UTI

Question 1

categories of UTI

Answer 1

Asymptomatic bacteriuria
Cystitis (lower urinary tract infection)
Urethral (Frequency dysuria) syndrome
Upper urinary tract infection (Pyelonephritis)

Question 2

describe lower UTI

Answer 2

Superficial inflammation of the urethra and bladder

Question 3

symptoms of lower UTI

Answer 3

Frequency, dysuria, haematuria, urgency, suprapubic discomfort, polyuria

Question 4

what is urethral syndrome

Answer 4

Also known as frequency/dysuria syndrome

Symptoms of UTI without evidence of infection

Question 5

describe upper urinary tract infection

Answer 5

aka pyelonephritis

Direct invasion of the renal tissue

Question 6

symptoms of pyelonephritis

Answer 6

Back pain, fever, rigors

Question 7

describe when a UTI becomes complicated

Answer 7

Congenital abnormality: Obstruction, neurological dysfunction

Acquired abnormality: Obstruction, neurological dysfunction

Catheter (if symptomatic)

Young male patient

Pregnancy

Upper urinary tract infection

Question 8

why is a man with a UTI always complicated?

Answer 8

Man with urinary tract infection is automatically complicated because of the risk of prostatitis which is harder to treat

Question 9

common causes of uncomplicated UTI

Answer 9

E. Coli
Staph saprophyticus
Klebsiella
Enterobacter

Question 10

causes of complicated UTI

Answer 10

E coli still common
But
Klebsiella sp, Enterobacter sp, Proteus sp, Enterococcus sp become commoner
Also other organisms such as Pseudomonas aeruginosa are commoner also

Question 11

what will you see on a urine dip with UTI

Answer 11

Nitrite detection
Bacteria change convert nitrate to nitrite
Red Blood cells
inflammation
White blood cells
inflammation
Protein
inflammation

Question 12

length of tx

Answer 12

3 days of uncomplicated adult females and children UTI (good evidence) – but not for every patient – depends on severity and response to non-antibiotic treatments
7 days for pregnant patients
7 days for male patients
7 days for symptomatic catheter related infections and change catheter
7-10 days or longer for Upper urinary tract infection
Treat asymptomatic bacteriuria in pregnancy
Do NOT treat asymptomatic bacteriuria in the elderly (good evidence)

Question 13

abx choices

Answer 13

Lower UTI non-pregnant female no catheter
1st Line: Nitrofurantoin, trimethoprim (if low rate of resistance)
2nd line: nitrofurantoin (if not 1st) pivmecillinam, fosfomycin

Lower UTI pregnant female no catheter
1st Line: Nitrofurantoin (not at term)
2nd line: amoxicillin, cefalexin or other option*

Lower UTI male no catheter
1st Line: trimethoprim, nitrofurantoin
2nd line: cefalexin, ciprofloxacin, co-amoxiclav*

Pyelonephritis (some drugs contraindicated in pregnancy)
1st line oral : cefalexin, trimethoprim, ciprofloxacin, co-amoxiclav
1st line IV: co-amoxiclav +gentamicin/amikacin, cefuroxime, ceftraxone, ciprofloxacin