Recurrent UTIs Flashcards

1
Q

What is the traditional definition of recurrent UTIs?

A

2 proven episodes within 6 months or 3 within a year

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2
Q

What is thought to cause most recurrences of UTIs?

A

Re-infection with the same organism

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3
Q

What is the lifetime risk of a UTI in women?

A

1 in 2

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4
Q

What happens to a woman’s risk of UTI with age?

A

Increases

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5
Q

What organism is responsible for 75-90% of all UTIs?

A

E. Coli

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6
Q

What are some less common causative organisms for UTIs?

A
  • Staphylococcus saprophyticus

- Proteus mirabilis

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7
Q

What are the risk factors for recurrent UTIs?

A
  • DM
  • Sexual intercourse
  • Atrophic urethritis and vaginitis
  • Abnormalities of the urinary tract
  • Incomplete bladder emptying
  • Contraception
  • History of urinary tract surgery
  • Immunocompromised e.g. HIV
  • First UTI under 15
  • History of recurrent UTI in mother
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8
Q

What are the symptoms of UTI?

A
  • Dysuria
  • Frequency
  • Urgency
  • Nocturia
  • Haematuria
  • Suprapubic discomfort
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9
Q

What are the signs of UTI?

A
  • Suprapubic tenderness
  • Cloudy or foul-smelling urine
  • Other signs in the elderly
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10
Q

What signs are often seen in elderly women with UTIs?

A
  • Incontinence
  • Confusion
  • Anorexia
  • Fever
  • Shock
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11
Q

What is the recommended investigation in recurrent UTIs?

A

MSU

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12
Q

Why is MSU recommended in recurrent UTIS?

A

Resistance is more likely

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13
Q

When may women with recurrent UTIs need to be referred to secondary care?

A
  • Have underlying risk factors
  • Have cultures showing multi-resistant organisms
  • Pneumaturia or faecaturia
  • Haematuria
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14
Q

What underlying risk factors for high risk UTI may need referral to secondary care?

A
  • Previous urological surgery
  • Stones
  • Anatomical abnormality
  • Immunocompromised
  • Flow problems
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15
Q

What is the investigation of choice for looking for underlying pathology in women with recurrent UTI?

A

CT scan

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16
Q

How is a recurrent UTI relapse managed?

A
  • Send MSU
  • Treat for 3 days with abs
  • (or 10 if underlying abnormality present)
17
Q

What may be appropriate if UTI symptoms are mild?

A

Offer delayed antibiotic prescription

18
Q

What is the option of prophylaxis for recurrent UTIs dependent on?

A

If related to sexual intercourse or not

19
Q

If recurrent UTI is related to sexual intercourse what prophylactic measures can be considered?

A
  • Change method of contraception if barrier or spermicide used
  • Suggest lubricant
  • Consider 100mg trimethoprim 2 hours after sexual intercourse
20
Q

If recurrent UTI is not related to sexual intercourse what prophylaxis can be given?

A

Consider 6 month course of low-dose nitrofurantoin or trimethoprim

21
Q

How should patients with repeated failure of recurrent UTI treatment be managed?

A

Refer to specialist