UTI

Question 1

What is a UTI?

Answer 1

presence of a pure growth of > 10^5 organisms per mL of fresh MSU

Question 2

How are UTIs classified?

Answer 2

Lower: urethra, bladder (cystitis), prostate
Upper: pyelitis + pyelonephritis.

Question 3

What is an uncomplicated UTI?

Answer 3

infection of UT by a usual pathogen in a person with a normal UT + normal kidney function.

Question 4

What is a complicated UTI?

Answer 4

where anatomical, functional, or pharmacological factors predispose the person to persistent infection, recurrent infection or tx failure - eg, abnormal urinary tract.

Question 5

What are most UTIs caused by?

Answer 5

Escherichia coli

Question 6

List 3 other causes of UTIs

Answer 6

Staphylococcus saprophyticus
Proteus mirabilis
Enterococci

Question 7

List 10 risk factors of UTI

Answer 7

Abnormality of the renal tract
Incomplete bladder emptying (e.g. prostatic obstruction)
Sexual activity.
New sexual partner.
Use of spermicide.
Diabetes.
Institutionalisation.
Pregnancy.
Immunocompromise.
Genetics

Question 8

List 3 iatrogenic risk factors for UTI

Answer 8

Recent instrumentation of the renal tract.
Abx use changes vaginal flora + promotes colonisation of the genital tract with E. coli
Presence of catheter.

Question 9

Give 2 epidemiological facts about UTIs

Answer 9

VERY COMMON

F > M

Question 10

List 10 symptoms of UTI

Answer 10

Frequency.
Dysuria.
Haematuria.
Foul-smelling ± cloudy urine.
Urgency.
Urinary incontinence.
Suprapubic or loin pain.
Rigors.
N+V
Acute confusional state

Question 11

List 5 signs of UTI

Answer 11

Fever  
Abdominal or loin tenderness  
Foul-smelling urine  
Distended bladder (occasionally)  
Enlarged prostate (if prostatitis)

Question 12

What is a positive result for UTI using Urine Dipstick ?

Answer 12

Positive leucocyte

Positive nitrites

Question 13

What bloods should be checked in suspected UTI?

Answer 13

FBC
U+Es: check renal function
CRP
Blood cultures: if systemically unwell + risk of urosepsis

Question 14

What is seen on urine microscopy and culture in UTI?

Answer 14

M: leucocytes indicates infection
C: exclude dx or if the pt failed to respond to empirical abx

Question 15

Why may ultrasound be performed in suspected UTI?

Answer 15

Exclude obstruction

Question 16

Which drugs would you use to treat an uncomplicated UTI pharmacologically?

Answer 16

TRIMETHOPRIM
NITROFURANTOIN
Treat for 3-6 days
Men may need a longer course

Question 17

Which 3 conservative strategies would you discuss with a patient who has a UTI?

Answer 17

Risk factors e.g. Spermicide, Sex
Increase fluid intake
Cranberry juice

Question 18

Which 2 antibiotics are used in mild uncomplicated pyelonephritis?

Answer 18

Co-amoxiclav

Cefalexin

Question 19

When may prophylactic low dose antibiotics be prescribed?

Answer 19

In women, for recurrent cystitis associated or not associated with sexual intercourse

Question 20

What 5 complications may be caused by ascending infection in UTI?

Answer 20

Pyelonephritis  
Perinephric + intrarenal abscess  
Hydronephrosis or pyonephrosis  
AKI 
Sepsis

Question 21

What complications may result in men with a UTI?

Answer 21

Prostatic abscess

Prostatitis

Question 22

What is the prognosis for UTI?

Answer 22

Good with appropriate treatment