Urinary tract infection

Question 1

What are the risk factors that increase the risk of developing a post-operative UTI?

Answer 1

• Age >60
• Female
• Significant co-morbidities (DM, renal failure)
• Catheterisation or recent instrumentation
• Pregnancy
• Urinary retention or renal stones

Question 2

What are the clinical features of a UTI?

Answer 2

• Urinary frequency, urgency and dysuria
• Suprapubic pain, pyrexia
• Should be consdiered in patients who present:
  
  • With delirium
  • Septic
  • In acute urinary retention

Question 3

Name some specific features of pyelonephritis?

Answer 3

• Loin pain
• Renal angle tenderness
• Pyrexia

Question 4

What investigations should be performed in someone with a suspected UTI?

Answer 4

• Urine dipstick
  
  • If positive for: Nitrites or leukocyte esterase +/- blood
  • => send for microscopy, culture and sensitivities (MC&S)
• Consider FBC, U&Es, CRP, VBG
• Bladder scan may be required to if patient is in retention

Question 5

What is sterile pyuria?

Answer 5

• Elevated white cells in urine without a demonstrable UTI
• Causes:
  
  • Inadequately treated UTI
  • Sexually-transmitted infection
  • Renal stones

Question 6

What is nitrites (+) an indication of infection in urine dipstick?

Answer 6

Most gram-negative bacteria will convert nitrates to nitrites

Question 7

Describe the management of a UTI following surgery?

Answer 7

• Ensure patient is well hydrated
  
  • (and satisfactory urine output >0.5mL/kg/hour
• Antibiotic therapy
  
  • Trimethoprim, nitrofurantoin, co-amoxiclav
• Catheter should be changed before antibiotics are commenced.

Question 8

How should urine be collected when testing for a UTI?

Answer 8

Mid-stream urine