Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI) includes:

• Cystitis - infection of bladder

• Pyelonephritis - infection of kidneys/renal pelvis

The most common cause is E.coli.

N.B. UTI's are more common in women as they have a shorter urethra, therefore easier for bacteria to ascend and cause infection.

Risk factors:

• ↑Bacterial growth - Catheter, DM, immunosuppression, obstruction, stones, renal tract malformation, pregnancy

• ↓Urine flow - Dehydration, Obstruction

• ↑Bacterial inoculation - Sexual activity, urinary/Faecal incontinence, constipation

• ↓Oestrogen - Menopause

N.B. Catheter-associated UTIs tend to be more severe and harder to treat.

Cystitis

It presents with:

• Dysuria

• LUTS - Frequency, Urgency

• Suprapubic pain

• Incontinence, confusion - commonly the only sign in elderly

Investigations:

• Urine dip - Nirites and Leukocytes

  • MSU for MC&S if +ve

• Rule out differential of pyelonepheritis (fever, vomiting)

Management:

• Trimethoprim or Nitrofurantoin for 3 days

  • Give for 7 days in men and pregnant women

N.B. Avoid Trimethoprim in 1st trimester, and Nitrofurantoin in 3rd trimester.

N.B. Trimethoprim preferred if eGFR is < 45.

Urethral syndrome is also known as Abacterial cystitis, and is where there's the presence of LUTS w/o bacterial cause.

Pyelonephritis

It presents with:

• Fever/rigors

• Loin pain/tenderness

• N+V

• Haematuria

• O/E - Renal angle/costovertebral tenderness

Investigations:

• Urine dip - Nitrites and Leukocytes

  • MSU for MC&S if +ve

• Bloods - FBC (raised WCC), U&E (renal impairment), Culture

• Renal US - check for hydronephrosis if severe infection occurs with AKI

• Rule out differential of cystitis (lack of fever, vomiting)

Management:

• IV Abx - Broad-spectrum, such as Cefalexin, Co-amoxiclav, Ciprofloxacin, Trimethoprim