UTI [NEW] in adults (Complete)

Question 1

UTI is also known as?

Answer 1

Cystitis

Question 2

What are main risk factors for UTI?

Answer 2

History of UTIs

Sexual activity

Catheterisation

Female specific:

Pregnancy

Post-menopausal: Vaginal atrophy secondary to oestrogen deficiency and increase risk of UTI

Male specific:

BPH

Urinary tract calculi

Urological surgeries

Question 3

What are main clinical features of UTI?

Answer 3

Symptoms:

Urinary frequency (e.g. new nocturia)

Dysuria: Pain/burning when peeing

Urgency

Foul-smelling urine

Suprapubic pain

Signs:

Suprapubic tenderness

Cloudy urine

Haematuria

Question 4

What additonal feature is suggestive of catheter associated UTI?

Answer 4

Flank pain

Costovertebral angle tenderness

Malaise

Rigors

Question 5

What additional features of UTI presents mainly in elderly patients?

Answer 5

New or worsening delirium

New incontience

Question 6

What is an important differential to consider in patients with UTI?

Answer 6

Pyelonephritis

Question 7

How does pyelonephritis differ to UTI?

Answer 7

Fever

Vomitting

Loin pain

Renal angle tenderness

Question 8

What investigations should be considred in patients suspected of UTI?

Answer 8

Bedside:

Urine dipstick

Mid-stream urine sample for urinalysis: In children, males and pregnant women and visible or non-visible haematuria

Question 9

What findings on urine dipstick are supportive of UTI?

Answer 9

Positive leukocytes

Positive nitrites

Question 10

Urine cultures should always be ordered in which patients?

Answer 10

Children

Males

Pregnant women

Age >65

Visible or microscopic haematuria

Question 11

What is the management for non-pregnant woman with confirmed UTI?

Answer 11

Medicine:

Nitrofurantoin or trimethropin for 3 days

Question 12

What is the management for pregnant woman with confirmed UTI?

Answer 12

Medicine:

Nitrofurantoin: First-line but avoid near term

Amoxicillin or cefalexin: Second-line if nitrofurantoin contraindicted.

Question 13

What antibiotic should be avoided in pregnant woman for UTI management?

Answer 13

Trimethropin (Teratogenic especially during first-term)

Question 14

What is the management for pregnant woman with assymptomatic bacteriuria?

Answer 14

Send urine culture

7-day course of Nitrofurantoin (avoid late-term), amoxicillin or cefalexin

Urine culture after treatment to ensure it is resolved

Question 15

Why should pregnant woman with assymptomatic bactaeriuria be treated with ABs?

Answer 15

Due to high risk of developing into pyelonephritis

Question 16

What is the management for males with confirmed UTI?

Answer 16

Send urine culture before ABs

Prescribe nitrofuratoin or trimethropin 7-day course (vs 3-day in non-pregnant woman)

Question 17

What is management for patients with suspected UTI who are catheterised?

Answer 17

Remove or change catheter if in place longer than 7-days.

ABs: 7-day course

Question 18

What is management for catheterised patients with assypmtomatic bacteria?

Answer 18

Dont treat

This is because bacteria probably from spontaneous formation within already drained urine

Question 19

What additional investigations should be considered for patients suspected of acute pyelonephritis?

Answer 19

Bedside:

Urinalysis: Positive nitrites, leukocytes

Urine MSU and MC&S

Basic obs: Check if systematically unwell

Bloods:

Blood culture: Check for sepsis

FBC: Raised WCC

U&Es: Check for impaired renal function

Imaging:

Renal US: Check for hydronephrosis in severe cases

Question 20

What is the management plan for patients with acute pyelonephritis?

Answer 20

Consider hospital admission

Medicine:

IV Broad-spectrum ABs: Cephalosporin, quinolone or gentamicin for 10-14 days

Question 21

Name 3 examples of broad-spectrum ABs used in management of pyelonephritis

Answer 21

Cephalosporin

Quinolone

Gentamicin

Question 22

What are main contraindictions for trimethoprin? (2)

Answer 22

Pregnancy

Methotrexate (Trimethoprin also inhibits folic acid metabolism)