Urinary Tract Infection Flashcards
What are the different UTI’s? (3 things)
Lower UTIs
- Cystitis = bladder infection
- Prostatits = prostate infection
Upper UTIs
- Pyelonephritis = kidney / renal pelvis infection
How are UTI’s classified?
Complicated vs Uncomplicated
What is an Uncomplicated UTI?
Normal renal structure + function
What is a Complicated UTI?
What are some examples of these complications? (4 things)
Structural / functional abn of Genitourinary tract
- Obstruction
- Stones
- Neurogenic bladder
- Renal transplant
What are the risk factors of UTIs? (11 things)
Bacteria introduction:
- Female (shorter urethra for bac to travel up)
- Sexual activity
- Urinary / faecal incontinence
- Constipation
Low urine flow:
- Dehydration
- Obst urinary tract
Bacteria growth:
- Stones
- Catheters
- Immunosuppression
- DM
- Pregnancy
What are the CF of Lower UTIs? (6 things)
- Confusion (elderly)
- Suprapubic pain / discomfort
- Urgency
- Frequency
- Dysuria
- Incontinence
- Swollen / tender prostate @ exam (if prostatitis)
What are the CF of Pyelonephritis (Upper UTI)? (6 things)
- Fever (more common in Upper UTI than Lower)
- Vomiting
- Loss of Appetite
- Renal angle tenderness @ exam
- Loin / Suprapubic / Back pain (bi or unilateral)
- Haematuria
What investigations should you do for sus UTIs? (4 things)
- Dipstick
- MSU culture
- Blood tests (if systemically unwell)
- Imaging
Which sus UTI patients do you treat straight away without doing investigations? (3 things)
A women who is:
- Not-pregnant
- NO vaginal discharge
- 3+ Lower UTI symptoms (or 1 severe)
What does a Urine dipstick show in UTI? (2 things)
- High nitrites
- High leukocytes
Why are nitrites high in UTI dipsticks?
Gram -ve bac causing UTI (e.g E coli) convert nitrates –> nitrites
(Nitrates = normal waste product of urine)
Why are leukocytes high in UTI dipsticks?
Leukocytes = WBC
obv jus high tryna fight da infection nigga
What should you do if you have a positive dipstick (high nitrites + leukocytes)?
Send urine to microbiology for confirmation
Which UTI patients should be considered for Imaging + urological assessment? (5 things)
What imaging + urological assessment should they get?
- Upper UTI
- Recurrent UTI (2+ / year)
- Persistent haematuria
- Unusual organism
- X respond to treatment
- Imaging: US / CT
- Urological assessments: Cystoscopy
What is the most common organism that causes UTIs?
E coli
What are the characteristics of E coli? (4 things)
- Gram -ve
- Anaerobic
- Rod-shaped
- Found in faeces so easily spreads to bladder
What is the FIRST LINE treatment for Lower UTI’s in non-pregnant women?
Trimethoprim / Nitrofurantoin (3 day course)
How do you manage non-pregnant women with Lower UTIs who don’t respond to Trimethoprim / Nitrofurantoin?
Culture urine + treat according to abx sensitivity
What is the management of non-pregnant women with UPPER UTIs? (3 things)
- Take urine culture + start broad spec abx (e.g co-amoxiclav)
- Consider hospitalization bc abx resistance risk
- Avoid Nitrofurantoin bc doesn’t reach effective conc in blood
Why should you get expert help for PREGNANT women with UTIs?
UTI in pregnancy assoc w preterm delivery + intrauterine growth restriction
What is the FIRST LINE abx for UTIs in PREGANT women?
Nitrofurantoin
(but avoid in 3rd trimester bc assoc w haemolytic anaemia in newborn)
What abx should be avoided when treating pregnant women w UTIs? (3 things)
- Ciprofloxacin
- Trimethoprim in 1st trimester
- Nitrofurantoin in 3rd trimester
How do you treat MEN with LOWER UTIs?
Trimethoprim / Nitrofurantoin 7 day course (longer than women)
What treatment should you consider for MEN with Prostatitis symptoms (pain in: pelvis / genitals / lower back / bum)?
Why?
Ciprofloxacin for 4 weeks course
Bc ability to penetrate prostate fluid
How should you manage MEN with recurrent / UPPER UTIs?
Refer for urological investigation (US / CT / cystoscopy)
What does NICE recommend for a patient diagnosed with a catheter related UTI?
Change catheter
