UTI

Question 1

How common are they?

Answer 1

Common

Question 2

What are some risk factors?

Answer 2

• Gender = Female

Question 3

What is a UTI?

Answer 3

Depends on patient’s symptoms and evidence of bacteruria.

+ve dipstick DOES NOT indicate UTI (esp in elderly

Question 4

How do you define bacteruria?

Answer 4

> 10⁵ colony forming units/ml of urine (using MSU)

• “Non-significant” / “mixed” bacterial growth may still be UTI with convincing symptoms and inflammatory cells in urine

VERY UNLIKELY TO HAVE NO BACTERIAL GROWTH / WHITE CELLS

Question 5

Do you treat asymptomatic bacteruria?

Answer 5

NO - it is an actively harmful thing to do!

Unless:

• Pregnant woman
• Prior to urological surgery

Question 6

Why do you treat pregnant women with asymptomatic bacteruria?

Answer 6

Increased risk of pre-term labour

Question 7

Why is it harmful to treat asymptomatic bacteruria?

Answer 7

Contributes to Abx resistance

Can disrupt patient’s natural bacteria and lead to more virulous infection

Question 8

When do you inititiate treatment for a UTI?

Answer 8

Presence of typical symptoms & nitrates/leucocytes is enough to start treatment

Question 9

How do you treat acute UTI?

Answer 9

• Uncomplicated UTI in female
  
  • 3 days of oral Abx
• UTI in male or pt with structural / functional abnormality
  
  • 7-10 days oral Abx
  • Send MSU, in case fail to respond to empirical Abx

Question 10

When would you avoid giving nitrofuantoin to patients & why?

Answer 10

• Pregnant patients
  
  • Can affect lung development in 3rd trimester
• Renal disease

Question 11

What options would you consider for treatment of UTI without resistance?

Answer 11

1. Nitrofurantoin - not for RF or final trimester
2. Trimethoprim (not for 1st trimester) / Sulfamethoxazole
3. Fosfomycin

Question 12

What oral antibiotic options do you have for a UTI with suspected / confirmed resistance?

Answer 12

1. Ciprofloxacin
2. Levofloxacin
3. Amoxicillin / Clavulanate

Question 13

What is an MGNO?

Answer 13

Multi-resistent organism

Question 14

How do you manage recurring UTI in women?

Answer 14

• USS (inc residual vol est.) +/- cystoscopy (in older women)
  
  • To exclude structural cause
• Advice (given no structural cause)
  
  • Fluid intake
  • Avoid synthetic pants
  • Avoid perfumed/expensive soaps
  • Shower over baths

Question 15

What is the non-abx

Answer 15

Non-Abx

• Topical oestrogens in post-meopausal women
• Cranberry capsules (buy over counter)
• D-Mannose (buy over counter, weak evidence, expensive)
• Methanamine Hippurate (prescribable
  
  • Urinary antiseptic

Question 16

How do you treat recurrent UTI’s with Abx?

Answer 16

• Post-coital
  
  • Single dose before/after sex
• Self start
  
  • Start at first sign of symptoms
• Low dose continuous prophylaxis
  
  • Strong evidence base for reducing infections but double edged sword