UTI Flashcards
Define bacturia
bacteria in urine, symptomatic or asymptomatic
Define UTI
symptomatic ̄c +ve culture or dipstick
Define urethral syndrome
symptomatic but no bacteriuria
Classification of UTI - uncomplicated, complicated, recurrent, relapse?
Uncomplicated: normal GU tract and function
Complicated: abnormal GU tract, outflow obstruction, ↓
renal function, impaired host defence, virulent organism
Recurrent: further infection ̄c new organism
Relapse: further infection ̄c same organism
Presentation of pyelonephritis
Fever, rigors
Loin pain and tenderness
Vomiting
Oliguria if ARF
Presentation of cystitis
Frequency and urgency Polyuria Haematuria Dysuria Suprapubic tenderness Foul smelling urine
Presentation of prostatitis
Flu-like symptoms
Low backache
Dysuria
Tender swollen prostate on PR
Causes of sterile pyuria
TB Treated UTI Appendicitis Calculi TIN Papillary necrosis Polycystic Kidney Chemical cystitis (e.g. cyclophosphamide)
Risk factors for UTI
Female Sex Pregnancy Menopause DM Abnormal tract: stone, obstruction, catheter, malformation
Organisms causing UTI
E. coli
Staphylococcus saprophyticus
Proteus (alkaline urine → struvite renal stones) Klebsiella
Investigations for UTI
Dipstick
MSU for MCS
Bloods: FBC, U+E, blood cultures (if systemic signs) US: children, men, recurrence, pyelonephritis
Positive culture =
> 10^4 CFU/ml pure growth
>10^3 CFU/ml pure growth of E. coli or S. saprophyticus >10^5 CFU/ml mixed growth ̄c one predominant organism
General treatment and advice
Drink plenty, urinate often, cranberry juice
Prevention
Drink more
Abx prophylaxis
? cranberry juice
Uncomplicated definition and treatment
Young-middle aged non-pregnant females with symptoms of lower urinary tract infections
1st line therapy: Trimethoprim PO 200 mg BD for 3 days
Alternative: Nitrofurantoin PO 50mg QDS for 3 days
Complicated definition and treatment
Males, older women, catheterised patients, abnormal renal tract, immunocompromised patients, or history of recurrent UTI’s
1st line: Trimethoprim PO 200 mg BD for 5 days
Alternative: Nitrofurantoin PO 50mg QDS for 5 days
LUTS with systemic sepsis treatment
1st Line: Co-amoxiclav IV 1.2g tds
Pyelonephritis treatment plus alternative due to pen allergy
1st Line: Co-amoxiclav orally 625mg tds for 14 days
Penicillin allergy: Ciprofloxacin orally 500mg bd for 7 days
Catheterised patients treatment
MRSA evidence
Antibiotics are only required if patient is systemically unwell. Treat as for complicated UTI if needed.
Trimethoprim and nitrofurantoin are usually active against MRSA - a cause of catheter-related UTI in hospital.
