UTIs

Question 1

What are 5 risk factors of UTI?

Answer 1

• Female (Short urethra)
• Neurological cognitions affecting bladder emptying
• Pregnancy (relaxation on musculature)
• Abnormal renal tract
• Impaired host defence

Question 2

Compare Uncomplicated and Complicated UTI

Answer 2

Uncomplicated;
- Infection by usual organisms in a patient with a normal urinary tract and normal urinary function

Complicated;
- 1 or more factors that predispose to persistent infection, recurrent infection or treatment failure

(Abnormal tract, virulent organism, impaired host defence/ renal function)

Question 3

Do you take a urine culture in Complicated and Uncomplicated UTI

Answer 3

Uncomplicated- No culture needed, treat supportively

Complicated- Take culture

Question 4

Suggest 2 occasions when a Urine dipstick is useful

Answer 4

• Females <65 to aid suspected diagnosis of Uncomplicated UTI
• To rule out infection in children >3 months

(Not useful in Catheterised patients and those >65, as asymptomatic infection is common)

Question 5

What 3 symptoms make UTI likely?

Suggest 2 things in a dipstick that indicate UTI

Answer 5

Dysuria
Nocturia
Cloudy urine

Nitrites
Leukocyte Esterase

Question 6

Suggest 4 groups who you would perform urinary tract imaging on

Answer 6

• All children with UTI
• Septic patients to identify possible renal involvement
• Males: Look for posterior urethral valves
• Females and children: Look for Vesico-ureteric reflux

Question 7

Suggest 6 causes of Sterile Pyuria on urine culture

High white cells but no growth

Answer 7

• Prior antibiotics (Culture then ABs)
• Urethritis (Chlamydia, Gonorrhoeae)
• Vaginal infection
• TB
• Appendicitis
• Fastidious organisms (slow growing)

Question 8

What are 2 risk factors for Asymptomatic Bacteriuria?

In who is it screened for and treated?

Answer 8

• Elederly and Indwelling catheters

- ONLY in pregnant women, as it increases risk of premature labour and pyelonephritis

Question 9

Compare treatment time of Uncomplicated and Complicated UTI

Answer 9

Complicated: 5-7 days
Uncomplicated: 3 days

Question 10

How is Simple Cystitis treated?

Answer 10

• 3 day course

- Nitrofurantoin, Trimethoprim, Pivemecillinam or Fosfomycin

Question 11

How is Complicated Lower UTI treated?

Answer 11

• 5-7 day course

- Nitrofurantoin, Trimethoprim, Pivmecillinam, Fosfomycin or Cefelexin

Question 12

How can Pyelonephritis/ Septicaemia be treated?

Answer 12

• 7-10 day course

Use agent with systemic activity;

• Not Nitrofurantoin, Fosfomycin
• Co-amoxiclav, Ciprofloxacin, Gentamicin (Nephrotoxic)