What is a UTI?
A bacterial infection in any part of the urinary system
What makes up the urinary system?
Upper urinary tract = kidneys and ureter
Lower urinary tract = bladder and urethra
What is the infection that effects the kidneys called?
Pyelonephritis (Upper UTI)
What is the infection that effects the bladder called?
Cystitis (Lower UTI)
What causes a UTI?
E.coli Pregnancy Catheters Kidney stones Enlarged prostate Constipation (kids) Familial link Urinary tract abnormality Weakened immune system
What are the symptoms of a UTI?
Incomplete emptying feeling Increased urgency/frequency to urinate New nocturia Dysuria Haematuria Cloudy urine Systemically unwell Fever Suprapubic pain Vaginal discharge
What are some symptoms of a UTI in babies?
Poor feeding
Failure to thrive
What are differential diagnoses of a UTI?
Thrush, BV Kidney stones Chlamydia Bladder cancer Pelvic inflammatory disease Benign prostatic hyperplasia
How do you test for a UTI?
Dipstick test to detect white cells, nitrites (which is a breakdown product of E. coli) or blood in the urine
Mid stream culture
When would you treat a patient with an empirical antibiotic?
If it was severe or ≥ 3 symptoms (urgency, frequency, polyuria, dysuria, haematuria, suprapubic tenderness)
AND
Absence of vaginal discharge/irritation
If a patients symptoms are mild or ≤ 2 symptoms, what would you do?
Check if their urine is cloudy, if it is then use a urine dipstick test to confirm diagnosis
If the urine is not cloudy then consider another diagnosis
Suspect pyelonephritis if they have a:
Fever
Flank/loin/lower back pain
What are some self care strategies to help a UTI?
If it is uncomplicated symptoms will resolve within 5 days so there is no need for antibiotics
Drink plenty of fluids
Paracetamol and NSAIDs (check suitability i.e., not for asthma, those on anticoagulants/SSRIs, at a risk of bleeding, CVD, elderly)
What is the first line antibiotic choice for a UTI?
Nitrofurantoin 100mg BD for 3 days (OR 50mg QDS) if eGFR ≥ 45ml/min
OR
Trimethoprim 200mg BD for 3 days
(However high level of resistance - check local guidelines)
When should a patient seek urgent medical help?
Shivering, chills, muscle pain Confused/drowsy Not passed urine all day Smelly urine Blood in urine Temp 38(+) or 36(-) Kidney pain in back (under ribs) Symptoms worsen/no improvement within 48hrs of strong antibiotic
How can you prevent a UTI?
Wipe from front to back Don’t wait to pass urine Urinate after sex Drink enough fluids Avoid occlusive underwear/tights
How do you treat a recurring UTI?
If the pt has experienced 2 episodes over the last 6 months / ≥ 3 infections per year
1st choice = Nitrofurantoin or Trimethoprim
2nd choice = Amoxicillin or Cefalexin
What is a complicated lower UTI?
Includes: Pregnancy Men Elderly Children Catheters
Why does bacteriuria (with/without symptoms) occur in pregnant women?
Associated with premature rupture of membranes and pre-term labour
Routine screening for asymptomatic bacteriuria by midstream urine culture is recommended in early pregnancy (NICE)
How do you treat symptomatic bacteriuria in pregnancy?
- Paracetamol
- Avoid alkalising agents and cranberry
- Urine culture and empirical antibiotic therapy
- Fever and loin pain suggest upper UTI -> hospital admission and IV abx
What is the treatment for UTI’s in pregnancy?
Nitrofurantoin MR 100mg BD for 7 days (OR 50mg QDS) if eGFR ≥ 45ml/min
NOT used at full term
NOT treated with Trimethoprim as it’s teratogenic
What are second line antibiotics to treat UTI’s in pregnancy?
Amoxicillin 500mg TDS for 7 days
Cefalexin 500mg BD for 7 days
How to treat men with UTI’s?
Same antibiotics however for 7 days instead of 3
How to treat a male with symptoms associated with an inflamed prostate?
Ciprofloxacin (longer course)
How to treat those with catheters?
Need 7 day course antibiotics
