Urinary tract infection

Question 1

Commonest micro-organism causing UTI?

Answer 1

E. coli

Question 2

Microbiological classification of E. coli?

Answer 2

Gram negative, facultatively anaerobic rod-shaped coliform

Question 3

Which organisms are seen in patients with underlying urinary pathology, immunosuppression or catheterised? (4)

Answer 3

Klebsiella
Proteus vulgaris
Candida
Pseumonas

Question 4

Important risk factors for UTI particularly in older people (6)

Answer 4

Older age
Female gender
Structural abnormality
Incomplete bladder emptying
Indwelling catheter
Diabetes

Question 5

Why is routine screening for UTI not recommended in older people?

Answer 5

High proportion of older people have asymptomatic bacteruria; unnecessary antibiotics may cause more harm than good

Question 6

What is the exception to non-treatment of asymptomatic bacteruria?

Answer 6

Patients undergoing invasive urological procedures

Question 7

Features which increase the likelihood of UTI? What caveat is there in older people?

Answer 7

Dysuria
Urinary frequency
Haematuria
These may not be features in older people

Question 8

How may UTI present in older people?

Answer 8

Dizziness (+/- fall)
Confusion
Nausea

Question 9

What should be taken into account when advising older people about using cranberry products|?

Answer 9

Cranberry products can potentiate warfarin

Question 10

Common condition in older men which predisposes to pyelonephritis?

Answer 10

Prostatic hypertrophy leading to retention

Question 11

Presentation of pyelonephritis?

Answer 11

Fever
Flank pain
Costovertebral tenderness
Asymptomatic- diagnosed when found to be in renal failure

Question 12

Contraindication to nitrofurantoin?

Answer 12

eGFR less than 60

Question 13

Why should co-amoxiclav not be prescribed to older people?

Answer 13

Risk of C diff, particularly in hospital

Question 14

Empirical treatment of uncomplicated UTI in female

Answer 14

Nitrofurantoin 50mg qds or 100mg MR bd
or
Trimethoprim 200mg bd

Three day course

Question 15

Empirical treatment of uncatheterised male

Answer 15

Same as for female, but seven day course

Question 16

Empirical management of complicated UTI/pyelonephritis/urosepsis

Answer 16

IV amox + gent
Step down to PO co-trimaxazole or as per sensitivities
Total 7 days

Question 17

What test(s) should be considered in men with symptoms of a lower UTI?

Answer 17

Prostate specific antigen and DRE

Question 18

Complications of UTI specific to men?

Answer 18

Prostatitis

Prostatic abscess