UTI

Question 1

What are the different upper and lower UTIs?

Answer 1

1. Upper - pyelonephritis

2. Lower - cystitis, prostatitis

Question 2

What are the risk factors for UTI?

Answer 2

1. Increased bacterial inoculation - sex, urinary/faecal incontinence, constipation.
2. Increased binding of uropathogenic bacteria - spermicide use, low oestrogen, menopause.
3. Decreased urine flow - dehydration, obstruction.
4. Increased bacteria growth - diabetes mellitus, stones, obstruction, immunosuppression, catheter, pregnancy.

Question 3

What is this a presentation of?
Fever, abdominal/loin pain, distended bladder, enlarged bladder. Frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria.

Answer 3

Cystitis

Question 4

What is this a presentation of?
Fever, abdominal/loin pain, distended bladder, enlarged bladder. Rigors, vomiting, frequency, dysuria, urgency, septic shock.

Answer 4

Pyelonephritis

Question 5

What is this a presentation of?
Fever, abdominal/loin pain, distended bladder, enlarged bladder. Pain in perineum, scrotum, penis, bladder, lower back. Malaise, nausea, LUTS, swollen/tender prostate on PR.

Answer 5

Prostatitis

Question 6

How is a suspected UTI investigated?

Answer 6

1. Dipstick - non-pregnant women <65 with <3 symptoms, not in catheterised patients.
2. MSU culture - anaerobes and gram -ve from bowel and vagina (E. coli).
3. Blood tests if systemically unwell.
4. Imaging - USS and referral to urology in men with upper UTI/failure to response to empirical/recurrent/unusual organism/persistent haematuria.

Question 7

Who should you treat for symptomatic bacteriuria?

Answer 7

Non-pregnant women, men, and adults with catheters.

Question 8

How do you treat UTI in a non-pregnant woman?

Answer 8

1. If 3 or more days symptoms and no discharge - 3-days trimethoprim/nitrofurantoin.
2. If empirical fails, culture urine and treat accordingly.
3. If upper UTI, culture first, treat with broad spectrum (co-amoxiclav)

Question 9

How do you treat a UTI in pregnant women?

Answer 9

1. Get expert help, confirm asymptomatic bacteriuria with 2nd sample.
2. Avoid trimethoprim in T1 and nitrofurantoin in T3.

Question 10

How do you treat a UTI in men?

Answer 10

1. Lower UTI - 7 days trimethoprim/nitrofurantoin.

2. If prostatitis - 4 weeks ciprofloxacin.

Question 11

When do you treat bacteriuria in catheterised patients?

Answer 11

All catheterised patients are bacteriuric, send MSU if symptomatic.