UTI

Question 1

Define Urinary Tract Infection (UTI)?

Answer 1

The presence of a pure growth oif > 10^5 organisms per mL of fresh MSU

Question 2

What is the sub-classification of UTI?

Answer 2

Lower UTI

Upper UTI

Question 3

What does the Lower UTI affect?

Answer 3

Urethra (urethritis)
Bladder (cystitis)
Prostate (prostatitis)

Question 4

What does the Upper UTI affect?

Answer 4

Renal Pelvis (pyelonephritis)

Question 5

What’s important to remember about the lab classification of UTI?

Answer 5

1/3 of women with symptoms of UTI will have a negative MSU

Question 6

What is the other classification of UTIs?

Answer 6

Uncomplicated UTI

Complicated UTI

Question 7

What are the characteristics of Uncomplicated UTI?

Answer 7

Normal renal tract and funxtion

Question 8

What are the characteristics of Complicated UTI?

Answer 8

Abnormal renal/genitourinary tract, voiding difficulty/obstruction, reduced renal function, impaired host defences, virulent organism (e.g. S. aureus)

Question 9

What are more UTIs caused by?

Answer 9

Escherichia coli

Question 10

What are the other causative organisms of UTIs?

Answer 10

Staphylococcus saprophyticus
Proteus mirabilis
Enterococci

Question 11

What are the atypical organisms that can cause UTI?

Answer 11

(usually in immunocompromised individuals)
Klebsiella
Candida albicans
Pseudomonas aeruginosa

Question 12

What are the risk factors for UTIs?

Answer 12

Female 
Sexual intercourse 
Exposure to spermicide 
Pregnancy
Menopause 
Immunosuppression
Catheterisation
Urinary tract obstruction
Urinary tract malformation

Question 13

What is the epidemiology of UTIs?

Answer 13

Very common
1-3% of GP consultations
The majority of women will have a UTI in their lifetime
Much more common in FEMALES

Question 14

What are the presenting symptoms of Cystitis?

Answer 14

Frequency
Urgency 
Dysuria 
Haematuria 
Suprapubic pain

Question 15

What are the presenting symptoms of Prostatitis?

Answer 15

Flu-like symptoms
Low backache
Few urinary symptoms
Swollen or tender prostate on PR

Question 16

What are the presenting symptoms of Acute Pyelonephritis?

Answer 16

High fever 
Rigors 
Vomiting 
Loin pain and tenderness 
Oliguria (if AKI)

Question 17

What are the signs of UTI on physical examination?

Answer 17

Fever 
Abdominal or loin tenderness 
Foul-smelling urine 
Distended bladder (occasionally)
Enlarged prostate (if prostatitis)

Question 18

What investigations do we do for UTIs?

Answer 18

Urine Dipstick 
Urine Microscopy
Urine Culture 
Ultrasound 
Bloods

Question 19

What do we see on a Urine Dipstick for UTIs?

Answer 19

Positive leucocyte esterase and nitrites

Question 20

What do we see in Urine Microscopy for UTIs?

Answer 20

Presence of leucocytes indicates infection

Question 21

Why do we do Urine Culture for UTIs?

Answer 21

To exclude diagnosis of it the patient failed to respond to empirical antibiotics

Question 22

Why do we do US for UTIs?

Answer 22

Rule out obstruction

Question 23

What bloods do we do for UTIs?

Answer 23

FBC
U&Es - check renal function
CRP
Blood cultures - if systemically unwell and risk of urosepsis

Question 24

What is the Empirical treatment of uncomplicated UTI?

Answer 24

Trimethoprin or Nitrofurantoin
Treat for 3-6 days
Men with UTI may need a longer course of antibiotics

Question 25

What are some alternative treatments of UTIs?

Answer 25

Co-amoxiclav

Cefalexin

Question 26

What is the other treatment of UTIs?

Answer 26

Prophylactic antibiotics may be used in certain circumstances (e.g. recurrent cystitis associated with sexual intercourse)

Question 27

What can ascending infection lead to in UTIs?

Answer 27

Pyelonephritis 
Perinephric and intrarenal abscess 
Hydronephrosis or pyonephrosis 
AKI
Sepsis

Question 28

What complication is common in men with UTIs?

Answer 28

Prostatic involement (e.g. prostatitis)

Question 29

What is the prognosis for UTIs?

Answer 29

GOOD prognosis with appropriate treatment