UTIs, Pyelonephritis and Prostatitis Flashcards
Define a lower urinary tract infection (LUTI).
Cystitis, i.e. infection of the bladder
Define an upper urinary tract infection (UUTI).
Infection of the urinary system above the bladder, including pyelonephritis, renal abscesses, and renal calculi
Define an uncomplicated UTI.
A lower UTI (i.e. cystitis), in a urinary system with normal structure and normal neurology
Define a complicated UTI.
An upper UTI, possibly with systemic signs and symptoms (e.g. sepsis), or any catheter associated UTI (CAUTI)
When would you treat asymptomatic bacteriuria? (4)
Preschool age children
Pregnant women
Renal transplant patients
Immunocompromised patients
How would you treat an uncomplicated UTI in non-pregnant women? (6)
Culture is NOT mandatory at 1st presentation
Investigations:
- Dipstick testing
- Previous culture results
Treatment:
-Antibiotics (3-7 days)
If antibiotics don’t work:
- Urine culture
- Change antibiotic
Which antibiotics might you give for an uncomplicated UTI? (5)
With which route of administration?
Oral
Amoxicillin Trimethoprim Nitrofurantoin Pivmecillinam Fosfomycin
How would you manage uncomplicated UTIs in pregnant women? (4)
Consider which antibiotics are NOT safe to use in pregnancy.
ALWAYS send urine culture
Antibiotics (7-10 days):
- AVOID: trimethoprim, nitrofurantoin
- SAFE: amoxicillin, cefalexin
- Treat aggressively
How would you treat an uncomplicated UTI in children or men? (2)
ALWAYS send urine culture
Treatment:
-Antibiotics (7-10 days)
How would you manage recurrent UTIs? (9)
ALWAYS send urine culture
Supportive treatment:
- Hydration
- Encourage urge initiated and post coital voiding
- Cranberry products
Antibiotics:
- Self-administered single dose/short course
- Single dose post-coital antibiotics
- Prophylactic (6 months)
Other treatments:
- Intravaginal/oral oestrogen
- Urology investigation
How would you manage acute pyelonephritis (UUTI)? (9)
Include investigations, antibiotics, and what to do if the antibiotics don’t work.
Investigations:
- Check recent/previous microbiology
- Urine culture
- Blood culture
- Imaging
Antibiotics:
- In community: trimethoprim, ciprofloxacin, amoxicillin
- In hospital: broad spectrum
- If uncomplicated: 7-14 days
- If complicated: 14+ days
If antibiotics don’t work:
-Further investigaiton
How would you prevent CAUTIs? (5)
Only catheterise when absolutely necessary Remove catheter as soon as possible Remove/replace catheter if infected Catheter care bundles Hand hygiene
How would you treat a CAUTI? (5)
Check recent/previous microbiology
Catheter removal:
- Remove if not needed
- Replace with a clean one if necessary
Antibiotics:
- Start empirical antibiotics
- Switch later
Which investigations would you do for complicated UTIs? (10)
Blood tests:
- FBC
- U&Es
- CRP
- Blood cultures (if pyrexial)
Urine tests:
- Urethral sample
- Catheter specimen (CSU)
- Suprapubic
- Nephrostomy
Imaging:
- Renal US
- CT
How would you manage complicated UTIs?
Antibiotics (14+ days)
- IV
- Hospital admission
