Recurrent UTIs Flashcards
(21 cards)
What is the traditional definition of recurrent UTIs?
2 proven episodes within 6 months or 3 within a year
What is thought to cause most recurrences of UTIs?
Re-infection with the same organism
What is the lifetime risk of a UTI in women?
1 in 2
What happens to a woman’s risk of UTI with age?
Increases
What organism is responsible for 75-90% of all UTIs?
E. Coli
What are some less common causative organisms for UTIs?
- Staphylococcus saprophyticus
- Proteus mirabilis
What are the risk factors for recurrent UTIs?
- DM
- Sexual intercourse
- Atrophic urethritis and vaginitis
- Abnormalities of the urinary tract
- Incomplete bladder emptying
- Contraception
- History of urinary tract surgery
- Immunocompromised e.g. HIV
- First UTI under 15
- History of recurrent UTI in mother
What are the symptoms of UTI?
- Dysuria
- Frequency
- Urgency
- Nocturia
- Haematuria
- Suprapubic discomfort
What are the signs of UTI?
- Suprapubic tenderness
- Cloudy or foul-smelling urine
- Other signs in the elderly
What signs are often seen in elderly women with UTIs?
- Incontinence
- Confusion
- Anorexia
- Fever
- Shock
What is the recommended investigation in recurrent UTIs?
MSU
Why is MSU recommended in recurrent UTIS?
Resistance is more likely
When may women with recurrent UTIs need to be referred to secondary care?
- Have underlying risk factors
- Have cultures showing multi-resistant organisms
- Pneumaturia or faecaturia
- Haematuria
What underlying risk factors for high risk UTI may need referral to secondary care?
- Previous urological surgery
- Stones
- Anatomical abnormality
- Immunocompromised
- Flow problems
What is the investigation of choice for looking for underlying pathology in women with recurrent UTI?
CT scan
How is a recurrent UTI relapse managed?
- Send MSU
- Treat for 3 days with abs
- (or 10 if underlying abnormality present)
What may be appropriate if UTI symptoms are mild?
Offer delayed antibiotic prescription
What is the option of prophylaxis for recurrent UTIs dependent on?
If related to sexual intercourse or not
If recurrent UTI is related to sexual intercourse what prophylactic measures can be considered?
- Change method of contraception if barrier or spermicide used
- Suggest lubricant
- Consider 100mg trimethoprim 2 hours after sexual intercourse
If recurrent UTI is not related to sexual intercourse what prophylaxis can be given?
Consider 6 month course of low-dose nitrofurantoin or trimethoprim
How should patients with repeated failure of recurrent UTI treatment be managed?
Refer to specialist
