Symptomatic infection of the urinary tract; classified as lower (cystitis) or upper (pyelonephritis).
Causes
- • E. coli (~80%)
- • Klebsiella, Proteus
- • Staph saprophyticus (young women)
Risk factors
- • Female, sexual activity, pregnancy
- • Catheter, obstruction
- • DM, immunosuppression
Clinical features
- • Dysuria, frequency, urgency
- • Suprapubic pain
- • Pyelonephritis: fever, flank pain, vomiting
Investigations
- • Urine dipstick (nitrites, leuc esterase)
- • MSU MC&S before antibiotics
- • Bloods if systemically unwell
- • Imaging if obstruction suspected
Management
- • Lower UTI: nitrofurantoin 100 mg BD × 3 d (women) / 7 d (men)
- • Alternative: trimethoprim 200 mg BD (resistance-dependent)
- • Pyelonephritis: co-amoxiclav 7–14 d or ciprofloxacin 7 d
- • Pregnancy: nitrofurantoin (not 3rd trim), cefalexin
Complications
- • Pyelonephritis
- • Urosepsis
- • Renal scarring (children)
Clinical pearls
- • Treat asymptomatic bacteriuria only in pregnancy / pre-urological surgery
- • Send catheter sample, not bag urine
Related in WardRound
Educational — verify locally.
