Urinary Tract Infection
Background
UTI is the second most common clinical indication for antimicrobial treatment in primary and secondary care. The common local (Cork Kerry region) pathogens are Coliform (80%), Enterococcus (6%), Proteus (4%) and Staph. (3%). Others include Pseudomonas, Strep. and MRSA.
Diagnosis
Lab testing for Culture &Sensitivity indicated in
- Pregnancy
- Suspected UTI in children
- Suspected pyelonehpritis
- Suspected UTI in men
- Recurrent UTI in women
- Failed antibiotic treatment
- Patients with known abnormalities of the GU tract
- Patients with renal impairment
Catheterised Patients
- Avoid unnecessary samples as bacteruria is usual
- Send sample if features of systemic infection
- In presence of catheter antibiotics will not eradicate bacteruria
- Only treat is systemically unwell or pyelonephritis likely
The Elderly
- Asymptomatic bacteruria in the elderly is very common
- It is not related to morbidity or mortality
- Ix and Rx will increase side effects and medicalise the condition
- Only sample if two signs of infection e.g. dysuria, >380 or new incontinence
Treatment
Management suspected UTI in men
- DDx includes prostatitis, chlamydial infection and epididymitis
- Take urine sample for C&S
- UTI in men should be treated for 14 days (cannot exclude prostatitis)
- Men should be referred to urology if
- recurrent UTI (2 or more episodes in 3/12)
- symptoms of upper UTI
- fail to respond to appropriate antibiotics
Recommended length of treatment
- Uncomplicated UTI in women - treat for 3/7
- UTI in pregnant women and children treated for 7 days
- UTI in men should be treated for 14 days (cannot exclude prostatitis)
- Upper UTI should
- Treat for 14 days (or 7 days if using quinolone)
- Admit to hospital if upper UTI not responding within 24 hours
