UTI

Question 1

Definitions: bacteriuria, UTI, lower UTI, upper UTI, recurrent UTI, uncomplicated UTI, complicated UTI

Answer 1

• Presence of bacteria in urine, may be symptomatic or asymptomatic
• UTI implies presence of characteristic symptoms and significant bacteriuria, 10^5 colony-forming units per millilitre is threshold, bacteriuria does NOT equate to UTI
• Lower
• Upper includes pyelitis and pyelonephritis
• Recurrent
• Uncomplicated- infection caused by a normal pathogen in a person with a a normal urinary tract with normal kidney function
• Complicated- Anatomical, functional or pharmacological factors predispose to persistent infection, recurrent infection or treatment failure (e.g. UTI in males, obstruction or or pregnancy or with atypical organisms)

Question 2

UTI Organisms

Answer 2

• Most common is E. coli

- Other include Staph saprophytic, Proteus mirabilis, Enterococci

Question 3

UTI Atypical Organisms

Answer 3

• More likely to occur in those with underlying pathology, immunosuppression or catheters
• Klebsiella
• Proteus vulgaris
• Candida albicans
• Pseudomonas spp.

Question 4

UTI Epidemiology

Answer 4

• More common in women

- Prevalence of bacteriuria increases with age but does not mean UTI

Question 5

UTI RFs

Answer 5

• Instrumentation
• Abnormality of renal tract
• Incomplete bladder emptying
• Antibiotic use
• New sexual partner

Question 6

UTI Presentation

Answer 6

• Urinary frequency
• Small amounts of urine
• Pain
• Haematuria
• Foul smelling urine

Question 7

UTI Differentials

Answer 7

• Urethral syndrome
• Atrophic vaginitis
• Other infections
• Prostate enlargement

Question 8

UTI Investigations

Answer 8

• Dipstick- can treat as bacterial if positive for nitrite and/or leukocyte (not useful in catheterised patients)
• Culture and sensitivity
• Can use urine microscopy in complicated UTI for antibiotic selection
• Can use post-void residual volume in unwell women with suspected UTI (as may continue to occur until resolution)

Question 9

UTI Management

Answer 9

• Trimethoprim or nitrofurantoin
• For uncomplicated pyelonephritis is oral ciprofloxacin 7-10 days
• Can use prophylactic antibiotics in some cases