uti

How is an uncomplicated UTI defined?

It is a urinary tract infection occurring in a healthy, non-pregnant female of child-bearing age with normal anatomy.

What factors characterize a complicated UTI?

It involves risk factors that increase the probability of bacterial colonisation or decrease the potential efficacy of antibiotic treatment, such as anatomical abnormalities or immunosuppression.

How is cystitis defined based on location?

It is an infection specifically located in the bladder.

Why are women significantly more likely to get UTIs than men?

Women have a much shorter urethra, and the opening is closer to the vagina and anus, which are rich in microbiota.

What are the common symptoms of an uncomplicated UTI?

Symptoms include urinary frequency, urgency, dysuria (painful urination), suprapubic pain, nocturia, and haematuria.

What systemic signs distinguish pyelonephritis from simple cystitis?

Signs include fever, chills, flank pain, nausea, vomiting, and an elevated white blood cell count.

How might a UTI present differently in an older patient?

They may not show usual symptoms but can present with altered mental status, poor appetite, and incontinence.

What is the most common causative pathogen for both uncomplicated and complicated UTIs?

Escherichia coli, specifically uropathogenic E. coli (UPEC).

Why is amoxicillin generally avoided as an empiric treatment for UTIs?

It is not commonly used because of high rates of resistance in E. coli.

How does Methenamine hippurate (Hiprex) help prevent recurrent UTIs?

It is hydrolysed in acidic urine to produce bacteriostatic formaldehyde, which inhibits bacterial growth.

Why is it essential to treat Asymptomatic Bacteriuria (ABU) in pregnant women?

Treatment reduces the risk of the infection progressing to pyelonephritis and prevents complications like preterm labour and low birth weight.

How is Asymptomatic Bacteriuria (ABU) clinically defined?

It is defined as having two positive consecutive clean catch urine specimens in a patient who shows no symptoms.

What specialized factors allow UPEC to successfully colonise the urinary tract?

They use adhesion factors like pili to attach, secrete toxins like haemolysin, and have mechanisms for iron acquisition in urine.

What is the first-line empiric oral antibiotic for an adult with a lower UTI in New Zealand?

Nitrofurantoin is the first-line choice.

What is the first-line empiric oral treatment for a child with a lower UTI?

Cefalexin is the preferred first-line choice for children.

When is a laboratory urine culture necessary for diagnosing cystitis?

It is required for pregnant women, patients with suspected pyelonephritis, those with recurrent infections, or patients with complicating factors like diabetes or renal impairment.

Why does chronic prostatitis have a high rate of treatment failure?

Antibiotics have difficulty penetrating and accumulating in prostatic tissue, often leading to relapse.

How is ureteral reflux defined?

It is the backflow of urine from the bladder to the kidneys, often caused by abnormal valves, leading to recurrent infections.

When must a child with cystitis be referred to the hospital?

Referral is recommended if they are aged less than 3 months, have severe illness, or have known renal tract abnormalities.

What are the primary goals of UTI therapy?

The goals are to eradicate the pathogen before it reaches the kidneys, prevent systemic consequences, and prevent the recurrence of infection.

How does D-Mannose potentially prevent recurrent UTIs?

It binds to type 1 pili on bacteria, which prevents them from invading the bladder wall.

What is the first-line oral treatment for an adult with mild uncomplicated pyelonephritis?

Cefalexin is the first-line antibiotic choice.

Why might a single dose of IV gentamicin be used for pyelonephritis in the community?

It is used as a potent "stat" dose for patients with severe symptoms before they begin a standard oral antibiotic course.

What is the role of urinary alkalinisers like Ural?

They are used only for symptomatic relief of burning and pain; they do not treat the underlying bacterial infection.

Why is diabetes considered a predisposing factor for UTIs?

Elevated glucose levels in the urine can promote the growth of bacteria.

What determines if a UTI recurrence is a relapse or a new infection?

In uncomplicated UTIs, recurrence is typically a new infection, whereas in complicated UTIs, it is often a relapse due to ineffective initial treatment.

Why is UPEC's urease activity clinically important?

Urease activity can induce the formation of urinary tract stones.

When is Fosfomycin used for a UTI?

It is reserved for cases where other antibacterials are not tolerated or the organism is resistant, and it requires special authority.

Why is vaginal oestrogen helpful for post-menopausal women with recurrent UTIs?

It helps treat vulvovaginal atrophy, which can be a predisposing factor for infections in this population.

What sepsis signs in a UTI patient require immediate hospital referral?

Tachycardia, low blood pressure, and an increased respiratory rate.

How is urethritis defined?

It is an infection or inflammation specifically of the urethra.

Why should trimethoprim no longer be the first choice for empiric cystitis treatment in NZ?

There is a significant pattern of growing antibiotic resistance to trimethoprim across the country.

How does the duration of treatment for acute pyelonephritis compare to simple cystitis?

Acute pyelonephritis requires a longer course, typically 10 days (and up to 14), compared to shorter courses for simple cystit