UTIs

Question 1

Bacteriuira

Answer 1

Bacteria in the urine
- Can be symptomatic or asymptomatic
of 10^6 per mL.

Asymptomatic is usually not treated

Question 2

UTI classifications

• Uncomplicated
• Complicated
• Recurrent
• Relapse

Answer 2

Uncomplicated
- Normal GU tract and function

Complicated

• Abnormal GU tract
• Outflow obstruction
• Decreased renal function
• Immunocompromised host
• Virulent organism

Reccurent
- Further infection, with new organism

Relapse
- Further infection with same organism

Question 3

UTI risk factors

Answer 3

Sexual intercourse

Female

Catheterisation

Pregnancy
Menopause

Diabetes

Abnormal tract: stones, obstruction, malformation

Question 4

Causative agents of UTIs

Answer 4

Most common= E.coli

Other enterobacteriacae
- Proteus mirabilis (alkaline urine, struvite stones)

Others

• S. auereus
• Klebs pneumonia

Question 5

Causes of sterile pyuria

Answer 5

• TB
• Untreated UTI
• Appendicitis
• Calculi
• Papillary necrosis
• PKD

Question 6

Symptoms

• Cystitis
• Prostatitis
• Pyelonephritis

Answer 6

Cystitis

• Urinary frequency, dysuria
• Urgency
• Haematuria
• Suprapubic pain

Prostatitis

• Flu-like symptoms
• low back pain

Pyelonephritis

• high fever
• rigors
• vomiting
• loin pain
• AKI

Question 7

Signs of UTI

Answer 7

Foul smelling urine

Enlarged prostate on PR (prostatitis)

Fever

Distended bladder

Question 8

Investigations for UTI

Answer 8

Bloods

• FBC: may show raised WCC
• CRP, elevated
• U+E; kidney dysfunction
• Culture is there are systemic signs

Urine dipstick

• Positive nitrites
• Blood and leucoytes may be present

Urine microscopy
- Presence of bacteria, blood and WBC

Urine culture
- Most specific/ sensitive

Imaging

• US: bladder, kidney
• CT KUB
• Cystoscopy

Question 9

Management of UTI

- Lower, uncomplicated

Answer 9

Oral antibiotics:

1. Trimethoprim/ Nitrofurantoin + sulfamethoxazole PO
   - Nitro not good in renal failure
2. Fosfomycin, Pivmecillinam

Question 10

Management of UTI in women

- pyelonephritis

Answer 10

Oral antibiotics

• Cefalexin
• Co-amoxiclav/ trimethoprim if culture results indicate
• Cipro

IV antibiotics
1. Co-amoxiclav (in combo or if culture indicated)
Gentamicin
Ceftriaxone/ cefuroxime
Ciprofloxacin

Question 11

Management of prostatitis in men

Answer 11

First line is PO fluoroquinolone

• Ciprofloxacin, ofloxacin
• Trimethroprim if above not appropiate

2. Levofloxacin, co-trimoxazole

IV drugs
- Cipro, levo, gentamicin, ceftriaxone, cefuroxime