Urinary tract infection

Question 1

Causes

Answer 1

Normal intestinal bacteria (E.coli)

Sexual activity

Incontinence

Poor hygiene

Question 2

Presentation

Answer 2

Dysuria

Suprapubic pain

Frequency

Urgency

Incontinence

Haematuria

Fever

Cloudy or foul smelling urine

Confusion in older/frail patients

Question 3

Urine dip

Answer 3

Nitrites (gram negative bacteria break down nitrates to nitrites)

Leukocytes (sign of infection or inflammation if significantly raised)

RBC (also cancer or nephritis)

Question 4

Pathogens

Answer 4

E.coli

Klebsiella pneumoniae

Enterococcus

Pseudomonas aeruginosa

Staphylococcus saprophyticus

Candida albicans

Question 5

Antibiotic choice

Answer 5

Trimethoprim (high rates of bacterial resistance)

Nitrofurantoin (avoid in patients with eGFR <45)

Question 6

Duration of antibiotics

Answer 6

3 days for simple LUTI in women

5-10 days for immunocompromised women, abnormal anatomy or impaired kidney function

7 days for men, pregnant women or CAUTI

Question 7

Management in pregnancy

Answer 7

7 days antibiotics

Nitrofurantion (avoid in 3rd trimester- neonatal haemolysis)

Amoxicillin only after sensitivities known

Cefalexin

Trimethoprim in 1st trimester causes neural tube defects