UTI [NEW] in adults (Complete) Flashcards
UTI is also known as?
Cystitis
What are main risk factors for UTI?
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
What are main clinical features of UTI?
Symptoms:
Urinary frequency (e.g. new nocturia)
Dysuria: Pain/burning when peeing
Urgency
Foul-smelling urine
Suprapubic pain
Signs:
Suprapubic tenderness
Cloudy urine
Haematuria
What additonal feature is suggestive of catheter associated UTI?
Flank pain
Costovertebral angle tenderness
Malaise
Rigors
What additional features of UTI presents mainly in elderly patients?
New or worsening delirium
New incontience
What is an important differential to consider in patients with UTI?
Pyelonephritis
How does pyelonephritis differ to UTI?
Fever
Vomitting
Loin pain
Renal angle tenderness
What investigations should be considred in patients suspected of UTI?
Bedside:
Urine dipstick
Mid-stream urine sample for urinalysis: In children, males and pregnant women and visible or non-visible haematuria
What findings on urine dipstick are supportive of UTI?
Positive leukocytes
Positive nitrites
Urine cultures should always be ordered in which patients?
Children
Males
Pregnant women
Age >65
Visible or microscopic haematuria
What is the management for non-pregnant woman with confirmed UTI?
Medicine:
Nitrofurantoin or trimethropin for 3 days
What is the management for pregnant woman with confirmed UTI?
Medicine:
Nitrofurantoin: First-line but avoid near term
Amoxicillin or cefalexin: Second-line if nitrofurantoin contraindicted.
What antibiotic should be avoided in pregnant woman for UTI management?
Trimethropin (Teratogenic especially during first-term)
What is the management for pregnant woman with assymptomatic bacteriuria?
Send urine culture
7-day course of Nitrofurantoin (avoid late-term), amoxicillin or cefalexin
Urine culture after treatment to ensure it is resolved
Why should pregnant woman with assymptomatic bactaeriuria be treated with ABs?
Due to high risk of developing into pyelonephritis
What is the management for males with confirmed UTI?
Send urine culture before ABs
Prescribe nitrofuratoin or trimethropin 7-day course (vs 3-day in non-pregnant woman)
What is management for patients with suspected UTI who are catheterised?
Remove or change catheter if in place longer than 7-days.
ABs: 7-day course
What is management for catheterised patients with assypmtomatic bacteria?
Dont treat
This is because bacteria probably from spontaneous formation within already drained urine
What additional investigations should be considered for patients suspected of acute pyelonephritis?
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
What is the management plan for patients with acute pyelonephritis?
Consider hospital admission
Medicine:
IV Broad-spectrum ABs: Cephalosporin, quinolone or gentamicin for 10-14 days
Name 3 examples of broad-spectrum ABs used in management of pyelonephritis
Cephalosporin
Quinolone
Gentamicin
What are main contraindictions for trimethoprin? (2)
Pregnancy
Methotrexate (Trimethoprin also inhibits folic acid metabolism)
