UTI

Question 1

What are complicated and uncomplicated UTIs?

Answer 1

• complicated: UURTI +/- systemic signs or catheter-associated UTI
• uncomplicated: lower UTI, normal structure and neurology

Question 2

Define relapse and recurrent

Answer 2

• relapse = infection with the same organism
• recurrent = infection with same or different organism, 2+ episodes in 6 months or 3+ in a year

Question 3

What are the risk factors of bacteriuria?

Answer 3

• female
• urinary catheterisation
• diabetes
• anatomical abnormalities of urinary tract
• pregnancy

Question 4

What patients are treated for bacteriuria?

Answer 4

• preschool children
• pregnancy
• renal transplant
• immunocompromised

Question 5

Describe ascending UTIs

Answer 5

• urethral colonisation
• female >male
• multiplication in bladder
• ureteric involvement

Question 6

Describe descending/haemotgenous UTIs

Answer 6

• haematogenous spread
• involvement of renal parenchyma

Question 7

What patients are at risk of poly-microbial or multi-drug resistant UTIs?

Answer 7

• multiple organisms: long-term catheters, recurrent infection, structural/neurological abnormalities
• multi-drug resistant: anatomical/neurological abnormalities, frequent infections, multiple antibiotic courses, prophylactic antibiotic use

Question 8

What are the common organisms that cause UTIs?

Answer 8

• gram-negative bacilli: E.coli, klebsiella, proteus, pseudomonas
• gram-positive: strep, enterococcus, s. agalactiae, staph
• candida
• anaerobes (associated with bladder malignancies)

Question 9

Describe the clinical features of UTI

Answer 9

• suprapubic discomfort
• dysuria
• frequency
• cloudy, blood stained, smelly urine
• low-grade fever
• sepsis
• failure to thrive, jaundice in neonates
• abdo pain and vomiting in children
• nocturne, incontinence and delirium in elderly

Question 10

When is a culture indicated for suspected UTI?

Answer 10

Non-pregnant women:
- if no response to empirical treatment
- change to targeted treatment

Children and men: always

Question 11

Describe the management of a UTI in pregnancy

Answer 11

• send urine for culture and treat each episode
• amoxicillin and cefalexin safe
• avoid trimethoprim in 1st trimester
• avoid nitrofurantoin near term
• hospital admission if severe
• risk of pyelonephritis

Question 12

How would you manage recurrent UTIs?

Answer 12

• send sample from each episode
• emphasise importance of hygiene
• encourage hydration
• encourage urge initiated and post-coital voiding
• urology investigation
• intravaginal/oral oestrogen
• antibiotic therapy as per symptoms

Question 13

How would you manage CAUTIs?

Answer 13

• send urine samples
• start empirical antibiotic therapy (look at previous microbiology)
• remove/replace catheter

Question 14

What is pyelonephritis and describe the clinical presentation

Answer 14

• upper UTI
• moderate to severe infection
• flank pain +/- systemic infection
• enlarged kidney
• abscess on surface of kidney

Question 15

Describe the management of acute pyelonephritis

Answer 15

• check previous microbiology results
• send urine and blood for culture
• imaging
• community: co-amoxiclav, ciprofloxacin, trimethoprim
• hospital: initial IV antibiotics

Question 16

Describe renal abscesses

Answer 16

• complication of pyelonephritis (similar symptoms)
• positive urine and blood culture
• gram negative bacilli usually
• can become life threatening (eg. emphysematous pyelonephritis)
• poor response to antibiotics alone, surgical intervention needed

Question 17

Describe perinephric abscess

Answer 17

• haemtogenous spread of infection (rare)
• common causes: gram negative bacilli (E.coli), gram-positive cocci (strep), candida spp.

Question 18

What are the symptoms and management of perinephric abscesses?

Answer 18

• symptoms similar to pyelonephritis
• localised signs and symptoms
• local invasion
• urine and bloods sent for culture (pyuria and bacterial growth)
• treat empirically as complicated UTI
• poor response to antibiotic therapy and requires surgical management

Question 19

What drugs are used for complicated UTI and any contraindications?

Answer 19

• amoxicillin, vancomycin
• contraindicated in renal failure

Question 20

Describe acute bacterial prostatitis and its clinical presentation

Answer 20

• usually spontaneous but can follow urethral instrumentation
• causes diffuse oedema and microabscesses
• causes perineal/back pain, UTI symptom, urinary retention, pyrexia
• urology referral necessary

Question 21

What are the complications of acute bacterial prostatitis?

Answer 21

• prostatic abscess
• spontaneous rupture (urethra, rectum)
• epididymitis
• ascending infection
• systemic sepsis

Question 22

What investigations would you want to carry out if suspecting acute bacterial prostatitis?

Answer 22

• urine and blood cultures
• trans-rectal US
• CT/MRI
• no prostatic secretions

Question 23

What are the likely causes and treatment for acute bacterial prostatitis?

Answer 23

• causes: gram-neg bacilli, S. aureus, n. gonorrhoea
• treatment: antibiotic management - empirical (ciprofloxacin/ofloxacin), check previous microbiology

Question 24

Describe chronic prostatitis and common causative organisms

Answer 24

• rarely associated with acute prostatitis
• can follow chlamydia urethritis
• causes recurrent UTI symptoms, back pain, low grade fever
• relapse common
• causes: gram-neg bacilli, enterococcus, s. aureus

Question 25

Describe epididymitis and the clinical features of it

Answer 25

- inflammatory reaction to epididymis - caused by ascending infection from urethra or urethral instrumentation - symptoms: UTI/urethritis symptoms, pain fever, swelling, penile discharge

Question 26

Describe orchitis and the clinical features of it

Answer 26

- inflammation of 1 or both testicles - testicular pain and swelling - dysuria - fever - penile discharge - can be associated with viral causes (mumps) and bacterial infections

Question 27

Describe the complications of bacterial orchitis

Answer 27

- pyogenic infection: severe and requires urological review, IV antibiotics (as per complicated UTI) - testicular infarction - abscess formation

Question 28

Describe Fournier's gangrene

Answer 28

- form of necrotising fasciitis - >50y - rapid onset and spread - systemic sepsis

Question 29

What are the risk factors for Fournier's gangrene?

Answer 29

- UTI - complications of IBD - truma - recent surgery

Question 30

What are the causes and management of Fournier's gangrene?

Answer 30

- causes: mixed, mainly gram-neg bacilli and anaerobes - blood and urine cultures - tissue/pus sample - surgical debridement (1st line) - broad spectrum antibiotics (pip-tazobactam + gentamicin + metronidazole +/- clindamycin)