UTI Flashcards
Which pathogens cause uncomplicated UTI?
75-95% E.coli
Staphylococcus saprophyticus is isolated in 5-15%
Enterococci, klebsiella and proteus account for the remaining 5-10%.
Which pathogens cause complicated UTI?
E.coli remains the dominant pathogen in complicated UTIs.
Symptoms of cystitis?
one or more of
dysuria, urinary frequency, haematuria, urgency and suprapubic discomfort
Urine dipstick in UTI
Nitrite sensitivity alone is 81%
leucocytes (leucocyte esterase) alone is 77%. If both are present, sensitivity is 94%.
Nitrites are only converted from nitrates in the presence of certain bacteria including E.coli.
Overtreatment rate on dip alone- has been estimated as 47%
Undertreatment rate -13%, illustrating its inability to predict UTI accurately
Which patients need culture sending for UTI?
all patients with suspected pyelonephritis, and all complicated UTIs should have their urine sent for culture before initiating antibiotics.
The presence of >105 per mL confirms significant bacteriuria.
What is the Gold standard for UTI diagnosis?
Urine culture remains the gold standard for detection of UTI,
The presence of >105 per mL confirms significant bacteriuria.
Treatment for acute uncomplicated cystitis?
In young, female, non-pregnant patients in areas with low E.coli resistance, Trimethoprim is still a reliable empiric treatment.
Nitrofurantoin must not be used if pyelonephritis is suspected, as it has poor efficacy in the upper urinary tract. Cephalexin is also an option.
Treatment for acute complicated cystitis
In cases of acute complicated cystitis, avoid Trimethoprim.
Instead, ciprofloxacin or cephalexin may be used.
Treatment of UTI in pregnancy?
UTIs in pregnancy are complicated.
May be treated with nitrofurantoin, cephalexin or amoxicillin.
treatment of simple uti in women?
Trimethoprim if local resistance is low one tablet bd 3 days
Cephalexin 500 mg tds 5/7
Ciprofloxacin 500 mg bd 3 days
UTIs in men common pathogen?
> 90% e coli
UTIs in males between 15 and 50 are unusual.
Recurrent infection or slow clearance of a single infection should trigger referral.
Prostate can be involved therefore need longer course
Empirical treatment with a two week course of a quinolone is reasonable
UTI treatment in pregnancy?
Trimethoprim is a folate antagonist. It should be avoided in pregnancy as there is a teratogenic risk to the foetus.
Penicillins and cephalosporins are safer alternatives: more detailed information can be found at the British National Formulary.
