urinary tract infections

Question 1

a patient has recently been started on abx for a UTI. she comes in worried because her urine is a different colour. what is the drug that has caused this and what colour would the urine be?

Answer 1

nitrofurantoin
yellow brown

Question 1

UTIs are predominantly caused by bacteria from the gastrointestinal tract entering the urinary tract, with this bacteria being the most common cause

Answer 1

e coli

Question 2

infection due to Candida albicans is rare but may occur in…

Answer 2

hospitalised patients who are immunocompromised or have an indwelling catheter.

Question 3

pylonephronitis is associated with lower or upper UTIs?

Answer 3

upper - this is when they affect the kidneys

Question 4

cystitis and urethritis is associated with lower or upper UTIs?

Answer 4

lower

Question 5

cytisis is inflammation of the

Answer 5

bladder

Question 6

urethritis is inflammation of the

Answer 6

urethra

Question 7

most common symptoms of lower UTI

Answer 7

• dysuria
• increased urinary freq and urgency
• strong smelling urine
• cloudy or bloody urine
• persistent lower abdominal pain

Question 8

these two signs usually indicate upper UTI

Answer 8

• loin pain (back pain where kidneys are)
• fever

Question 9

in pregnant women, this is a risk factor for pyelonephritis and premature labour

Answer 9

asymptomatic bacteriuria

Question 10

UTIs have been associated with these issues in the infant, aswell as fetal death (2)

Answer 10

• developmental delay
• cerebral palsy

Question 11

insertion of a catheter into the urinary tract increases risk of..

Answer 11

developing UTI

Question 12

the longer the catheter is in place for increases risk of …

Answer 12

bacteriuria

Question 13

when are UTIs considered recurrent (2)

Answer 13

at least 2 episodes within 6 months
or three or more episodes within 12 months

Question 14

what is acute prostatitis and what is it usually caused by

Answer 14

infection of prostate gland
usually caused by UTI

Question 15

common symptoms of acute prostatitis

Answer 15

• sudden onset of fever
• acute urinary retention or irritative voiding symptoms

Question 16

chronic prostatitis is a complication of acute prostatitis and is defined as at least…

Answer 16

3 months of urogenital pain usually associated with lower UTI symptoms

Question 17

non drug treatment of UTI

Answer 17

• drink plenty of fluids to avoid dehydration
• self care strategies to reduce risk of recurrent infections (e.g. wipe from front to back, do not delay urination, do not wear occlusive underwear)

Question 18

Is asymptomatic bacteriuria routinely treated with abx?

Answer 18

no, with the exception of pregnant women

Question 19

oral 1st line abx in non pregnant women (2 options)

Answer 19

nitrofurantoin or trimethoprim (if low risk of resistance)

Question 20

oral 2nd line if no improvement after at least 48h, or first like not suitable in non-pregnant women

Answer 20

• nitrofurantoin if not used 1st line
• fosfomycin
• pivmecillinam
• amoxicillin (high rate of resistance, only use if culture susceptible)

Question 21

when can amoxicillin be used for abx therapy for non pregnant women with acute uncomplicated lower UTI

Answer 21

it is one the the 2nd line options but high rate of resistance so only use if culture sensitive

Question 22

when should you consider treatment non-pregnant women acute uncomplicated lower UTI

Answer 22

• can be self limiting
• option is so delay abx treatment with back up rx to see if symptoms will resolve
• consider back up rx for use if symptoms worsen or do not improve within 48h or an immediate abx rx

Question 23

when should you treat lower UTI In men

Answer 23

• give immediate abx rx
• take midstream urine sample before treatment and send for culture and suscepibility testing

Question 24

oral 1st line for lower UTI In men (2 options)

Answer 24

nitro or trimethoprim

Question 25

What to consider if UTI in men if no improvement after at least 48h or if 1st line not suitable

Answer 25

consider pyelonephritis or prostatitis

Question 26

when should you treat UTI in pregnant women

Answer 26

immediate abx rx should be given take midstream urine sample before treatment is taken and sent for culture and susceptibility testing

Question 27

what is 1st line and second line in pregnant UTI

Answer 27

- 1st line: nitrofurantoin - 2nd line if no improvement after at least 48h ,or first line not suitable: amoxicillin (only if sensitive) or cefalexin

Question 28

drug treatments for pregnancy asymptomatic bacteriuria (3)

Answer 28

amoxicillin cefalexin nitrofurantoin

Question 29

use of nitrofurantoin in pregnancy and BF

Answer 29

avoid at term - may produce neonatal haemolysis avoid in BF - only small amounts in milk but enough to produce haemolysis in G6PD-deficient infants

Question 30

when should you give treatment for acute prostatitis

Answer 30

An immediate antibacterial prescription should be given A midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing

Question 31

when to refer acute prostatitis

Answer 31

Refer patients to hospital if symptoms are not improving after 48 hours of treatment, or if they have any signs or symptoms suggestive of a more serious condition such as sepsis, acute urinary retention, or prostatic abscess.

