Urinary tract infections in females (Complete) Flashcards
What are 6 most common risk factors associated with UTI?
Sexual activity
Spermicides (Contraceptive)
Post-menopause (Oestrogen has protective qualities)
Family history of UTIs (2-4x risk if mother had previous history of UTIs)
History of UTIs
Foreign object (e.g. catheter, sutures, surgical material)
What are 3 less common risk factors associated with UTI?
Age
Antibiotic usage
Poor bladder emptying (need to clear out batcteria)
What are 5 common signs and symptoms of a UTI?
Dysuria (painful urination often described as burning)
New nocturia
Cloudy urine
Fever
Presentation of risk factors
What are the 3 key diagnostic signs/symptoms of a UTI?
Dysuria
Nocturia
Cloudy-white urine
List 9 less common signs/symptoms of a UTI and potential differentials.
Urgency (consider overactive bladder)
Haematuria (Consider other causes if presentation is haematuria alone)
Frequency
Suprapubic pain or tenderness
Flank pain (especially if they were recently catheterised)
New incontinence (especially if over 65 and presentation of at least 1 other UTI symtpom)
New or worsening delirium (esp if over 65)
Malaise (especially if catheterised)
Fever
What symptoms often present themselves in UTIs caused due to catheterisation? (6)
Suprapubic pain or tenderness
Flank pain
Costo-vertebral angle tenderness
New or worsened delirium/debility
Malaise
Rigors (shivering)
What are some red-flag differentials in patients suspected with having a UTI?
Sepsis
Pyelonephritis (especially if they have signs of fever, rigors, kidney/rib tenderness, flu-like symptoms, vomitting ect)
Pre-term delivery in pregnant woman
Bladder cancer (especially if also presenting with haematuria and 45 years of age)
What investigation should be ordered in patients suspected of a UTI?
What findings would be indicative of a UTI?
Urine dipstick test (mid-stream)
Results: High nitrites, High leukocytes
How reliable are urine dipstick tests when used in patients suspected of UTI?
Aren’t 100% accurate. Therefore should still suspect UTI and should be treated if high clinical suspicion.
Give 6 examples of situations where you would consider doing a urine culture and sensitivity over a urine dipstick test. (6)
Has 2/3 of the key diagnostic signs/symptoms
Presentation of RBCs and risk of antibiotic resistance
Suspected sepsis or pyelonephritis
Previous AB treatment has failed
Recurent UTIs in Pmx
Has been catheterised and will be recieving ABs
What is assymptomatic bacteriuria?
Culture or microscopy in a urine sample shows the presence of bacteria, without the patient experiencing any symptoms of lower or upper urinary tract infection
What is the management plan for patients with assymptomatic bacteriuria?
No treatment needed UNLESS the patient is pregnant as there is a risk of pyelonephritis and premature delivery.
UTI management plan differs depending on the type of patient. What are the two treatment pathways for UTI?
Category 1: Non-pregnant woman
Category 2: Pregnant woman, men or children under 16
What is the management plan for non-pregnant woman with UTI?
Give immediate antibiotics if the symptoms are severe .
Provide a back-up antibiotic prescription if the symptoms are mild and patient is not in need of immediate treatment (symptoms may resolve by the time AB is available)
What is the management plan for UTIs in pregnant woman, males and children under 16?
Send a midstream urine sample for culture and sensitivity (make sure to do this BEFORE giving ABs) for pregnant woman or men
Urine dipstick in children under 16 years of age
Give immediate antibiotics after samples are sent
