Urinary tract infections (UTIs) in Females Flashcards
Background
Mainly caused by bacteria from GI tract entering urinary tract. E coli most common.
LUTI = inflammation of the bladder (cystitis) and urethra (urethritis).
Can go up and become UUTI (proximal part of the ureters (pyelitis) or the proximal part of the ureters and the kidneys (pyelonephritis), and can cause renal scarring,/abscess/or failure, and sepsis.
Mechanisms:
Colonization with ascending spread, hematogenous spread and peri-urogenital spread
Types of UTI:
Uncomplicated - caused by typical uropathogens in a non-pregnant woman with no anatomical or functional abnormalities of the UT, and no predisposing comorbidities. Usually self-limiting and resolves within a few days.
Recurrent - 2 or + eps of UTI in 6 months, or 3 or + eps in 1 year.
Catheter associated - is catheterised or has had a urinary catheter within the last 48 hours
Asymptotic - presence of significant levels of bacteria in urine without UTI symptoms/signs.
Risk factors
- Previous UTI
- Sexual activity
- Changes in the bacteria that live inside the vagina, or vaginal flora. Eg menopause or spermicides use can cause these bacterial changes.
- Pregnancy
- Age (older adults and young children are more likely to get UTIs)
- Structural problems in the UT
- Poor hygiene
Pregnant - asymptomatic bacteriuria is a risk factor for pyelonephritis and premature labour
Signs and Symptoms
- Dysuria,
- Increased frequency & urgency,
- Changes in urine appearance or consistency (cloudy, different colour or odour),
- Haematuria (blood in urine),
- Nocturia or suprapubic discomfort/tenderness
- Continuous abdominal pain
Pyelonephritis also have:
- Fever
- Loin or back pain (bilateral or unilateral)
- Nausea or vomiting
Diagnosis
Look at symptoms
Assessment: Urine dipstick testing, urine culture.
Dipstick not needed if: <65 yrs, 2/3 key symptoms no risk factor of complicated UTI
Dipstick done if: <65, 1 key symptom.
- dipstick is positive for nitrite or leukocyte and RBCs, UTI is likely.
If dipstick negative THEN send mid stream urine (MSU)
MSU used instead of dipstick if:
- Is pregnant.
- >65 years.
- Symptoms are persistent, not resolving with antibiotic treatment, or recurring within 4 weeks after antibiotic treatment.
- History of recurrent UTI.
- Has urinary catheter in situ or been catheterised within last 48 hrs.
- Risk factors of antibiotic resistance
- Atypical symptoms
- Blood in urine
Duration of antibiotics
Duration:
3 days simple LUTI
5-10 immunosuppressed, abnormal anatomy or impaired kidney
7 days men, pregnant, Catheter related UTI
Treatment
NON pharmacological:
- Drink plenty fluids
- Hygiene
- Don’t delay urination
Drug treatment:
LUTI:
1st try resolve on its own if no improvement within 48 hours =
1st LINE
- Nitrofurantoin 50mg QDS. Severe/ prophylaxis 100mg QDS (avoided eGFR <45,) or
- Trimethoprim 200mg BD. 100mg OD prophylaxis ALT 200mg 1 dose for triggers.
2nd line
Nitrofurantoin, fosfomycin [IV Infusion 12-16 g daily] (elder or renal impaired), pivmecillinam, or amoxicillin (P/catheter 500mg TDS. Prophylaxis 250mg OD ALT 500mg 1 dose when triggers. Short course 3g 1 dose then repeat but 10/12 hrs after)
Treatment in pregnancy
Immediate antibiotics + MSU b4 treatment. All treatment 7 days
Oral 1st line:
Nitrofurantoin (avoid in 3rd trimester) 100mg MR BD
Oral 2nd line (no improvement after at least 48 hours or 1st line not suitable):
- Amoxicillin 500mg TDS(only if culture susceptible known), or cefalexin 500mg BD
ALT 2nd line:
Fosfomycin when benefits outweighs risk
Consult local microbiologist
Asymptomatic bacteriuria:
Amoxicillin, cefalexin, or nitrofurantoin.
- Cant use trimethoprim 1st trimester = folate antagonist. Folate is essential in early pregnancy for the normal development of the foetus = congenital malformations or neural tube defects. Can use in 3rd
RED flags
- Haematuria
- Fever
- Severe abdominal pain
- Shiver/rigors
