Urinary tract infections (UTIs)

Question 1

1) What is infection of the bladder called?
2) What is infection of the kidney called?

Answer 1

1) Cystitis
2) Pyelonephritis

Question 2

Name 3 ways a lower UTI can present

Answer 2

• Dysuria
• Suprapubic pain or discomfort
• Frequency
• Urgency
• Incontinence
• Confusion is commonly the only symptom in older more frail patients

Question 3

Name 3 ways pyelonephritis can present

Answer 3

• Fever
• Unilateral or bilateral loin, suprapubic or back pain
• Malaise
• Vomiting
• Loss of appetite
• Haematuria
• Renal angle tenderness on examination

Question 4

1) What does nitrites on a urine dipstick imply, and why?
2) Name something else that may be raised in the urine dipstick of a patients with a UTI

Answer 4

1) Bacteria, gram negative bacteria (i.e. E.coli) breakdown nitrates, a normal waste product in urine, into nitrites
2) Leukocytes

Question 5

1) What is the commonest cause of a UTI?
2) What kind of bacteria is this (3)?
3) Name 2 other bacteria that can cause a UTI
4) Name a fungus that can cause a UTI

Answer 5

1) E.coli
2) Gram-negative, anaerobic, rod-shaped bacteria
3) Klebsiella pneumoniae, enterococcus, pseudomonas aeruginosa, staphylococcus saprophyticus
4) Candida albicans

Question 6

1) What is the duration of antibiotics for a simple lower urinary tract infection in women?
2) What is the duration of antibiotics for women that are immunosuppressed, have abnormal anatomy or impaired kidney function?
3) What is the duration of antibiotics for men, pregnant women or catheter related UTIs

Answer 6

1) 3 days
2) 5-10 days
3) 7 days

Question 7

1) Name an appropriate initial antibiotic for UTI in the community
2) Name an alternative antibiotic

Answer 7

1) Trimethoprim, nitrofurantoin
2) Pivmecillinam, amoxicillin, cefalexin

Question 8

1) Name 2 things UTIs in pregnancy increase the risk of
2) What is the 1st line antibiotic for UTI in a pregnant person
3) Name a 2nd line antibiotic
4) When is nitrofurantoin avoided, and why?
5) Why is trimethoprim avoided in the 1st trimester?

Answer 8

1) Pyelonephritis, premature rupture of membranes and preterm labour
2) Nitrofurantoin
3) Cefalexin or amoxicillin
4) 3rd trimester - associated with haemolytic anaemia of the newborn
5) Anti-folate effect

Question 9

1) Name 2 first line antibiotics for pyelonephritis
2) How long are they taken for?

Answer 9

1) Cefalexin, co-amoxiclav, trimethoprim, ciprofloxacin
2) 7-10 days

Question 10

Do you need to treat asymptomatic bacteria in catheterised patients, if so what is given?

Answer 10

No

Question 11

1) If a patient has symptoms of a UTI and is catheterised, how long should they be given antibiotics for?
2) What else should be considered in the patients management?

Answer 11

1) 7 days
2) Removing or changing catheter if its been in place for more than 7 days

Question 12

How should breastfeeding mothers with a UTI be managed?

Answer 12

Trimethoprim 200mg twice daily 3 days. Nitrofurantoin should be avoided during breastfeeding