11:9: UTI

Question 1

What is bacteriuria?

Answer 1

• Bacteria in the urine

- Significant if over 10 to the fifth

Question 2

What is cystitis?

Answer 2

• Infection of bladder characterized by dysuria, frequency, urgency and suprapubic pain

Question 3

What is dysuria?

Answer 3

Painful or difficult urination

Question 4

What is urethritis?

Answer 4

• Infection confined to urethra characterized by dysuria, and mucoid or purulent discharge from urethral meatus

Question 5

What is acute pyelonephritis?

Answer 5

• Infection of kidney characterized by flank pain / tenderness and fever
• Often associated with dysuria, urgency, frequency

Question 6

What is an uncomplicated UTI?

Answer 6

• Dysuria, frequency, and urgency with bacteriuria and pyuria
• Often seen in women
• On renal or urologic dysfunction or obstruction

Question 7

What is a complicated UTI?

Answer 7

• Pyuria and document microbial pathogen
• Shows local and systemic signs: fever, chills, malaise, pain
• Occurs in presence of urinary tract abnormality

Question 8

Most common route of UTI infection and how is it caused?

Answer 8

ASCENDING

1. Gut flora reach bladder through urethra
2. Perineal colonization in women
3. Intercourse
4. Catheterization

Question 9

What is hematogenous route?

Answer 9

• Bacteria reach tract through blood

Question 10

What is hemolysin?

Answer 10

• Enzyme produced by UTI bacteria forming pore in epithelial wall allowing bacteria to colonize

Question 11

What does urease do?

Answer 11

Elevate urinary PH by breaking down urea making more hospitable environment for organisms

Question 12

What is Type I (MS)?

Answer 12

• Mannose sensitive fimbriae that attaches to D mannose on many cells of bladder and lower tract

Question 13

What are P fimbriae?

Answer 13

Attaches to P blood group antigens on RBC and urothelium of renal pelvis and kidney

Question 14

What does iron scavenging allow?

Answer 14

• The UTI organism to grow and multiply

Question 15

What causes most UTIs?

Answer 15

1. E Coli 80%

2. Staph saprophyticus 15%

Question 16

Risk factors for UTIs?

Answer 16

1. Sexual intercourse
2. Spermicide
   3, PH
3. Voiding of urine empties bacteria
4. Pregnancy
5. Obstruction
6. Catheterization

Question 17

What is vesicoureteral reflux?

Answer 17

• Congenital condition carrying bacteria to renal pelvis

- Returns infected urine to bladder after voiding

Question 18

Risk of UTI with catheterization?

Answer 18

3% - 10% per day under catheterization

Question 19

Impact of age and sex on UTI?

Answer 19

• Females more at risk than males

- Equal risk in both genders in elderly

Question 20

Why do elderly get UTIs?

Answer 20

1. Bladder prolapse
2. Prostate hypertrophy
3. Incontinence

Question 21

Clinical features of cystitis?

Answer 21

1. Acute dysuria, urgency, frequency
2. Suprapubic pain and tenderness
3. Hematuria
4. Pyuria
5. Positive culture even at low levels

Question 22

Risk factors for cystitis?

Answer 22

• Young sexually active women
• Anal sex in men
• Lack of circumcision

Question 23

Differential diagnosis in women with dysuria?

Answer 23

1. Cystitis
2. Urethritis
3. Vaginitis

Question 24

What is special about dysuria in vaginitis?

Answer 24

Pain is external and not in urethra

Question 25

What is external pain and not in urethra indicative of?

Answer 25

Vaginitis

Question 26

Where is hematuria seen in women with dysuria?

Answer 26

Cystitis

Question 27

When do we not see pyuria in women with dysuria?

Answer 27

Vaginitis

Question 28

Clinical features of pyelonephritis?

Answer 28

1. Acute flank pain, fever, and lower tract symptoms 2. Costovertebral tenderness 3. Bacteremia / septic shock 4. Papillary necrosis 5. WBC casts

Question 29

What does WBC cast in urine tell you?

Answer 29

- Upper urinary tract infection | - Likely pyelonephritis

Question 30

Clinical features of prostatitis?

Answer 30

1, Perineal and lower back pain 2. Fever chills, dysuria 3. Boggy tender prostate

Question 31

How to get clean specimen in urine sample?

Answer 31

"Clean voided midstream urine" - Want sample from midstream flow so it is not contaminated by organisms outside tract in genital tissue - Want urine from bladder

Question 32

Diagnostic definition of pyuria?

Answer 32

- 10 WBCs per microliter | - Mainstay diagnosis for UTI

Question 33

What is leukocyte esterase?

Answer 33

- Noted in dipstick urine test indicating pyuria

Question 34

What does nitire on dipstick test mean?

Answer 34

- Activity of bacterial nitrate reductase which is indicative of UTI - May not work on some bacteria or small colony count

Question 35

How to treat UTI?

Answer 35

1. Treat all with symptoms regardless of age | 2. Bacteriostatic agents work just fine

Question 36

Treatment for acute cystitis?

Answer 36

- Culture or urinalysis not necessary | - Antibiotic for 3 - 5 days

Question 37

Treatment for pyelonephritis?

Answer 37

- Urinalysis and culture indicated | - Antibiotics 5 - 14 days

Question 38

Most significant risk factor for catheter associated UTI?

Answer 38

Duration of use