UTI

Question 1

Bacteriuria definition

Answer 1

Bacteria in urine

Can be a/symptomatic, is not a disease in itself

Question 2

Lower UTI definition

Answer 2

Cystitis/prostatitis

Question 3

Upper UTI definition

Answer 3

Pyelonephritis - infection of kidney/renal pelvis

Question 4

Abacterial cystitis (urethral syndrome) definition

Answer 4

Diagnosis of exclusion in pt with dysuria + frequency with no infection

Question 5

UTI in >65yrs MSU

Answer 5

MSU is no longer diagnostic as 10% of men and 20% women have bacteriuria, so clinical diagnosis needed

Question 6

UTI classification

Answer 6

Uncomplicated - normal renal structure + function

Complicated - structure/function abnormality of GU tract e.g. stones/ catheter/ neurogenic bladder

Question 7

UTI RFs

Answer 7

Increased bacterial inoculation (sex, urine/faecal problems)
Increased binding of uropathogenic bacteria (e.g. menopause, spermicide use)
Decreased urine flow
Increased bacterial growth (DM, immunosuppressed, obstruction)

Question 8

UTI presentation

Answer 8

Cystitis - dysuria, subrapubic pain, haematuria
Acute pyelonephritis - vomiting, rigor, septic shock
Prostatitis - perineal/lower back pain, nausea, swollen/tender prostate
Fever
Abdo/loin pain

Not classic signs in catheterised pt

Question 9

UTI tests

Answer 9

Dipstick NPV 80%, use in non-pregnant <65yrs women
MSU culture >10^5 cfu/ml; use in pregnant, men, children
Blood tests if systemically unwell
USS in men with upper UTI, recurrent/refractory UTI, pyelonephritis

Question 10

UTI organisms

Answer 10

E. coli 75-95% (decreased in hospital)
Staph saprophyticus 5-10%
Other enterobacteria

Question 11

Sterile pyuria causes

Answer 11

Recent UTI
Catheter
Pregnancy
Drugs (steroids)
TB
SLE
PKD/ renal tract tumour/ tubulointerstitial nephritis

Question 12

UTI management non-pregnant women

Answer 12

Non-pregnant women with cystitis treat empirically with 3d trimethoprim (or nitrofurantoin if eGFR >30 + can’t use trimethoprim (e.g. with methotrexate))
In non-pregnant women upper UTI broad spec Abx

Question 13

UTI management pregnant women

Answer 13

Pregnant women treat with Abx (avoid trimethoprim/ciprofloxacin in 1st trimester, nitrofurantoin in 3rd) + OBGYN referral

Question 14

UTI management men

Answer 14

Lower UTI 7d trimethoprim or nitrofurantoin (eGFR>30)
If prostatitis consider 4wk fluoroquinolone (e.g. cipro)
If upper/recurrent UTI, refer to urology

Question 15

UTI management catheterised pt

Answer 15

Send MSU only if symptomatic (fever, flank pain, vomiting, sepsis)
Change long-term catheter before starting Abx

Question 16

Urinary tract TB diagnosis

Answer 16

Sterile pyuria
Normal TB symptoms
Acid-fast staining of early morning MSU