Urology - UTIs

Question 1

Presentation of lower UTIs?

Answer 1

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul smelling urine
Confusion is commonly the only symptom in older and frail patients

Question 2

Important to distinguish UTI from

Answer 2

Pyelonephritis

Question 3

Suspect pyelonephritis if

Answer 3

Fever
Loin/back pain
Nausea/vomiting
Renal angle tenderness on examination

Question 4

Investigations in suspected UTI

Answer 4

Urine dipstick:

• Positive for nitrites (gram negative bacteria e.g. E.Coli break down nitrates into nitrates)
• Significant raised leukocytes can indicated infection or other cause of inflammation
• Blood - may be seen on urine dip
• Nitrites are a better indicator than leukocytes (treat as UTI if nitrites)

MSU for culture and sensitivities
- Especially in recurrent UTIs, atypical symptoms and if symptoms not improving with antibiotics

Question 5

Causes of UTI

Answer 5

E.Coli (most common)

Other causes:
Klebsiella pneumoniae (gram-negative anaerobic rod)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)

Question 6

Antibiotic choice for UTI

Answer 6

Initial:

• Trimethoprim (often associated with high rates of bacterial resistance)
• Nitrofurantoin (avoided in patients with an eGFR <45)

Alternatives:
Pivmecillinam
Amoxicillin
Cefalexin

Question 7

Duration of antibiotics in UTI

Answer 7

3 days - women with simple infection

5-10 days for immunosuppressed women, abnormal anatomy or impaired kidney function

7 days for men, pregnant women or catheter-related UTIs