Urinary Tract Infection

• The presence of a pure growth of >105 organisms per ml of fresh MSU
• UTI sites – urethra (urethritis), bladder (cystitis), prostate (prostatitis) or renal pelvis (pyelonephritis)
• UTI’s may be uncomplicated (normal renal tract and function) or complicated (abnormal renal/GU tract, reduced renal function, impaired host defences, or virulent organisms)
• A recurrent UTI is a further infection with a new organism
• A relapse is a further infection with the same organism

Risk factors

• Being female
• Intercourse
• Exposure to spermacide
• Pregnancy
• Menopause
• Reduced host defences
• DM
• Urinary tract obstruction – stones, catheter, malformation

Organisms

• E.coli
• Staph saprophyticus
• Proteus mirabilis
• Entercoccus faecalis

Symptoms

• Cystitis
  • Frequency, dysuria, urgency, haematuria, suprapubic pain
• Acute pyelonephritis
  • High fever, rigors, vomiting, loin pain
• Prostatitis
  • Flu-like symptoms, low back ache, swollen or tender prostate on PR

Tests

• Treat empirically if dipstick is positive for nitrites of leukocytes
• If negative send MSU to lab for microscopy and culture
• Send anyway if male, a child, pregnant, immunosuppressed

Bloods

• FBC, U&Es, CRP and blood cultures if systemically unwell

Treatment

• Advice about drinking lots of fluids and urinating often
• Cystitis – trimethoprim
• Acute pyelonephritis – cefuroxime IV
• Prostatitis – ciprofloxacin for 4 weeks