Urinary Tract Infections Flashcards
What are two examples of factors which make a UTI ‘complicated’?
Systemic symptoms or a renal tract structural abnormality
What are some risk factors for the development of a UTI?
Diabetes, catheterisation, sexual activity/pregnancy in women
What organism is the most common cause of a UTI?
E. coli
Which organism causing UTI produces a ‘burnt chocolate’ smell on culture, and shows a ‘swarming’ pattern?
Proteus spp.
Which organism causing UTI can result in the formation of struvite (triple phosphate) stones?
Proteus spp.
S. saprophyticus is an organism which can cause UTI- it is most common in who?
Women of child-bearing age
Symptoms of dysuria, haematuria, frequency/urgency and suprapubic pain are characteristic of which UTI?
Acute cystitis
Other than the characteristic features of cystitis, what are some additional features of acute pyelonephritis?
Fever/rigors, nausea/vomiting, loin pain
What are some presenting symptoms of prostatitis?
Flu-like symptoms, lower backache, haematospermia
A swollen/tender/boggy prostate on examination suggests what possible diagnosis?
Acute prostatitis
If an MSSU cannot be taken for any reason, what are some other methods of obtaining an uncontaminated urine sample for microscopy, culture and sensitivity?
Suprapubic aspiration or straight catheter
Which two elements of urinalysis testing are most specific for a UTI?
Nitrites and leukocytes
What investigation is used as a first line investigation for UTI in hospital, or to confirm a diagnosis suspected on urinalysis in primary care?
Urine cultures
What investigation should be performed on every uncatheterised male who presents with a UTI?
Urine cultures
If patients with a UTI are systemically unwell, what blood tests should be taken?
FBC, U&E, CRP, blood cultures
What is the first line investigation if imaging is necessary for someone with a UTI?
Renal ultrasound
If nothing is detected on renal ultrasound, what is the second line imaging test for UTI?
Cystoscopy
Which antibiotic commonly used to treat UTIs must be avoided in the first trimester of pregnancy?
Trimethoprim
Which antibiotic commonly used to treat UTIs must be avoided in late pregnancy, breastfeeding and children aged < 3 months?
Nitrofurantoin
What is the risk of using nitrofurantoin in late pregnancy, breastfeeding and children aged < 3 months?
Neonatal haemolysis
Which antibiotic commonly used to treat UTIs comes with a risk of severe pulmonary reactions and should be avoided in those with pre-existing interstitial lung disease?
Nitrofurantoin
If a patient has an eGFR < 20ml/min, what antibiotic should be used instead of gentamicin?
Aztreonam
What lifestyle advice should be given to all patients with a UTI?
Drink lots of fluids and urinate often
What is meant by the term abacterial cystitis?
The patient has symptoms of a UTI but no significant growth on culture
Symptomatic relief is the treatment advised for abacterial cystitis or urethral syndrome. What can be used to alkalinise the urine for this purpose?
Potassium citrate
What is meant by the term asymptomatic bacteriuria?
The patient has bacteria in the urine but remains asymptomatic
When is antibiotic treatment required for asymptomatic bacteriuria and why?
In pregnant women- if untreated, this risks progressing to pyelonephritis or causing IUGR/premature delivery
How should pregnant women with asymptomatic bacteriuria be treated?
Antibiotics for 7 days and a test of cure
What is the antibiotic of choice for the treatment of asymptomatic bacteriuria or UTI in the first two trimesters of pregnancy?
Nitrofurantoin
What is the antibiotic of choice for the treatment of asymptomatic bacteriuria or UTI in the third trimester of pregnancy?
Trimethoprim
What is the first line antibiotic treatment for an uncomplicated lower UTI?
PO nitrofurantoin (100mg bd)
What is the second line antibiotic treatment for an uncomplicated lower UTI?
PO trimethoprim (200mg bd)
How long should antibiotic treatment be given for a lower UTI in men and women?
7 days for men, 3 days for women
What is the antibiotic treatment required for a complicated UTI or pyelonephritis in primary care?
PO co-amoxiclav or co-trimoxazole for 7 days
What is the empirical antibiotic therapy for a complicated UTI or pyelonephritis in secondary care?
IV amoxicillin and gentamicin
When treating a complicated UTI or pyelonephritis, how long should antibiotics be given for (PO/IV)?
7 days
If a patient is penicillin allergic, what should amoxicillin be substituted for in the empirical treatment of pyelonephritis?
Co-trimoxazole
If there is a definite UTI in a catheterised patient, how should they be treated?
As for a complicated UTI
What is the advice regarding removing the catheter in catheterised patients who have a UTI?
It should be removed and replaced within 24-72 hours of starting antibiotics
How is prostatitis treated?
28-day course of ofloxacin or ciprofloxacin
UTIs with extended spectrum beta lactamase producing bacteria can only be treated with what?
IV meropenem
What is the definition of a recurrent UTI?
2 or more in 6 months, 3 or more in a year
Which antibiotics can be given as prophylaxis for recurrent UTIs?
Methanamine, trimethoprim or nitrofurantoin
Use of prophylactic antibiotics for recurrent UTI should be stopped after how long?
6 months
In post-menopausal women with recurrent UTIs, what treatment (other than antibiotics) can be considered?
Oestrogen pessary or cream
In individuals who are immunosuppressed and have sterile pyuria, you should have a high index of suspicion for what diagnosis?
Tuberculous pyelonephritis
