Microbiology Nuts & Bolts
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Urinary Tract Infection (UTI)

Urinary tract infection (UTI) is infection of the urinary tract by microorganisms, which normally originate in the gastrointestinal tract and ascend into the urinary tract. It is important to distinguish between uncomplicated and complicated UTIs as the length of treatment differs. 

• Uncomplicated UTI is an infection in a structurally and functionally normal urinary tract
• Complicated UTI is an infection in a structurally and / or functionally abnormal urinary tract
   - UTIs in men, pregnancy and children are also ALL complicated 

Catheter associated UTIs have similar symptoms to uncomplicated or complicated UTIs but different causes and therefore different treatment.

Urethral syndrome is a form of UTI that only occurs in women and is characterised by urgency and pain on passing urine. It is important to make the distinction of urethral syndrome from other types of UTI because although the causes are the same, the treatment is different. 

Clinical Features

  • Frequency
  • Urgency
  • Incontinence
  • Dysuria
  • Nocturia
  • Polyuria
  • Hesitancy
  • Suprapubic pain
  • Loin-to-groin pain e.g. flank and back
  • Fever or chills
  • Rigors
  • Sepsis

Causes

Common
• Escherichia coli
• Proteus sp.
• Klebsiella sp.
• Enterobacter sp.
Pregnancy
As for common plus:
•  Staphylococcus saprophyticus

Catheter Associated
As for common plus:
• Pseudomonas sp.
• Enterococcus sp.
• Staphylococcus aureus
• Candida sp.
Hints & Tips - UTI - Proteus spp.
Warning - UTI Staphylococcus aureus

Investigations

• Urine- Mid-stream urine (MSU), clean catch urine or supra-pubic aspirate (SPA)
  - Urine dipstick (bacterial nitrites PLUS leucocytes)
  - Negative Predictive Value (NPV) ≈ 97% CAN rule out UTI
  - Positive Predictive Value (PPV) ≈ 60% CANNOT prove UTI
• Blood cultures if systemic symptoms
Hints & Tips - UTI - Intrepreting a urine
Warning Box - UTI - Dipsticks
Treatment - UTI
Total Duration
Uncomplicated UTI (women only): 3 days
Complicated UTI (including pregnancy): 7 days
Pyelonephritis: 7 days
Pyelonephritis in pregnancy: 14 days

Dosing
See section - Antibiotics, Empirical Antibiotic Guidelines.
Hints & Tips - UTI - Nitrofurantoin
Prognosis and Complications
UTI can result in impairment of renal function, especially in young children with recurrent infections and vesico-ureteric reflux.

Prophylaxis and Prevention
Prophylactic antibiotics are used in children who experience recurrent UTIs in order to try and preserve renal function.
Warning - UTI - ESBLs

Examples of Urology Requests, Results and Interpretations

Example of UTI interpretation
Example of UTI interpretation
Example of UTI interpretation
Microbiology Nuts & Bolts on Amazon
Topics in Clinical Scenarios - Urogenital ​Infections:
  • Urinary Tract Infection (UTI)
  • Examples of Urology Requests, Results and Interpretations
  • Prostatitis
  • Sexually Transmitted Diseases (STDs)

​All these topics are covered in the book...Ready to buy your copy? Click here to buy your copy of "Microbiology Nuts & Bolts" Its updated and amazingly only slightly larger considering its got 1/3 more in it! (11cmx18cmx2.5cm).

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