UTIs Flashcards
Urinary-tract infections (UTIs) are
~ infections that affect any part of urinary tract
~ occur more frequently in females, and usually independent of any risk factor
~ predominantly caused by bacteria from GIT entering urinary tract, with Escherichia coli being most common cause.
~ Infection due to Candida albicans rare, but may occur in hospitalised patients immunocompromised or indwelling catheter.
Lower UTIs are
~ associated with inflammation of bladder (cystitis) and urethra (urethritis)
~ most common signs & symptoms of lower UTIs = dysuria, increased urinary frequency + urgency, urine strong smelling, cloudy or contains blood, + persistent lower abdominal pain
~ complicated lower UTI = lower UTI with increased risk of more serious outcome or tx failure, for example in a patient with a structural or functional abnormality of the urinary tract, or an underlying disease.
Upper UTIs
~ affect proximal part of ureters (pyelitis) or proximal part of ureters & kidneys (pyelonephritis), & can cause renal scarring, abscess or failure, & sepsis
~ usually present with accompanying loin pain & fever
recurrent UTIs are
least two episodes within 6 months OR three or more episodes within 12 months.
Acute prostatitis
~ symptom
~ complications
~ infection of prostate gland & usually caused by UTI
~ occur spontaneously or after certain medical procedures & can last for several weeks.
~ Common symptoms = sudden onset of fever, acute urinary retention or irritative voiding symptoms.
~ Possible complications = prostatic abscess, bacteraemia, epididymitis, and pyelonephritis.
Chronic prostatitis
complication of acute prostatitis & defined as at least 3 months of urogenital pain usually associated with lower urinary tract symptoms.
Non drug tx for UTIs
~ advised to drink plenty of fluids to avoid dehydration, & to use self-care strategies to reduce risk of recurrent infections. These include wiping from front to back after defaecation, not delaying urination, and not wearing occlusive underwear.
~ To reduce risk of recurrent infections, some females (non-pregnant) with recurrent UTIs may wish to try cranberry products (evidence of benefit uncertain) or D-mannose
~ advised to consider sugar content of these products
~ no evidence to support use of cranberry products for tx of UTIs
Uncomplicated lower UTI in NON-pregnant females
Acute, uncomplicated lower UTIs in these individuals can be self-limiting & for some, delaying abx tx with back-up prescription to see if symptoms will resolve, may be option. Consider back-up abx prescription for use if symptoms worsen or do not improve within 48 hours or immediate antibacterial prescription.
Oral 1st line:
~ Nitrofurantoin, or trimethoprim (if low risk of resistance).
Oral 2nd line (if no improvement after at least 48 hours, or 1st line not suitable):
~Nitrofurantoin (if not used first line), fosfomycin, pivmecillinam hydrochloride, or amoxicillin (high rate of resistance, so only use if culture susceptible).
Uncomplicated lower UTI in males
immediate antibacterial prescription given & midstream urine sample obtained before treatment taken & sent for culture & susceptibility testing.
~ Oral 1st line:
Nitrofurantoin, or trimethoprim.
~ Oral second line (if no improvement after at least 48 hours, or 1st line not suitable):
Consider pyelonephritis or prostatitis.
Uncomplicated lower UTI in Pregnant females
~ immediate antibacterial prescription given & midstream urine sample obtained before treatment taken and sent for culture and susceptibility testing.
~ Oral 1st line:
Nitrofurantoin.
~ Oral 2nd line (if no improvement after at least 48 hours, or 1st line not suitable):
Amoxicillin (only if culture susceptible), or cefalexin.
~ Alternative 2nd line:
Consult local microbiologist.
~ Asymptomatic bacteriuria:
Amoxicillin, cefalexin, or nitrofurantoin
Prostatitis acute
~ immediate antibacterial prescription given & midstream urine sample obtained before treatment taken & sent for culture and susceptibility testing.
Refer to hospital if symptoms not improving after 48 hours of tx, or if signs / symptoms of more serious condition i.e. sepsis, acute urinary retention, or prostatic abscess.
~ Oral 1st line:
Ciprofloxacin, or ofloxacin.
~ Alternative 1st line if quinolone not appropriate (seek specialist advice): trimethoprim.
