Lower UTI Flashcards
Why are women far more susceptible to UTIs?
Urethra is shorter, easier for bacteria to track up to bladder
What is the primary source of bacteria for UTI?
Faeces
How do lower urinary tract infections present?
Dyrsuria
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul smelling urine
Confusion (commonly only symptom in older patients)
What symptoms cause pyelonephritis to be suspected?
Fever
Loin/back pain
Nausea/vomiting
Renal tenderness
Why do nitrites in urine suggest bacteria?
Gram negative bacteria break down nitrates into nitrites
Best indication of infection
Why does raised leukocyte esterase suggest infection?
Leukocyte esterase is a product of leukocytes
Small numbers of leukocytes are normal in urine, significant numbers can be due to infection or other causes of inflammation
What is micro/macroscopic haematuria?
Microscopic haematuria
Blood identified on urine dipstick, but not seen on sample
Macroscopic haematuria
Blood visible in the urine
Which patients is a midstream urine sample important in?
Pregnant patients
Patients with recurrent UTIs
Atypical symptoms
Symptoms not improving with antibiotics
What is the most common cause of UTI?
Escherichia coli
Gram-negative
Anaerobic
Bacilli
What are some less frequent UTI causes?
Klebsiella pneumoniae
(gram-negative anaerobic bacilli)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candid albicans
What antibiotics are appropriate in UTIs?
Trimethoprim high bacterial resistance association
Nitrofurantoin avoided in patients with eGFR < 45
Alternatives:
- Pivmecillinam
- Amoxicillin
- Cefalexin
How long should antibiotics be given for in UTIs?
3 days
Simple LUTI in women
5-10 days
Immunosuppressed women
Abnormal anatomy
Impaired kidney function
7 days
Men
Pregnant women
Catheter-related UTIs (NICE recommend changing catheter in catheter-related UTI)
What do UTIs in pregnancy increase the risk of?
Pyelonephritis
Premature rupture of membranes
Pre-term labour
What antibiotics may be given for UTI in pregnancy?
Nitrofurantoin NOT IN 3rd TRIMESTER
Amoxicillin
(Only after sensitivities are known)
Cefalexin
Why is nitrofurantoin avoided in the third trimester of pregnancy when treating a UTI?
Neonatal haemolysis risk
