Name the 4 parts of the urinary system where infection occurs
Urethra, ureters, kidneys, bladder
Where do bacteria enter through
Urethra
Which bacteria causes UTI
Escherichia Coli (gram negative)
What symptoms occur in bladder (cystitis)
Polyuria (peeing more than normal), dysuria (burning when urinating), lower abdominal discomfort
What symptoms occur in urethra (urethritis)
Burning on passing urine, discharge
Why can differential diagnosis include STI
Due to the proximity of the urethra to the vagina
List risk factors for UTI
- More common in females (shorter urethra, proximity to the anus)
- Postmenopausal women (decline in circulating oestrogen)
- Indwelling catheters
- Recent antibiotic use (disrupts flora)
- Spermicides (irritation & attachment sites for E coli)
- Sexual intercourse (bacteria to urinary tract)
- Pregnancy
List reasons for referral
- Pregnancy (pyelonephritis - kidney infection, premature birth, rupture of membranes and other complications)
- Men
- <16 years
- Symptoms of pyelonephritis (fever, loin pain, nausea/vomiting, flu-like illness)
- Signs of sepsis (altered behaviour, increased HR, low BP, anuria (lack of urine production)
- Non-response to first antibiotics
Who not to carry urine dipstick on
Over 65 years as asymptomatic bacteria common in this age and therefore unnecessary antibiotics
Which part of urine is tested
Mainstream
Why we don’t use urine culture often
Results not available straight away therefore uncomplicated infections will have resolved by then
How many days of antibiotics prescribed for non-pregnant uncomplicated lower UTI cases
3-day course
When do we prescribe antibiotics for UTI
Women under 65 with 2 or more key symptoms and no other causes (STI/sepsis)
When do we not prescribe antibiotics
No symptoms unless pregnant
What is urethritis
Inflammation post sexual intercourse
How do we differentiate between pyelonephritis and sepsis?
- Pyelonephritis (kidney pain/back pain, flu like illness, nausea/vomiting)
- Sepsis
(altered mental state, increased RR/HR, low BP, anuria, mottled skin, rash)
How do we diagnose UTI?
Dysuria, new nocturia, cloudy urine
- 2/3 present (UTI likely & dipstick not needed)
- 1 present (perform dipstick)
- 0 present (check urgency, visible haematuria - blood in urine, frequency, suprapubic tenderness)
If yes to other symptoms, perform dipstick, otherwise consider other diagnoses
What if a dipstick is negative for nitrites, leukocytes and RBC?
UTI less likely
What if dipstick is negative for nitrites and positive for leukocytes?
Could be UTI, send urine culture and consider treatment depending on symptom severity
What if a dipstick is positive RBC with positive nitrite or leukocyte?
Likely UTI, treat or wait with back up depending on symptom severity
What is the key differences between over and under 65?
- No urine dipsticks, new onset dysuria or 2 new symptoms of UTI, always send urine culture, delirium considerations/other diagnostics
Who is there seperate guidance for?
Children, pregnant women and men
What screening do pregnant women receive as part of antenatal care?
MSU (mid-stream specimen of urine) screening
How are pregnant women treated if suspected UTI?
- Symptomatic relief with paracetamol
- Prescribe antibiotic (check suitable)
- Send MSU for culture
- Amend prescription if needed
- If a group B streptococcus is isolated, prophylactic antibiotics will be offered during labour and delivery