~ Oral second line (on specialist advice):
Levofloxacin, or co-trimoxazole.
IV first line (if severely unwell or unable to take oral). Antibacterials may be combined if concerned about sepsis.
~ Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin, or levofloxacin.
~ Intravenous second line:
Consult local microbiologist.
Pyelonephritis, acute
Males and non-pregnant females
~ immediate antibacterial prescription given & midstream urine sample obtained before tx taken & sent for culture & susceptibility testing.
~ Oral first line:
Cefalexin. If sensitivity: co-amoxiclav, or trimethoprim. If other first line antibacterials are inappropriate, ciprofloxacin may be used.
~ Intravenous first line (if severely unwell or unable to take oral treatment). Antibacterials may be combined if concerned about susceptibility or sepsis.
Amikacin, ceftriaxone, cefuroxime, or gentamicin. Co-amoxiclav may be used if given in combination or sensitivity known.
~ If other first line antibacterials are inappropriate, ciprofloxacin may be used.
~ Intravenous second line:
Consult local microbiologist.
Pyelonephritis, acute
pregnant females
~ Oral 1st line:
Cefalexin.
~ Intravenous first line (if severely unwell or unable to take oral treatment):
Cefuroxime.
~ Second line or combining antibacterials if concerned about susceptibility or sepsis:
Consult local microbiologist.
Recurrent UTIs non-pregnant females
When behavioural & personal hygiene measures not effective or appropriate:
~ In perimenopausal, menopausal, and postmenopausal females
vaginal estriol / estradiol [unlicensed indication]; reviewed within 12 months. Systemic oestrogens (HRT) NOT given specifically to reduce risk of recurrent UTIs;
~ Consider single-dose abx prophylaxis [unlicensed indication] when there has been exposure to identifiable trigger;
~ Methenamine hippurate considered for prophylaxis of recurrent uncomplicated lower UTI. Specialist advice sought if considering use in non-pregnant females with recurrent upper UTI or complicated lower UTI (lack of evidence to inform when methenamine hippurate may be beneficial in these patients). reviewed within 6 months and then annually, or earlier if required;
~ Daily antibacterial prophylaxis considered if no improvement with above measures.
Recurrent UTIs Males and pregnant females
When behavioural & personal hygiene measures alone not effective or appropriate, seek specialist advice if considering methenamine hippurate for prophylaxis of recurrent uncomplicated lower UTI. reviewed within 6 months and then annually, or earlier if required. If methenamine hippurate is not effective, with specialist advice, consider daily antibacterial prophylaxis as an alternative.
~ Oral first line:
Trimethoprim, or nitrofurantoin.
~ Oral second line:
Amoxicillin [unlicensed indication], or cefalexin.
Advise about risk of resistance with long-term antibacterial use, seeking medical help if symptoms of acute UTI develop, & to return for review within 6 months.
Review success & ongoing need for antibacterial prophylaxis at least every 6 months. If antibacterial prophylaxis stopped, ensure patient has rapid access to treatment if they develop acute UTI
Catheter-associated UTIs ~ males & non pregnant females
~ Oral first line (if no upper UTI symptoms):
Amoxicillin (only if culture susceptible), nitrofurantoin, or trimethoprim (if low risk of resistance).
~ Oral second line (if no upper UTI symptoms & first-line not suitable):
Pivmecillinam hydrochloride.
~ Oral first line (upper UTI symptoms):
Cefalexin, co-amoxiclav (if culture susceptible), or trimethoprim (if culture susceptible). If other first line antibacterials inappropriate, ciprofloxacin may be used.
~ Intravenous first line (if severely unwell or unable to take oral treatment). Antibacterials may be combined if concerned about susceptibility or sepsis.
Amikacin, ceftriaxone, cefuroxime, gentamicin, or co-amoxiclav (only in combination, unless culture results confirm susceptibility). If other first line antibacterials inappropriate, ciprofloxacin may be used.
~ Intravenous second line:
Consult local microbiologist.
Catheter-associated UTIs ~ pregnant females
~ Oral first line:
Cefalexin.
~ Intravenous first line (if severely unwell or unable to take oral treatment):
Cefuroxime.
~ Second line or combining if concerned about susceptibility or sepsis:
Consult local microbiologist.
