34 Urinary Tract Infections

Question 1

Which organisms make up the perineal flora?

Answer 1

Skin: Coagulase -ve staphylococci.

Lower GI: enterbacteriaceae. Enterococcus.

Question 2

Where is the boundary between upper and lower urinary tract infections?

Answer 2

Bladder.

Question 3

What are the symptoms of cystitis? (7)

Answer 3

Dysuria.
Urinary frequency.
Urgency.
Suprapubic tenderness.
Polyuria.
Nocturia.
Haematuria.

Question 4

What is pyelonephritis?

Answer 4

Infection of the kidney or renal pelvis.

Question 5

What are the symptoms of pyelonephritis? (3)

Answer 5

Loin/abdominal pain/tenderness.
Fever.
Evidence of systemic infection.

Question 6

What is urethral syndrome?

Who gets it?

Answer 6

Bacterial cystitis/frequency-dysuria syndrome.
30-50 y/o women.
Symptoms of UTI without demonstrable infection.

Question 7

What is the definition of significant bacteriuria?

Answer 7

over 10^5 cfu/cml.

Question 8

What are the limitations of significant bacteriuria? (4)

Answer 8

Some have symptoms below 10^5.
Lower counts significant in males (10^3).
Not applicable to catheter urine.
Bacterial count is normally distributed.

Question 9

What is asymptomatic bacteriuria?

Who commonly has it?

Answer 9

Significant bacteriuria of a single organism, with no clinical symptoms.
Community dwelling females over 70.

Question 10

What is sterile pyuria?

Answer 10

Pus cells in the urine with no organisms grown.

Question 11

What are the predisposing factors for UTI? (6)

Answer 11

Sex: 10F : 1M.
Urinary stasis.
Instrumentation.
Sexual intercourse.
Fistulae.
Congenital abnormalities: vesico-ureteric reflux.

Question 12

What are the three sources of a UTI infection?

Answer 12

Perineal.
Fistulae (genital/GI tract).
Haematogneous (rare)/

Question 13

What are the most common causes of UTI in a community setting? (3)

Answer 13

E.coli 70%.
Staphylococcus saprophyticus (sexually active W).
Proteus mirabilis (kidney stone related).

Question 14

What are the most common causes of UTI in a hospital setting? (5)

Answer 14

E. coli. 50%
Enterococcus. 20%
Klebsiella.
Coliforms.
Pseudomonas aeruginosa.

Question 15

What are the causes of sterile pyuria? (6)

Answer 15

Inhibition of bacterial growth (antibiotics, contamination).
Fastidious organisms: M.tubercuosis, Haemophilus, Neisseria gonorrhoea.
Inflammation: urinary stones, renal disease.

Question 16

Why does long term indwelling catheterisation result in bacteriuria?
When might this change to bacteraemia?

Answer 16

Biofilm colonisation.

On manipulation/removal of catheter.

Question 17

When should prophylaxis be used in catheterisation? (3)

Answer 17

History of symptomatic catheter associated UTI.
Purulent discharge from site.
Colonisation with staphylococcus aureus.

Question 18

Which urine tests are used in UTI? (4)

Answer 18

Midstream (MSU).
Catheter urine (CSU).
Clean catch.
Supra-pubic aspirate.

Question 19

When are blood samples taken in UTI diagnosis?

Answer 19

On suspicion of pyelonephritis.

Question 20

When is an early morning urine sample taken?

Answer 20

Suspected urinary tuberculosis.

Question 21

When does a UTI warrant further investigation? (4)

Answer 21

Recurrent UTI.
UTI in adult male.
UTI in childhood.
Suspected pyelonephritis.

Question 22

Which antibiotics are used for UTI infection? (4).

Answer 22

Nitrofurantoin.
Pivmecillinam.
Trimethoprim.
Fosfomycin.

Question 23

What is the treatment for cystitis?

Answer 23

Females: 3 day course antibiotics.

Males/recurrent cases: 7 day course antibiotics.

Question 24

What is the empiric therapy for pyelonephritis? (2,2)

Answer 24

Cefuroxime, ciprofloxacin.

Piperacillin-tazobactam if >65y/o.

Question 25

Who should be treated for asymptomatic bacteriuria? (3)

Answer 25

Pregnant (associated with upper UTI, pre-term baby + low birth weight).
Infants: prevention of pyelonephritis.
Prior to urological procedures.