Wk 28: UTI Flashcards
Who would be classed as complicated UTI?
- Pregnant
- Male
- Children
- Elderly
- Pyelonephritis
- Recurrent
- Abnormal urinary tract
- Poor diabetes control
- Immunosuppressive
- Impaired renal function
What are typical signs of uncomplicated UTI?
- Dysuria
- Freq
- Suprapubic tenderness
- Urgency
- Polyuria
- Haematuria
What are signs of pyelonephritis?
- +- UTI symptoms
- Fever
- Flank, loin, lower back pain
- Can lead to renal failure + septicaemia
How is UTI diagnosed?
- Clinical history + symptoms
- Urine - smelly, cloudy, blood
- Urine microscopy
- Dipstick test - leukocyte + nitrite
- Urine culture
When would you not perform a urine dipstick?
- Over 65
- Unreliable
- Most w/ urinary catheter will have bacteria present in bladder w/o infection
How is uncomplicated UTI managed?
- Nitrofurantoin MR 100mg BD for 3 days/ 50mg QDS
- Trimethoprim 200mg BD for 3 days
How is complicated UTI managed?
Requires 5-10 days treatment
What are the important points of nitrofurantoin?
- Taken w/ food
- eGFR <45 caution
- eGFR 30-45 only if muti-drug resistant
- Inc risk of peripheral neuropathy
- S/e: GI, cough, chest pain, hypoxemia (w/draw + corticosteroids)
What inc risk of peripheral neuropathy?
- Diabetes
- Anaemia
- Folate deficiency
- Electrolyte imbalance
What are important points of trimethoprim?
- eGFR 15-25: normal dose for 3 days then half dose
- eGFR <15: half dose
- CI: blood dyscrasias - antifolate
- Interactions: mxt, aza, phenytoin, digoxin, warfarin
- Adverse: GI, blood disorders
What are common pathogens that cause pyelonephritis?
- E coli
- Klebsiella pneumonia
- Proteus, pseudomonas + enterococcus species
When would you admit pyelonephritis to hospital?
- > 38 + <36 degrees
- Tachycardia, hypotension, SOB
- Impaired consciousness, rigors, sweating
- Dehydration
- Not able to tolerate fluids/oral meds
When would you be cautious when managing pyelonephritis?
- Pregnancy
- Elderly
- Lack improvement follow Abx 24 hrs
- Immunocompromised
- Renal impairment
- Diabetes
How would you manage pyelonephritis in primary care?
- Co-amoxiclav 625mg TDS 7 days
- Ciprofloxacin 500mg BD 7 days
How would you manage pyelonephritis in secondary care?
- Gentamicin
- Tazocin
- Meropenem
- Teicoplanin
- Ciprofloxacin
What are the causes of recurrent UTI?
- Relapse: same strain w/in 2 wks of treatment
- Reinfection: diff strain, >2wks after
What is the treatment for UTI in men?
- 7 days of trimethoprim/nitro
- Recurrent in men/febrile: quinolones
What is the presence of bacteriuria in pregnant women associated with?
- Premature rupture of membranes + pre-term labour
- Requires midstream urine culture
Which bacteria found in pregnant women require antibiotics during delivery?
Group B streptococcus
How is cystitis in pregnancy managed?
- Paracetamol
- Alkalizing + cranberry = avoid
- Fever + loin pain = hospital admin
How does UTI usually present in elderly?
- Functional decline
- Inc confusion
How is UTI in patients with indwelling catheters managed?
- Catheter checked for correct position + ensure not blocked
- If more than 1 wk, change before starting Abx
- Urine cultures taken prior to initiating
- 7 day course
What are the risks of UTI in diabetes?
- Inc risk of asymptomatic bacteriuria
- Inc risk of recurrent infections
- Higher prevalence of atypical pathogens
- Antimicrobial resistance
- Fungal UTI more common
What are clinical presentations of UTI in infants?
- Fever
- Vom
- Lethargy
- Offensive urine
- Poor feeding
- Jaundice
In children and infants, when would you give a urine sample test?
Fever > 38 + w/in 24 hrs
What are the indications for a culture?
- Pyelonephritis/upper UTI
- <3 yrs
- Single positive for leukocyte or nitrite
- Recurrent
- No response w/in 24-48 hrs
What are the risk factors for UTI in children?
- Incomplete bladder emptying: constipation, poor urine flow
- Fx: vesicoureteric reflux or renal disease
- Previous UTI
- Spinal lesion
- Poor growth
- High BP
How is UTI managed in children or infants >3 months?
- Acute pyelonephritis: 7-10 days, IV for 2-4 days then oral
- Low UTI: 3 days, reassess if unwell after 24-48hrs
- Trimethoprim, nitro, cephalosporin, amox
How is UTI prevented in children?
- High fluid
- Regular voiding
- Complete bladder emptying
- Prevent constipation
- Good perineal hygiene
When is antibiotic prophylaxis indicated in children?
- Recurrent
- <2 w/ congenital abnormality
- Severe reflux
- Trimethoprim
