Urinary tract infection

Question 1

Types of UTI (4)

Answer 1

Cystitis - bladder
Prostatitis - prostate
Pyelonephritis - kidney/renal pelvis
Abacterial cystisis - symptomatic but wo evidence of infection

Question 2

Complicated UTI

Answer 2

Abnormal structure or function = obstruction, catheter, neurogenic bladder, renal transplant.

Question 3

Risk factors: 
 Increased bacterial inoculation (3)
 Increase binding of bacteria (2)
 Reduced urine flow (2)
 Increase bacterial growth (5)

Answer 3

1. Urinary/ faecal incontinence. constipation.
2. Spermicide use, menopause (low oestrogen)
3. Dehydration, obstruction
4. DM, immunosuppression, stone, catheter, pregnancy

Question 4

Symptoms of cystitis (5)

Answer 4

Dysuria with frequency + nocturia. 
Haematuria
Suprapubic pain 
Polydipsia 
Fever

Question 5

Symptoms of pyelonephritis (4)

Answer 5

Loin pain
Vomiting
Fever
Cystitis symptoms.

Question 6

Symptoms of prostatitis (4)

Answer 6

Pain at affected area.
Acute urinary retention
Fever
Urinary symptoms

Question 7

Signs of UTI (4)

Answer 7

Suprapubic or loin tenderness
Distended bladder
Vaginal discharge or enlarged prostate
Fever

Question 8

Initial Ix

Answer 8

Urine dipstick - if <65 yrs and have <3 symptoms

Question 9

Further Ix when….

Answer 9

Bloods if systemically unwell = FBC, U+E, CRP, DM, Blood culture.
MSU culture = pregnant, man, child, no response to Tx.
USS, cystoscopy, CT = recurrent UTI, pyelonephritis, persistent heamaturia.

Question 10

Organisms causing UTI (4)

Answer 10

Anaerobes
E. coli
Staphylococcus saprophyticus
Enterobacteriaceae

Question 11

Causes of sterile pyuria (10)

Answer 11

Infection: TB, recent UTI, chlamydia.

Non infective: Calculi, tumour, nephritis, PKD, pregnancy, SLE, steroids

Question 12

Tx:

1. lifestyle
2. non pregnant
3. man
4. catheterise.
5. pregnant

Answer 12

1. Lifestyle = Drink plenty, wipe front to back, don’t hold urine, don’t wear restrictive clothing.
2. 1st trimethoprim/ nitrofurantoin. 2nd urine culture
3. Man - same as above. Upper UTI = Ix. Prostatitis - ciprofloxacin.
4. Catheterised - MSU culture, change catheter.
5. Non pregnant - Preterm delivery + IUGR. Amoxicillin. Avoid trimethroprim + nitrofurantoin (3rd trimester)