UTI

Question 1

Joan Jett is a 30-year-old woman with irritative voiding symptoms.

Impression/DDx/Goals

Answer 1

Impression:
Most likely an uncomplicated UTI (cystitis) given irritative LUTS and patient demographic. Would want to rule out concerting Ddx:
- Bladder cancer
- Renal cancer
- Complicated UTI/pyelonephritis
- Sepsis

Other differentials to consider:

• STI/ PID
• appendicitis
• pregnancy (counts as complicated, needs to be treated)

Goals:

• establish diagnosis and rule out red-flag differentials
• initiate empirical treatment
• establish appropriate safety-netting for patient

Question 2

UTI - History

Answer 2

History:

• Sx: establish irritative LUTS (urgency, frequency, burning/stinging, incontinence), suprapubic tenderness
• RED FLAGS: fevers, sx of malignancy, haematuria, pneumaturia, vomiting, flank pain
• Sexual history, recent sexual partners etc, vaginal discharge
• PHx (recurrent infection treated differently), diabetes
• FHx, Medications (SGLT2, etc)
• SNAP

Question 3

UTI - Examination

Answer 3

Exam:

• Vitals
• Abdominal examination
• If indicated, bimanual palpation/ speculum examination

Question 4

UTI - Investigations

Answer 4

Investigations:
Diagnosis can be made clinically

Diagnostic
- MSU for MCS: looking for significant bacteriuria of 10^8 CFU, but 10^5 is indicative

Bedside:

• Vitals, urinalysis (nitrites, ketones, haematuria)
• Bloods: FBC, UEC, ESR/CRP,
• Imaging: not indicated in simple UTI, may be necessary for recurrent, start with Renal tract US.

Question 5

UTI - Management

Answer 5

Management:
Non-pharm
- hydration (to flush)

Pharm
- simple analgesia
- ABx: Trimethoprim 300mg PO OD for 3 days, then Nitrofurantoin 100mg QID for 5 days. If resistant to first line treatment then:
1 Amoxicilin
2 Trimethoprim + Sulfamethoxazole
3 Augmentin
4 Norfloxacin

Review/safety-netting

• To return to GP if symptoms are unresolving with empirical therapy
• to present to ED if signs of severe infection

NB

• Trimethoprim only for use in 2nd and 3rd trimesters in pregnancy
• In recurrent UTI, provide patient-initiated ABx, requires further investigation, manage other risk factors