UTIs

Question 1

What is a UTI?

Answer 1

A bacterial infection in any part of the urinary system

Question 2

What makes up the urinary system?

Answer 2

Upper urinary tract = kidneys and ureter

Lower urinary tract = bladder and urethra

Question 3

What is the infection that effects the kidneys called?

Answer 3

Pyelonephritis (Upper UTI)

Question 4

What is the infection that effects the bladder called?

Answer 4

Cystitis (Lower UTI)

Question 5

What causes a UTI?

Answer 5

E.coli 
Pregnancy 
Catheters 
Kidney stones 
Enlarged prostate 
Constipation (kids) 
Familial link 
Urinary tract abnormality 
Weakened immune system

Question 6

What are the symptoms of a UTI?

Answer 6

Incomplete emptying feeling 
Increased urgency/frequency to urinate
New nocturia 
Dysuria
Haematuria 
Cloudy urine 
Systemically unwell 
Fever 
Suprapubic pain 
Vaginal discharge

Question 7

What are some symptoms of a UTI in babies?

Answer 7

Poor feeding

Failure to thrive

Question 8

What are differential diagnoses of a UTI?

Answer 8

Thrush, BV
Kidney stones 
Chlamydia 
Bladder cancer 
Pelvic inflammatory disease 
Benign prostatic hyperplasia

Question 9

How do you test for a UTI?

Answer 9

Dipstick test to detect white cells, nitrites (which is a breakdown product of E. coli) or blood in the urine

Mid stream culture

Question 10

When would you treat a patient with an empirical antibiotic?

Answer 10

If it was severe or ≥ 3 symptoms (urgency, frequency, polyuria, dysuria, haematuria, suprapubic tenderness)

AND

Absence of vaginal discharge/irritation

Question 11

If a patients symptoms are mild or ≤ 2 symptoms, what would you do?

Answer 11

Check if their urine is cloudy, if it is then use a urine dipstick test to confirm diagnosis

If the urine is not cloudy then consider another diagnosis

Suspect pyelonephritis if they have a:
Fever
Flank/loin/lower back pain

Question 12

What are some self care strategies to help a UTI?

Answer 12

If it is uncomplicated symptoms will resolve within 5 days so there is no need for antibiotics

Drink plenty of fluids

Paracetamol and NSAIDs (check suitability i.e., not for asthma, those on anticoagulants/SSRIs, at a risk of bleeding, CVD, elderly)

Question 13

What is the first line antibiotic choice for a UTI?

Answer 13

Nitrofurantoin 100mg BD for 3 days (OR 50mg QDS) if eGFR ≥ 45ml/min

OR

Trimethoprim 200mg BD for 3 days
(However high level of resistance - check local guidelines)

Question 14

When should a patient seek urgent medical help?

Answer 14

Shivering, chills, muscle pain 
Confused/drowsy 
Not passed urine all day 
Smelly urine 
Blood in urine 
Temp 38(+) or 36(-)
Kidney pain in back (under ribs) 
Symptoms worsen/no improvement within 48hrs of strong antibiotic

Question 15

How can you prevent a UTI?

Answer 15

Wipe from front to back 
Don’t wait to pass urine 
Urinate after sex 
Drink enough fluids 
Avoid occlusive underwear/tights

Question 16

How do you treat a recurring UTI?

Answer 16

If the pt has experienced 2 episodes over the last 6 months / ≥ 3 infections per year

1st choice = Nitrofurantoin or Trimethoprim

2nd choice = Amoxicillin or Cefalexin

Question 17

What is a complicated lower UTI?

Answer 17

Includes:
Pregnancy 
Men 
Elderly 
Children 
Catheters

Question 18

Why does bacteriuria (with/without symptoms) occur in pregnant women?

Answer 18

Associated with premature rupture of membranes and pre-term labour

Routine screening for asymptomatic bacteriuria by midstream urine culture is recommended in early pregnancy (NICE)

Question 19

How do you treat symptomatic bacteriuria in pregnancy?

Answer 19

• Paracetamol
• Avoid alkalising agents and cranberry
• Urine culture and empirical antibiotic therapy
• Fever and loin pain suggest upper UTI -> hospital admission and IV abx

Question 20

What is the treatment for UTI’s in pregnancy?

Answer 20

Nitrofurantoin MR 100mg BD for 7 days (OR 50mg QDS) if eGFR ≥ 45ml/min
NOT used at full term
NOT treated with Trimethoprim as it’s teratogenic

Question 21

What are second line antibiotics to treat UTI’s in pregnancy?

Answer 21

Amoxicillin 500mg TDS for 7 days

Cefalexin 500mg BD for 7 days

Question 22

How to treat men with UTI’s?

Answer 22

Same antibiotics however for 7 days instead of 3

Question 23

How to treat a male with symptoms associated with an inflamed prostate?

Answer 23

Ciprofloxacin (longer course)

Question 24

How to treat those with catheters?

Answer 24

Need 7 day course antibiotics

Question 25

What are symptoms of a UTI in an elderly person? And why can’t these symptoms be used alone to confirm diagnosis?

Answer 25

Confusion
Cognitive impairment

Have led to UTI over diagnosis

Question 26

How to treat the elderly with a UTI?

Answer 26

Check if Nitrofurantoin is suitable (eGFR ≥ 45ml/min)

Be aware of toxicity symptoms - monitor liver symptoms and lung function

Question 27

What other symptoms should be present to diagnose a UTI (with the presence of delirium) in the elderly?

Answer 27

Acute dysuria alone
OR
Fever (> 37.9)

AND
new/worsening urgency/frequency to urinary
Signs of irritation - suprapubic pain, flank/loin tenderness, gross haematuria

Question 28

What are the upper UTI symptoms?

Answer 28

Systemically unwell
Fever
Back pain
Haematuria

Question 29

What can pyelonephritis lead to?

Answer 29

Sepsis

Question 30

How do you treat an upper UTI?

Answer 30

Consider hospitalisation if unable to take fluids/signs of sepsis

Antibiotic choice = Oral Co-Amoxiclav or Ciprofloxacin

IV 1st line = Co-Amoxiclav, Cefuroxime, Ceftriaxone

IV 2nd line = Ciprofloxacin, Gentamicin