Urinary Tract Infection

Question 1

What is UTI?

Answer 1

• Infection of any part of urinary system
  
  • bladder > cyctitis
  • kidney > pyelonephritis

Question 2

How do you clinically define UTI?

Answer 2

• dysuria, frequency
• significant bacteriuria: > 10^5 CFU/ml

Question 3

What are the categories of UTI?

Answer 3

• Upper UTI: pyelonephritis
• Lower UTI: cystitis
• Uncomplicated UTI: healthy, non-pregnant adult woman
• Complicated UTI: the presence of factors that increase the risk of treatment failure (e.g diabetes, structural abnormalities, catheter and all UTIs in men)

Question 4

What are the causative organisms for UTI?

Answer 4

• Escherichia Coli (most common)
• K. Pneumonia
• Staphylococcus Saprophyticus
• Extended Spectrum Beta-Lactamase (ESBL) E.coli

Question 6

What are the features of ESBL E.Coli?

Answer 6

• highly resistant to most beta-lactam antibiotics
  
  • Penicillin, Cephalosporin
• Requires carbapenems for tx

Question 7

Anatomically, why are men less likely to catch UTI?

Answer 7

• Longer urethra
• Prostatic secretion - antimicrobial properties
• Periurethral area drier

Question 8

Which organisms are typically involved in haematogenous spread of UTI?

Answer 8

• Staph aureus
• Candida albicans
• M. Tuberculosis

Question 9

What are the RF of UTI?

Answer 9

• Incomplete bladder emptying - particularly by prostatic obstruction in men.
• Antibiotic use
• Sexual activity
• New sexual partner
• Use of spermicide
• Diabetes
• Presence of catheter.
• Pregnancy
• Immunocompromise

Question 10

What are the Sx of UTI?

Answer 10

• Dysuria
• Frequency
• Urgency
• Incontinence
• Suprapubic pain
• Haematuria
• Foul-smelling ± cloudy urine
• N&V

Question 11

What are the signs of UTI?

Answer 11

• Fever
• Rigors
• Flank pain
• Confusion
• Costovertebral angle tenderness

Question 12

What are the differentials for UTI?

Answer 12

• urethral syndrome
• atrophic vaginitis
• enlarged inflamed prostate
• infection of tract from STI

Question 13

What is urosepsis?

Answer 13

• sepsis that originates from urinary infection
• SIRS (+)

Question 14

How would you diagnose UTI in young, non-pregnant females?

Answer 14

• dysuria
• suprapubic pain
• other typical features
• no vaginal sx

>90% UTI

Question 15

What Ix would you perform in complicated UTI?

Answer 15

• Bedside
  
  • urine dip stick - leucocyte esterase, nitrites
• Bloods
  
  • FBC, U&Es, CRP
• Imaging
  
  • ultrasonography
  • CT
• Special test
  
  • Urine MCS - guide antibiotic sensitivity

Question 16

When would you refer UTIs for imaging or cystoscopy?

Answer 16

• Have persistently not responded to treatment.
• Have a history of renal tract disease or anomaly.
• Have haematuria.
• Are women with recurrent infections who are not responding to preventative measures
• men with two or more episodes in three months

Question 17

How would you mx uncomplicated UTI?

Answer 17

• Trimethoprim
  
  • women: 200mg BD for 3 days
  • men: 200mg BD 7-14 days
• Nitrofurantoin
  
  • women: 50mg QDS for 3 days
  • men: 50mg QDS 7days

Acute uncomplicated pyelonephritis

• ciprofloxacin
  
  • 500 mg 12-hourly for 14 days

Question 19

How would you mx complicated UTI?

Answer 19

• oral course of a fluoroquinolone (ciprofloxacin)
• IV co-amoxiclav (e.g. 1.2 g 8-hourly)

Question 20

What are the cx of UTI?

Answer 20

• Pyelonephritis.
• Perinephric and intrarenal abscess.
• Hydronephrosis or pyonephrosis.
• Acute kidney injury.
• Sepsis

Question 22

What are the cx of untreated asymptomatic bacteriuria in pregnancy?

Answer 22

• Pyelonephritis (in up to 40% of women)
• Preterm delivery and infants with low birth weight
• Anaemia

Question 23

When should each of these drugs be avoided?

1. Trimeethoprim
2. Nitrofurantoin

Answer 23

1. pregnancy
2. renal impairment