Urinary Tract Infections

Question 1

What are two examples of factors which make a UTI ‘complicated’?

Answer 1

Systemic symptoms or a renal tract structural abnormality

Question 2

What are some risk factors for the development of a UTI?

Answer 2

Diabetes, catheterisation, sexual activity/pregnancy in women

Question 3

What organism is the most common cause of a UTI?

Answer 3

E. coli

Question 4

Which organism causing UTI produces a ‘burnt chocolate’ smell on culture, and shows a ‘swarming’ pattern?

Answer 4

Proteus spp.

Question 5

Which organism causing UTI can result in the formation of struvite (triple phosphate) stones?

Answer 5

Proteus spp.

Question 6

S. saprophyticus is an organism which can cause UTI- it is most common in who?

Answer 6

Women of child-bearing age

Question 7

Symptoms of dysuria, haematuria, frequency/urgency and suprapubic pain are characteristic of which UTI?

Answer 7

Acute cystitis

Question 8

Other than the characteristic features of cystitis, what are some additional features of acute pyelonephritis?

Answer 8

Fever/rigors, nausea/vomiting, loin pain

Question 9

What are some presenting symptoms of prostatitis?

Answer 9

Flu-like symptoms, lower backache, haematospermia

Question 10

A swollen/tender/boggy prostate on examination suggests what possible diagnosis?

Answer 10

Acute prostatitis

Question 11

If an MSSU cannot be taken for any reason, what are some other methods of obtaining an uncontaminated urine sample for microscopy, culture and sensitivity?

Answer 11

Suprapubic aspiration or straight catheter

Question 12

Which two elements of urinalysis testing are most specific for a UTI?

Answer 12

Nitrites and leukocytes

Question 13

What investigation is used as a first line investigation for UTI in hospital, or to confirm a diagnosis suspected on urinalysis in primary care?

Answer 13

Urine cultures

Question 14

What investigation should be performed on every uncatheterised male who presents with a UTI?

Answer 14

Urine cultures

Question 15

If patients with a UTI are systemically unwell, what blood tests should be taken?

Answer 15

FBC, U&E, CRP, blood cultures

Question 16

What is the first line investigation if imaging is necessary for someone with a UTI?

Answer 16

Renal ultrasound

Question 17

If nothing is detected on renal ultrasound, what is the second line imaging test for UTI?

Answer 17

Cystoscopy

Question 18

Which antibiotic commonly used to treat UTIs must be avoided in the first trimester of pregnancy?

Answer 18

Trimethoprim

Question 19

Which antibiotic commonly used to treat UTIs must be avoided in late pregnancy, breastfeeding and children aged < 3 months?

Answer 19

Nitrofurantoin

Question 20

What is the risk of using nitrofurantoin in late pregnancy, breastfeeding and children aged < 3 months?

Answer 20

Neonatal haemolysis

Question 21

Which antibiotic commonly used to treat UTIs comes with a risk of severe pulmonary reactions and should be avoided in those with pre-existing interstitial lung disease?

Answer 21

Nitrofurantoin

Question 22

If a patient has an eGFR < 20ml/min, what antibiotic should be used instead of gentamicin?

Answer 22

Aztreonam

Question 23

What lifestyle advice should be given to all patients with a UTI?

Answer 23

Drink lots of fluids and urinate often

Question 24

What is meant by the term abacterial cystitis?

Answer 24

The patient has symptoms of a UTI but no significant growth on culture

Question 25

Symptomatic relief is the treatment advised for abacterial cystitis or urethral syndrome. What can be used to alkalinise the urine for this purpose?

Answer 25

Potassium citrate

Question 26

What is meant by the term asymptomatic bacteriuria?

Answer 26

The patient has bacteria in the urine but remains asymptomatic

Question 27

When is antibiotic treatment required for asymptomatic bacteriuria and why?

Answer 27

In pregnant women- if untreated, this risks progressing to pyelonephritis or causing IUGR/premature delivery

Question 28

How should pregnant women with asymptomatic bacteriuria be treated?

Answer 28

Antibiotics for 7 days and a test of cure

Question 29

What is the antibiotic of choice for the treatment of asymptomatic bacteriuria or UTI in the first two trimesters of pregnancy?

Answer 29

Nitrofurantoin

Question 30

What is the antibiotic of choice for the treatment of asymptomatic bacteriuria or UTI in the third trimester of pregnancy?

Answer 30

Trimethoprim

Question 31

What is the first line antibiotic treatment for an uncomplicated lower UTI?

Answer 31

PO nitrofurantoin (100mg bd)

Question 32

What is the second line antibiotic treatment for an uncomplicated lower UTI?

Answer 32

PO trimethoprim (200mg bd)

Question 33

How long should antibiotic treatment be given for a lower UTI in men and women?

Answer 33

7 days for men, 3 days for women

Question 34

What is the antibiotic treatment required for a complicated UTI or pyelonephritis in primary care?

Answer 34

PO co-amoxiclav or co-trimoxazole for 7 days

Question 35

What is the empirical antibiotic therapy for a complicated UTI or pyelonephritis in secondary care?

Answer 35

IV amoxicillin and gentamicin

Question 36

When treating a complicated UTI or pyelonephritis, how long should antibiotics be given for (PO/IV)?

Answer 36

7 days

Question 37

If a patient is penicillin allergic, what should amoxicillin be substituted for in the empirical treatment of pyelonephritis?

Answer 37

Co-trimoxazole

Question 38

If there is a definite UTI in a catheterised patient, how should they be treated?

Answer 38

As for a complicated UTI

Question 39

What is the advice regarding removing the catheter in catheterised patients who have a UTI?

Answer 39

It should be removed and replaced within 24-72 hours of starting antibiotics

Question 40

How is prostatitis treated?

Answer 40

28-day course of ofloxacin or ciprofloxacin

Question 41

UTIs with extended spectrum beta lactamase producing bacteria can only be treated with what?

Answer 41

IV meropenem

Question 42

What is the definition of a recurrent UTI?

Answer 42

2 or more in 6 months, 3 or more in a year

Question 43

Which antibiotics can be given as prophylaxis for recurrent UTIs?

Answer 43

Methanamine, trimethoprim or nitrofurantoin

Question 44

Use of prophylactic antibiotics for recurrent UTI should be stopped after how long?

Answer 44

6 months

Question 45

In post-menopausal women with recurrent UTIs, what treatment (other than antibiotics) can be considered?

Answer 45

Oestrogen pessary or cream

Question 46

In individuals who are immunosuppressed and have sterile pyuria, you should have a high index of suspicion for what diagnosis?

Answer 46

Tuberculous pyelonephritis