11. UTI

Question 1

What is a UTI a common source of?

Answer 1

Gram negative septicaemia

Question 2

What are the major defences of urinary tract?

Answer 2

Emptying of bladder during micturition
Vesico-ureteral valves
Immunological factors
Mucosal barriers
Urine acidity

Question 3

What is a UTI in bladder called?

Answer 3

Cystitis

Question 4

What is a UTI in kidney called?

Answer 4

Pyelonephritis

Question 5

What are the risk factors for UTI?

Answer 5

Female
Obstructive causes - stones, enlarged prostate
Neurological conditions affecting bladder emptying - MS
Pregnancy - enlarged uterus
Abnormal renal tract - vesico-ureteric reflux in children, catheter
Impaired host defence - diabetes, immunosupression

Question 6

What is the most common organism causing UTI?

Answer 6

E. coli (coliforms)

Question 7

What are the clinical syndromes of UTI?

Answer 7

Cysitis (lower UTI)
Pyelonephritis (upper UTI)
Chronic pyelonephritis 
Asymptomatic bacteriuria (pregnancy)
Septicaemia

Question 8

What is the clinical presentation of cystitis?

Answer 8

Dysuria
Cloudy urine
Nocturia or frequency
Urgency
Suprapubic tenderness
Haematuria
Pyrexia

Question 9

What is the clinical presentation of pyelonephritis?

Answer 9

Higher fever +/- rigors
Loin pain and tenderness
Nausea/vomiting
+/- symptoms of cystitis

Question 10

What is the definition of an uncomplicated UTI?

Answer 10

Defined as infection by a usual organisms in a patient with a normal urinary tract and normal urinary function

Question 11

What is a complicated UTI?

Answer 11

More than one factor that predispose to persistent infection, recurrent infection or treatment failure:

• abnormal urinary tract
• virulent organism (staph aureus)
• impaired host defence
• impaired renal function

Question 12

What investigations are done in UTI?

Answer 12

Urine culture - no need in healthy, non-pregnant women of child bearing age
Urine dipstick - leucocyte esterase, nitrites, blood, pH, protein

Question 13

How is a urine sample collected?

Answer 13

Mid-stream urine
Clean catch in children
Collection bag (20% false positives)
Catheter sample
Supra-pubic aspiration

Question 14

When is a urine dipstick not useful?

Answer 14

Patients >65 years old

Catheterised patients

Question 15

When is imaging of urinary tract considered?

Answer 15

All children with UTI
Valuable in septic patients to identify renal involvement
Males - posterior urethral valves
Females and children - vesico-ureteric reflux

Question 16

What can a sterile pyruria (WBC in urine) show?

Answer 16

Prior antibiotics
Urethritis
Vaginal infection/inflammation
TB
Appendicitis

Question 17

Hat is asymptomatic bacteriuria?

Answer 17

Significant levels of bacteria in urine with no UTI symptoms
High prevalence in elderly, indwelling catheters
Screened for and treated only in pregnancy

Question 18

What is the treatment for UTI?

Answer 18

Increase fluid intake
Regular analgesia 
Address underlying disorders 
3 day course for uncomplicated 
5-7 days course for complicated lower UTI

Question 19

What is simple cystitis treated with?

Answer 19

Uncomplicated infections - nitrofurantoin, trimethoprim, pivmecillinam, fosfomycin
3 day course (reduces resistance)

Question 20

What is the treatment for complicated lower UTI?

Answer 20

Nitrofurantoin, trimethoprim, pivmecillinam, fosfomycin, cefelexin
5-7 day course

Question 21

What is the treatment for pyelonephritis/septicaemia?

Answer 21

7-10 day course
Use agent with systemic activity
Possibly IV initially - co-amoxiclav, ciprofloxacin, gentamicin

Question 22

When should prophylaxis be considered?

Answer 22

> 3 episodes of UTI a year
Despite behavioural and personal hygiene measures
No treat be underlying condition
Trimethoprim or nitrofurantoin