. amoxicillin | 2. cefalexin

Question 37

How do you check if complicated UTI?

Answer 37

1. structural or functional condition of genitourinary tract OR 2. underlying disease

Question 38

For upper UTIs how do you administer medication?

Answer 38

IV if unable to take oral antibiotics or severely unwell (i.e:. Sepsis concern)

Question 39

What is the 1st line oral treatment for uncomplicated upper UTI or complicated upper UTI (men)?

Answer 39

1. Cefalexin 2. Co-amoxiclav 3. Trimethoprim 4. Ciprofloxacin

Question 40

What is the 1st line IV treatment for uncomplicated upper UTI or complicated upper UTI (men)?

Answer 40

1. Co-amoxiclav 2. Cefuroxime 3. Ceftriaxone 4. Ciprofloxacin 5. Gentamicin

Question 41

What is the 1st line oral treatment for complicated upper UTI (pregnant)?

Answer 41

Cefalexin

Question 42

What is the 1st line IV treatment for complicated upper UTI (pregnant)?

Answer 42

Cefuroxime

Question 43

What are the key antibiotics for UTI?

Answer 43

- Trimethoprim (avoid in pregnancy) / Nitrofurantoin | - Pyelonephritis – Cefalexin 1st line