Question 32

1st line for acute prostatitis (3)

Answer 32

ciproflox or oflox alternative if unable to take quinolones (e.g. tendon disorder related to quinolone use, caution in seizures, psychiatric disorders etc) is trimethoprim

Question 33

2nd line on specialist advice for acute prostatitis (2)

Answer 33

levoflox if not given 1st line cotrimoxazole

Question 34

when to treat acute pyelonephritis

Answer 34

An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing.

Question 35

when would you refer acute pyelonephritis

Answer 35

Consider referring or seeking specialist advice for patients with acute pyelonephritis who are significantly dehydrated or are unable to take oral fluids and medicines, are pregnant, or have a higher risk of developing complications.

Question 36

pyelonephritis choice of abx therapy in non pregnant women and men - oral 1st line (4)

Answer 36

cefalexin or ciproflox if sensitivity known, co-amox or trimethoprim

Question 37

pregnant women 1st line for acute pyelonephritis (plus IV)

Answer 37

cefalexin 1st line IV if severely unwell or unable to take oral treatment: cefuroxime

Question 38

for postmenopausal women experiencing recurrent UTIs, what can you consider

Answer 38

consider a vaginal oestrogen [unlicensed indication] at the lowest effective dose if behavioural and personal hygiene measures alone are not effective or appropriate. Treatment should be reviewed within 12 months. Oral oestrogens (hormone replacement therapy) should not be given to postmenopausal women specifically to reduce the risk of recurrent UTIs.

Question 39

for patients with recurrent UTIs (men, pregnant, suspected cancer, or recurrent upper UTI and those with recurrent lower UTI with unknown cause)....

Answer 39

refer or seek specialist advice

Question 40

in non pregnant women, what can you consider for people recurrent UTI

Answer 40

- consider a trial of antibacterial prophylaxis if behavioural and personal hygiene measures, and vaginal oestrogen (in postmenopausal women) are not effective or appropriate. - Single-dose antibacterial prophylaxis [unlicensed indication] should be considered for use when exposed to an identifiable trigger. - Daily antibacterial prophylaxis should be considered in non-pregnant women who have had no improvement after single-dose antibacterial prophylaxis, or who have no identifiable triggers.

Question 41

what to do consider for men and pregnant women if behavioural and personal hygiene measures alone are not effective or appropriate in reducing recurrent UTI

Answer 41

With specialist advice, daily antibacterial prophylaxis should be considered

Question 42

1st line and 2nd line for women and men - recurrent UTI (4)

Answer 42

1st line trimethoprim or nitrofurantoin 2nd line amox (unlicensed) or cefalexin

Question 43

what to do if catheter associated UTI and when to give treatment

Answer 43

onsider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days, without delaying antibacterial treatment. An immediate antibacterial prescription should be given and a urine sample obtained before treatment is taken and sent for culture and susceptibility testing.

Question 44

when to consider referring or seeking specialist advice for catheter associated UTI

Answer 44

who are significantly dehydrated or unable to take oral fluids and medicines, are pregnant, have a higher risk of developing complications, have recurrent catheter-associated UTIs, or have bacteria resistant to oral antibacterials.

Question 45

catheter associated UTI for non pregnant women and men - oral 1st line if no upper UTI symptoms (3)

Answer 45

- amox (only if susceptible) - nitrofurantoin - trimethoprim (if low risk resistance)

Question 46

catheter associated UTI for non pregnant women and men - oral 2nd line if no upper UTI symptoms and 1st line not suitable

Answer 46

pivmecillinam

Question 47

catheter associated UTI for non pregnant women and men - oral 1st line if upper UTI Symptoms

Answer 47

- cefalexin, ciproflox, co-amox (if susceptible), trimethoprim (if low risk of resistance)

Question 48

catheter associated UTI - pregnant women, 1st line oral and IV

Answer 48

oral cefalexin IV if severely unwell or unable to take oral treatment cefuroxime