UTI (1)

Question 1

What conditions does it include? What are they?

What is its most common cause?

Why is it more common in women?

What are its risk factors?

Answer 1

➊ • Cystitis - infection of bladder
• Pyelonephritis - infection of kidneys/renal pelvis

➋ E.coli

➌ They have a shorter urethra

➍ • ↑Bacterial growth - Catheter, DM, immunosuppression, obstruction, stones, renal tract malformation, pregnancy
• ↓Urine flow - Dehydration, Obstruction
• ↑Bacterial inoculation - Sexual activity, urinary/Faecal incontinence, constipation
• ↓Oestrogen - Menopause

N.B. Catheter-associated UTIs tend to be more severe and harder to treat

Question 2

Cystitis:
How does it present?

How is it investigated?

How is it managed?

What is Urethral syndrome?
→ How is it diagnosed?

Answer 2

➊ • Dysuria
• LUTS - Frequency, Urgency
• Suprapubic pain
• Incontinence, confusion - commonly the only sign in elderly

➋ • Urine dip - Nirites and Leukocytes
‣ MSU for MC&S if +ve
• Rule out differential of pyelonepheritis (fever, vomiting)

➌ Trimethoprim or Nitrofurantoin for 3 days
• Give for 7 days in pregnant women and men

N.B. Avoid Trimethoprim in 1st trimester, and Nitrofurantoin in 3rd trimester

N.B. Trimethoprim preferred if eGFR is < 45

➍ Abacterial cystitis
→ Presence of LUTS w/o bacterial cause

Question 3

Pyelonephritis:
How does it present?

How is it investigated?

How is it managed?

Answer 3

➊ • Fever/rigors
• Loin pain/tenderness
• N+V
• Haematuria
• O/E - Renal angle/costovertebral tenderness

➋ • Urine dip - Nitrites and Leukocytes
‣ MSU for MC&S if +ve
• Bloods - FBC (raised WCC), U&E (renal impairment), Culture
• Renal US - check for hydronephrosis if severe infection occurs with AKI
• Rule out differential of cystitis (lack of fever, vomiting)

➌ IV Abx - Broad-spectrum, such as Cefalexin, Co-amoxiclav, Ciprofloxacin, Trimethoprim