Urinary tract infections

Question 1

UTIs are more common in…

Answer 1

Women than men

Question 2

Causative bacteria of UTIs is most commonly

Answer 2

endogenous enteric flora from the GI Tract e.g.

E. coli

Question 3

Signs and symptoms key to diagnosis for lower UTI

Answer 3

Dysuria,
Frequency,
Urgency,
Supra-pubic pain/tenderness

Question 4

signs and symptoms key to diagnosis for upper UTI

Answer 4

Lower UTI symptoms + loin pain, fever, signs of systemic infection (rigors, nausea, diarrhoea, vomiting).

Question 5

Signs and symptoms key to diagnosis for catheter associated UTI

Answer 5

systemic symptoms,

supra-pubic pain/tenderness, purulent discharge around the catheter

Question 6

signs and symptoms key to diagnosis for urosepsis

Answer 6

any location of UTI with systemic signs of infection such as:

1. rigors,
2. tachycardia,
3. hypotension,
4. raised inflammatory markers

Question 7

signs and symptoms key to diagnosis prostatitis

Answer 7

Lower UTI symptoms in men,
recurrence,
tender prostate,
acute retention

Question 8

How can you test for UTIs?

Answer 8

1. Dipstick green
2. Send BEFORE antibiotics wherever possible
3. Blood cultures - always send for urosepsis and pyelonephritis and anyone using IV medication
4. Imaging (CT and ultrasound) for upper symptoms

Question 9

Don’t use dipstick green in

Answer 9

> 65 y/o

children under 3 months

Question 10

Lab urine samples and what they indicate

Answer 10

Mid stream specimen or clean catch sample

Raised leucocytes = inflammation

Bacterial growth - in the presence of symptoms confirms a pathogen and DIRECTS antimicrobial therapy

Question 11

prosthetic material and UTI

Answer 11

catheters and nephrostomy tubes become colonised quickly

Question 12

Treatment for UTIs: asymptomatic bacteriuria

Answer 12

• In pregnancy - 2x samples confirm AND treat
• In elderly - don’t treat

Refers to bacteria in the urine at levels often regarded as clinically significant ( >100 000 colony forming units per millilitre of urine) in patients with no symptoms suggestive of urinary tract infection

Question 13

Treatment for UTIs: lower UTI

Answer 13

women 3 days

men 7 days

ABx:
•Nitrofurantoin,

pivemecillinam,

fosfomycin

Question 14

Treatment for pyelonephritis

Answer 14

7-14 days
•Need systemically active antibiotics - 
e.g. cefuroxime, 
aztreonam, 
ciprofloxacin, 
gentamicin

•NEVER use nitrofurantoin

Question 15

Treatment of prostatitis

Answer 15

2-4 weeks
•Few antibiotics penetrate the prostate:

Piperacillin-tazobactam, ciprofloxacin and cotrimoxazole