Urinary tract infections

Question 1

Etiology

Answer 1

1. E coli most common 2. Staphylococcus saprophyticus 3. Proteus mirabilis and Klebsiella species, enterococci, group B streptococci, Pseudomonas aeruginosa, and Citrobacter species.

Question 2

Risk factors

Answer 2

1. Sexual activity 2. Spermicide use 3. Post-menopausal 4. Positive family history 5. History of recurrent UTI 6. Foreign body 7. Stasis and obstruction PUV, reflux, medication, BPH, urethral stricture, cystocele, neurogenic bladder 8. Trauma, anatomic abnormalities Insulin DM, recent antibiotics, poor bladder emptying, +age

Question 3

Presenting complaints in women

Answer 3

Dysuria Frequency Hematuria Back/flank pain CVT Uncommonly fever Urgency Supra-pubic pain and tendeness

Question 4

Investigations in women

Answer 4

1. Urine MCS only required in: a. pregnant b. men c. aged care facility d. recent antibiotic use/treatment failure e. recurrent infection f. international travel in last 6 months Other tests to consider when ++++ and abnormal presentation 1. Post void residual 2. Renal USS->stone, hydroneprhosis, renal abscess 3. Abdominal/pelvic CT->stone/abscess 4. Cystoscopy->tumor, stone, foreign body

Question 5

Uncomplicated UTI

Answer 5

1. nonpregnant women who do not have a functional or anatomical abnormality of the urinary tract. 2. Acute uncomplicated cystitis and pyelonephritis is most commonly caused by Escherichia coli (70% to 95% of cases) and Staphylococcus saprophyticus (5% to 10% of cases).

Question 6

Complicated UTI

Answer 6

1. Anatomical or functional abnormalities->neurogenic bladder, nephrolithiasis, diabetes 2. +risk of serious complications or treatment failure
2. E. coli most common, but associated with others including Proteus, Klebsiella, enterococci faecalis, streptococcal agalactaie

Question 7

Treatment in non-pregnant women

Answer 7

1. Trimethoprim 300mg orally, daily for 3 days
2. Cephalexin 500mg BD 5 days

Question 8

Treatment in pregnant women

Answer 8

1. Cephalexin 500mg PO BD 5 days OR 1. Nitrofurantoin 100mg PO BD for 5 days

Question 9

Treatment in men

Answer 9

1. Trimethoprim 300mg PO for 7 days

Question 10

Treatment mild pyeloneprhitis

Answer 10

1 amoxycillin+clavulanate 875+125 mg orally, 12-hourly for 10 to 14 days OR 1 cephalexin 500 mg orally, 6-hourly for 10 to 14 days OR 1 trimethoprim 300 mg orally, daily for 10 to 14 days.

Question 11

Treatment for severe pyelonephritis

Answer 11

1. Gentamycin IV + amoxy/ampicillin IV

Question 12

Indications for investigations

Answer 12

1. Pyeloneprhitis 2. Persistent symptoms/pyuria despite treatment 3. Severe infection with +in Cr 4. Atypical pathogen (urea splitting) 5. Hx of structural abnormality/decreased flow

Question 13

Indications for investigations

Answer 13

1. Pyeloneprhitis 2. Persistent symptoms/pyuria despite treatment 3. Severe infection with +in Cr 4. Atypical pathogen (urea splitting) 5. Hx of structural abnormality/decreased flow

Question 14

Management of recurrent/chronic cystitis

Answer 14

1. Lifestyle Limit caffeine Increase fluid 2. Continuous vs post coital antibiotics 3. Topical estrogen? 4. No treatment for asymptomatic bacteruria except in pregnant women/women undergoing urinary tract instrumentation
2. Antibiotics->trimethopri 300md OD for 10 days or cephalexin 500mg BD for 10 days

Question 15

Management of recurrent/chronic cystitis

Answer 15

1. Lifestyle Limit caffeine Increase fluid 2. Continuous vs post coital antibiotics 3. Topical estrogen? 4. No treatment for asymptomatic bacteruria except in pregnant women/women undergoing urinary tract instrumentation

Question 16

What is painful bladder syndrome

Answer 16

1. Chronic urgency, frequency and pain without other reasonable causation

Question 17

Etiology of painful bladder

Answer 17

• unknown ƒƒa. theories: increased epithelial permeability, autoimmune, neurogenic, defective glycosaminoglycan (GAG) layer overlying mucosa b.ƒƒ associations: severe allergies, IBS, fibromyalgia

Question 18

Etiology of painful bladder

Answer 18

• unknown ƒƒ theories: increased epithelial permeability, autoimmune, neurogenic, defective glycosaminoglycan (GAG) layer overlying mucosa ƒƒ associations: severe allergies, IBS, fibromyalgia

Question 19

Management of painful bladder syndrome

Answer 19

1. first-line: patient empowerment (diet, lifestyle, stress management), pain management 2. second-line: ƒƒoral: pentosan polysulfate sodium, amitriptyline, cimetidine, hydroxyzine ƒƒ intravesical: dimethylsulfoxide (DMSO), heparin, lidocaine 3. third-line: cystoscopy with bladder hydrodistention (traditionally diagnostic) under GA, treat Hunner’s ulcers if present 4. other: neuromodulation, cyclosporine A, intradetrusor botulinum toxin 5. surgery (last resort): augmentation cystoplasty, or urinary diversion ± cystectomy

Question 20

When is a urine sample for culture required prior to antibiotic therapy

Answer 20

1. Pregnant
2. Men
3. Aged care facility
4. Recent antibiotics/treatment failure
5. Recurrent infection
6. Travel internationally in last 6 months

Question 21

Clinical features of pyeloneprhitis

Answer 21

1. Flank pain
2. Fever
3. Dysuria

Chills, NVD