UTIs

Question 1

What is the definition of:
- Relapse,
- Recurrent,
- Urosepsis/complicated UTI

Answer 1

• Relapse = infection with the same organism.
• Recurrent = infection with same or different species with > 3 infections per year.
• Complicated UTI = Temp>38, HR>90, RR>20 and WBC >15 or <4.

Question 2

What are the risk factors and management for bacteriuria?

Answer 2

• Risk factors onclude urinary catheterisation, diabetes, anatomical abnormalities and pregnancy.
• Only treat asymptomatic bacteriuria in preschool children, pregnancy and immunocompromised.

Question 3

What are the different methods of transmission for UTIs?

Answer 3

Ascending - Urethral colonisation which can have bladder and ureteric involvement.
Descending - Haematogenous spread involving renal parenchyma

Question 4

What are the common causative organisms in UTIs?

Answer 4

• Gram negative bacilli such as E.coli, klebsiella, proteus.
• Gram positive such as streptococcus, enterococcus sp, group B strep, staphylococcus, candida and anaerobes

Question 5

What are the clinical features of UTIS

Answer 5

• Suprapubic discomfort,
• Dysuria,
• Urgency,
• Frequency,
• Cloudy, blood stained, smelly urine,
• Low grade fever or sepsis.
• In Neonates it can cause failure to thrive, jaundice.
• In children it can cause abdominal pain and vomiting.
• In elderly it can cause nocturia, incontinence and delirium.

Question 6

What is the management of a UTI in a non-pregnant women, children and men

Answer 6

1. First presentation, do urine dip, check previous culture results are prescribe empirically (trimethoprim or nitrofurotoin). If there is no response to treatment then do a urine culture and change abx.
2. In children and men send a urine sample for culture first them prescribe

Question 7

What is the management of a UTI in pregnancy?

Answer 7

• Always send urine sample.
• Check previous sensitivities. Amoxicillin is relatively safe but avoid trimethoprim in 1st trimester and avoid nitrofurantoin near term.
• Hospital admission for IV if severe.

Question 8

Explain the management of recurrent UTIs

Answer 8

1. Send samples from each episode and emphasise importance of hygiene, hydration, post coital voiding.
2. Urology investigations
3. Self administered single dose (can be taken post coital)/short course therapy,

Question 9

What is the management of catheter associated UTIs and the prevention

Answer 9

1. Send CSU,
2. Start antibiotics (initially empirically)
3. Remove/replace catheter.
   Prevention - Only catheterise if necessary, remove when no longer needed, remove/replace if causing infection, catheter care bundles and infection prevention precautions

Question 10

What are the symptoms of acute pyelonephritis

Answer 10

• Flank pain +/- systemic infection,
• Enlarged kidney,
• Potential abscesses on surface of kidney

Question 11

What is the management of acute pyelonephritis?

Answer 11

• Send urine culture, blood culture and maybe do imaging. Always do blood cultures if pyrexial/septic.
• For community pyelonephritis give oral co-amoxiclav/ciprofloxacin/trimethoprim. In hospital give IV abx.
• Complicated UTIs may need surgical intervention

Question 12

What are some complications of pyelonephritis?

Answer 12

• Scarring,
• Renal abscess which has similar symptoms to pyelonephritis and usually has a positive urine and blood culture. Can progress to emphysematous pyelonephritis which has a high mortality rate. Requires surgical drainage and abx

Question 13

What are the symptoms and features of perinephric abscesses

Answer 13

• Uncommon infections which occur due to haematogenous spread. Common organisms incl. e.coli or s.aureus.
• Symptoms are similar to pyelonephritis but with a slow onset.
• Treatment is surgical drainage with empirical abx therapy such as co-amoxiclav (treat as complicated UTI)

Question 14

What are the typical antibiotics for complicated and uncomplicated UTIs

Answer 14

• Always check previous microbiology, local guidelines and drug allergies.
• Uncomplicated UTI is oral amoxicillin, trimethoprim or nitrofurantoin.
• Complicated UTIs is with IV amoxicillin and vancomycin. Need to be dual therapy. If penicillin allergy then musty find a substitute for amoxicillin

Question 15

Describe symptoms and complications of acute bacterial prostatitis

Answer 15

• Usually occurs spontaneously. Presents with perineal and back pain, UTI symptoms, urinary retention and pyrexia.
• Complications include prostatic abscess, spontaneous rupture, epididymitis, ascending infection or systemic sepsis

Question 16

What are the investigations, likely organisms and treatment for acute bacterial prostatitis

Answer 16

Investigations - Urine culture, blood culture, trans-rectal ultrasound, CT/MRI.
- Likely organisms are gram neg bacilli like e.coli. S.aureus or N.gonorrhoea.
- Treatment is ciprofloxacin or ofloxacin but always check previous/recent microbiology

Question 17

Describe features of chronic prostatitis

Answer 17

• May follow chlamydia urethritis.
• Can present as recurrent UTI symptoms. Relapse is common.
• Likely orgnaisms include gram negative bacilli such as E.coli, or enterococcus or s.aureus

Question 18

What is epididymitis and symptoms

Answer 18

• Inflammation of epididymis. Occurs due to ascending infection from the urethra.
• Symptoms include pain, fever, swelling, penile discharge and UTI symptoms

Question 19

What are the common organisms which cause epididymitis

Answer 19

• E.coli is the most common cause
• Staphylococci,
• TB in high risk areas,
• Chlamydia and N.gonorrhoea is the mist likely in sexually active males

Question 20

What is orchitis and its symptoms

Answer 20

• Inflammation of one or both testicles which is usually viral (mumps) but can be bacterial.
• Symptoms include testicular pain and swelling, fever, dysuria and penile discharge

Question 21

Describe features and complications of bacterial orchitis

Answer 21

• Usually a complication of epididymitis. It is Severe infection requiring urological review. Treated as compilated UTI.
• Complications include testicular infarction or abscess formation

Question 22

What is Fournier’s Gangrene and the risk factors?

Answer 22

• Form of necrotising fasciitis which normally occurs over the age of 50.
• risk factors include UTI, complications of IBD, trauma and recent surgery.

Question 23

What are the investigations and treatment for Fournier’s gangrene?

Answer 23

• Blood culture, urine culture and intra operative samples of tissue and pus.
• 1st line treatment is surgical debridement combined with broad spectrum antibiotics such as piperacillin and tazobactam with gentamycin and metronidazole