Urinary Tract Infection

Question 1

Defintion

Answer 1

Infection of the bladder (also known as cystitis), usually caused by bacteria from the gastrointestinal tract ascending through the urethra into the bladder (retrograde).

Question 2

Transmission

Answer 2

• Via the bloodstream : particularly if immunosuppressed
• Directly : e.g. due to insertion of a urinary catheter, or surgery

Question 3

Aetiology

Answer 3

Klebsiella
Escherichia coli
Proteus mirabilis
Staphylococcus saprophyticus
Candida

Question 4

Epidemiology

Answer 4

Female
Post menopausal

Question 5

Risk factors for recurrent UTIs in young and pre-menopausal women:

Answer 5

• Sexual intercourse
• A mother with a history of UTI
• History of UTI in childhood

Question 6

Risk factors for recurrent UTIs In elderly and post-menopausal women:

Answer 6

History of UTI before menopause
Urinary incontinence
Atrophic vaginitis
Cystocele
Increased post-void urine volume
Catheterisation and reduced functional status in elderly hospitalised women

Question 7

Signs

Answer 7

Suprapubic tenderness

Question 8

Symptoms

Answer 8

• Dysuria
• Frequency
• Urgency
• Changes in urine appearance/consistency
  = a cloudy or pungent odour
  = haematuria
• Nocturia
• Suprapubic discomfort

Question 9

Diagnosis

Answer 9

FIRST LINE = Urine dip
- Nitrite OR Leukocytes +ve AND Positive RBCs
- - ve Nitrite AND +ve Leukocytes
GOLD STANDARD = Urine MC + S
- Request in all women with the above urine dipstick findings
- Request in women >65 years , catheterised, pregnant or with visible or non-visible haematuria , regardless of urine dipstick findings

Question 10

Treatment non pregnant women

Answer 10

FIRST LINE =
- Nitrofurantoin (if eGFR ≥45ml/minute), OR
- Trimethoprim
SECOND LINE = if no improvement within 48 hours of a first-line antibiotic, or if first-line is unsuitable
- Nitrofurantoin (if eGFR ≥45ml/minute and not used as first-line), OR
- Pivmecillinam, OR
- Fosfomycin single-dose sachet

Question 11

Pregnant women

Answer 11

First-line =
- Nitrofurantoin (if eGFR ≥45ml/minute; avoid near term) for 7 days
Second-line : if no improvement within 48 hours of a first-line antibiotic, or if first-line is unsuitable
- Amoxicillin (only if culture results available and susceptible), OR
- Cefalexin

Question 12

Treatment for men

Answer 12

First-line:
- Trimethoprim, OR
- Nitrofurantoin (if eGFR ≥45ml/minute)
Second-line : if no improvement within 48 hours of a first-line antibiotic, or if first-line is unsuitable
- Amoxicillin (only if culture results available and susceptible), OR
- Cefalexin