UTI in practice Flashcards
what parts of the urniary system make up the lower urinary tract?
Bladder
– Urethra
what parts make up the upper urinary tract- i.e more serious?
– Kidneys
– Ureters
how do bacteria enter the urinary tract? what is the usual bacteria found?
hrough urethra
• Typically Escherichia Coli (Gram negative),
commonly found in GI tract
what are the bladder symptoms of lower UTI?
– Polyuria
– Dysuria
– Lower abdominal discomfort
what are the urethra symptoms of a lower UTI?
– Burning on passing urine
– Discharge
why are stis included in differeential diagnosis of UTI?
Note that sexually transmitted infections can cause
urethritis due to proximity of uretha to vagina-
therefore differential diagnosis includes STIs such as
chlamydia, gonorrhoea etc
why are UTIs more common in females?
- Shorter urethra
* Urethra proximity to anus
what are the risk factors for UTIs?
Post menopausal women
• decline in circulating oestrogen
– Indwelling catheters
• provide an ascending route for bacteria
– Recent antibiotic use
• disrupts normal bacterial flora
– Spermicides can cause irritation & attachment sites for E.Coli
– Sexual intercourse – may introduce bacteria to urinary tract
– Pregnancy
when would you refer UTI?
Pregnant woman
– risks include pyelonephritis, premature birth, rupture of membranes
and other complications
• Men
– always “complicated”
• <16 years
• Symptoms of pyelonephritis
– Fever, loin pain, rigors, flu-like illness, nausea/vomiting – symptoms of
upper UTI
• Signs of Sepsis
– See risk stratification tool NICE- high risk signs include altered mental
state/behaviour, increased RR/HR, low BP, anuria, mottled/ashen skin,
cyanosis, non-blanching rash
• Non-response to first antibiotics
– MSU for culture
when would you not use a urine dipstick?
Not recommended in the elderly (>65yrs) as
asymptomatic bateriuria is common in this
group and could result in unnecessary
antibiotics
how do you give a urine culture?
midstream
what would be suggest a UTI on a urine dipstick?
positive nitrate or leukocyte and RBC positive
when do you treat asymptomatic UTI?
if pregnant
when considering diagnosis what sort of vaginal and urethral causes of urinary symptoms would you exclude?
- 80% of women with vaginal discharge do not have a UTI
- Urethritis- inflammation post sexual intercourse, irritants
- Check sexual history to exclude STI
- Genitourinary syndrome of menopause (vulvovaginal atrophy)
what are the signs and symptoms of pyelonephritis?
– Kidney pain/tenderness in back under ribs – New/different myalgia, flu like illness – Rigors or pyrexia – Nausea/vomiting
what are the signs of sepsis?
– High risk signs include: • Altered mental state/behaviour • Increased RR/HR • Low BP • Anuria • Mottled/ashen skin • Cyanosis • Non-blanching rash
when diagnosing UTI what are the 3 key diagnostic fectures?
Dysuria, new nocturia, cloudy urine
– If 2 or 3 present UTI likely and dipstick not needed
– If 1 present perform urine dipstick
– If 0 check if other symptoms are present (urgency,
visible haematuria, frequency, suprapubic
tenderness)
what does the urine dipstick tell us?
• Negative for nitrites, leukocytes & RBC: UTI
less likely
• Negative nitrite but positive leukocyte
• Could be UTI – send urine culture and consider
treatment depending on symptom severity
• Positive RBC with positive nitrite or leukocyte
• Likely UTI – treat or watch/wait with backup
antibiotic depending on symptom severity
how does the guidance for over 65’s differ?
• No urine dipsticks • New onset dysuria or 2+ new symptoms UTI likely • Always send urine culture • Delirium considerations/ other diagnostics
what extra precautions need to be done for pregnant women?
• Regular MSU screening as part of antenatal care
• Antibiotics given if bacteriuria confirmed even if
asymptomatic (2 x culture)
if suspected UTI in a pregnant women what should be done?
– Symptomatic relief with paracetamol
– Prescribe antibiotic 7d (check suitable- often
nitrofurantoin but not recommended at term)
– Send MSU for culture
– Amend prescription if needed
– If a group B streptococcus is isolated, prophylactic
antibiotics will be offered during labour and delivery.
what should you take into account when prescribing antibiotics?
how severe are symptoms risks of complications previous urine culture results previous antibiotic use culture results
what do you consider when giving an antibiotic?
– Immediate
– Back up (to use if no improvement at 48hr or
symptoms worsen at any time)
who have low risk of resistance?
• younger women with acute UTI and no resistance risks
