3. UTI

Question 1

what is a UTI

Answer 1

infection of the urinary tract anywhere from kidneys
upper = kidneys, ureters
lower = bladder, urethra

Question 2

what is cystitis?

Answer 2

infection of bladder

Question 3

what is the most common cause of UTI?

Answer 3

Escherichia coli

Question 4

what is the 2nd most common cause of UTI and who does it most commonly affect?

Answer 4

staphylococcus saprophytic

- young sexually active women

Question 5

risk factors for UTI?

Answer 5

• female gender - shorter urethra so shorter distance for ascending bacteria
• sexual intercourse
• catheterisation
• menopause - decreased oestrogen so loss of protective flora
• diabetes mellitus - hyperglycaemia inhibits nuetrophil action and increased glucose as food for bacteria
• pregnancy

Question 6

gram stain of E coli?

Answer 6

gram negative

bacilli

Question 7

characteristics of E coli?

Answer 7

• Normal flora of colon (Pathogenic within GI tract or UT)

* Transmission by faecal-oral or faecal-urethral

Question 8

clinical significance of E coli?

Answer 8

• UTIs (cystitis/pyelonephritis) – Women at greater risk

* Peritonitis and Neonatal meningitis

Question 9

virulence factors of E coli?

Answer 9

1) Fimbriae/Pili = adherence to host

2) Lipopolysaccharide capsule: Antiphagocytic/Antigenic

Question 10

investigations of E coli?

Answer 10

• DIPSTICK!

Question 11

what is found on urine dipstick of E coli?

Answer 11

• +Ve Nitrites/Leukocyte Esterase

Nitrites are generally found in urine due to reduction of nitrates to nitrites by some Gram-negative bacteria such as E. coli.
Gram-positive pathogens do not produce nitrate reductase so dipstick will be negative for nitrite.

Leukocyte esterase is an enzyme released by neutrophils and macrophages. A urine dipstick positive for this enzyme indicates pyuria (an increased number of leukocytes / white blood cells). Urinary tract infections including cystitis and urethritis are common causes of pyuria.

Question 12

first line treatment for E coli?

Answer 12

nitrofurantoin - nucleic acid synthesis inhibitor

Question 13

an alternative treatment for E coli and why is it not given to all women?

Answer 13

trimethoprim - folic acid inhibitor so not given to pregnant or women of pregnancy age as can affect fetus

Question 14

symptoms of UTI?

Answer 14

dysuria
urinary frequency
urinary urgency
suprapubic pain
cloudy urine
strong urine smell

Question 15

symptoms that may indicate upper UTI?

Answer 15

fever
nausea
vomiting
pain at costovertebral angle

Question 16

advice to UTI patients?

Answer 16

drink plenty of fluid
wash genitals before and after intercourse
wipe from front to back
urinate after intercourse