Clinical infections: Urinary

Question 1

Pyelonephritis

Answer 1

• Upper UTI
• loin and abdomen pain or tenderness
• Other evidence of systemic infection

Question 2

Prostatitis

Answer 2

• Inflammation of prostate

- Can be acute bacterial or chronic

Question 3

Acute bacteria Prostatitis

Answer 3

• Post procedure
• Lower UTI symptoms - fever, tender prostate
• Uropathogens = E.coli

Question 4

Chronic Prostatitis

Answer 4

• Recurrent UTI’s with same organism

- Fluoroquinolones - Ciprofloxacin used

Question 5

Abscesses

Answer 5

Perinephric:
- Can cause renal stones
- Due to obstruction of infected kidney
- Caused by gram negative bacteria
Intrarenal:
- Haematogenous spread
- S.aureus
- Associated with acute pyelonephritis

Question 6

Cystitis treatment

Answer 6

• Antibiotic therapy
• Females - 3 days
• Males - 7 days

Question 7

Pyelonephritis treatment

Answer 7

• Empiric therapy

- 7-14 days use of Cefuroxime, Ciprofloxacin

Question 8

Cystitis

Answer 8

• Lower UTI infection
• Caused by E.coli + others
• Symptoms include dysuria, frequency+urgency, supra-pubic pain

Question 9

Urinary tract flora

Answer 9

• Urethra has perineal flora
• Skin = negative staphylococci
• Lower GIT = Enterobacteria

Question 10

Urethral syndrome (Abacterial cystitis)

Answer 10

• symptoms of lower UTI without demonstrable infection
• Caused by hormonal imbalances, inflammation of Skene glands
• Hypersensitivity following UTI

Question 11

Asymptomatic bacteriuria

Answer 11

• No symptoms of UTI bur cultured urine sample grows a single organism in significant numbers
• Affects people with catheters, haemodialysis, diabetics, pregnant women

Question 12

Sterile pyuria

Answer 12

• Pus cells in urine
• No organisms grown
  Causes:
• Inhibition of bacterial growth
• Urinary tract inflammation
• Urethritis

Question 13

Treatment for asymptomatic bacteriuria

Answer 13

• Antibiotic course
• Only test specific groups
  Pregnant women
  Infants
  Prior to urological procedures

Question 14

Recurrent UTI

Answer 14

• Re-infection - 3 episodes within 12 months is significant

- bacterial persistence

Question 15

Recurrent UTI treatment

Answer 15

• Lifestyle modification - more intake of fluids, change contraception
• Continuous prophylaxis with methenamine Hippurate
• Continuous antibiotic prophylaxis

Question 16

Complicated UTI causes

Answer 16

• Underlying abnormality - structural and functional
• Presence of foreign body = catheter, renal calculi
• Children under 12 and men under 65 often have complications

Question 17

Urostomy associated UTI’s

Answer 17

• Bacteria can colonise catheters
• Fever, ascending infection = upper UTI
  symptoms
• Para-stomal skin infections

Question 18

What is a Urostomy

Answer 18

• Ileal conduit/urostomy

- short section of ileum used to drain the ureters directly to a stoma on the anterior abdominal wall after cystectomy

Question 19

What is a Nephrostomy

Answer 19

• Percutaneous straight into the kidney

- drains urine from the kidney if there is a blockage in the urinary system

Question 20

Nephrostomy associated UTI

Answer 20

• Bacteria colonise nephrostomy tube
• Fever, tenderness at site
• Haematuria or purulent discharge

Question 21

Catheter associated UTI treatment

Answer 21

• Catheter removal/change

- Pre-emptive catheter cover: gentamicin

Question 22

Catheter associated UTI

Answer 22

• Indwelling catheterisation results in bacteriuria; Biofilm formation = colonisation
• Manipulation or catheter removal may result in bacteraemia

Question 23

When can antibiotic prophylaxis be used for Catheter associated UTI

Answer 23

• History of similar infection
• Purulent urethral catheter exit site discharge
• Exit site colonisation