Definition: > 3 proven urinary tract infections within 12 months (positive msu or symptoms of cystitis associated with nitrite positive dipstick).
Women have a 50% lifetime risk of UTI and this increases with age. There is often no significant underlying identifiable cause.
- Increasing age with atrophic vaginitis post menopause
- Urinary tract abnormality (anatomical/functional/stones/indwelling catheter)
- Residential care
- Chronic pelvic pain syndrome
- Drug induced cystitis eg ketamine
Management prior to referral:
- Send MSU prior to starting antibiotics and change according to sensitivities. Consider treatment for 1-2 weeks.
- Request USS renal tract. If this is normal further investigation is not usually required.
- Lifestyle advice: adequate fluid intake/regular cranberry/hygiene/void after intercourse
- Topical oestrogens (intravaginal) in post menopausal women
- Antibiotic dose after intercourse if a predisposing factor
- Prophylactic antibiotic course for six months. If breakthrough infection send msu, treat for 2 weeks and change antibiotics according to sensitivities.
Indications for referral:
- Emergency referral if features of systemic sepsis: pyrexia/confusion/tachycardia/tachypnoea/hypotension/severe nausea and vomiting.
Clinical suspicion of obstructed kidney in the presence of sepsis requires urgent imaging and emergency drainage of kidney if confirmed.
- Persistent haematuria after treatment of infection refer as per 2WW haematuria guidelines
- Abnormal USS: refer to appropriate speciality depending on abnormality.
- Women with rec UTI and definite suggestion of bladder outflow obstruction (RV>100ml)
- In those who have had the treatments suggested above, eg. low-dose abx, with normal USS and RV, but are still very symptomatic and distressed may be referred for review. However, it is likely that there is little else to offer.