CSIM 1.42 Case 43 Launch - A woman with painful micturition

Question 1

What is ‘significant bacteruria’?

Answer 1

Bacteria in urine that exceed the number usually due to contamination from the anterior urethra

Question 2

What is ‘asymptomatic bacteruria’?

Answer 2

significant bacteriuria without symptoms

Question 3

What is cystitis?

Answer 3

A UTI affecting the lower urinary tract (bladder)
• Urge incontinence and frequent urination
• Lower abdomen discomfort
• Painful urination (dysuria)
• Blood in urine

Question 4

What is pyelonephritis? What are the symptoms of this

Answer 4

A UTI affecting the upper urinary tract (kidneys)
  •  Upper back and side (flank) pain
  •  High fever
  •  Shaking and chills
  •  Nausea and vomiting

Question 5

What is a ‘complicated’ and ‘uncomplicated’ UTI?

Answer 5

Complicated:
• Infection in a structurally and neurologically normal urinary tract

Uncomplicated:
• Infection in a structurally and neurologically normal urinary tract

Question 6

What are the types of recurrence of UTI?

Answer 6

Relapses
• bacteriuria with the same infecting bacterium (due to persistence)

Reinfections
• with a bacterium different to original infecting bacterium (new infection)

Question 7

What must bacteria be able to do in order to cause a UTI?

Answer 7

• Gain entry to the urinary tract
  
  • Adhere to the epithelial surface to avoid being flushed away
  • Multiply, and stimulate an inflammatory response

Question 8

What are the routes of UTI pathogenesis?

Answer 8

Ascending route:
• Bacteria colonise the periurethral area (usually gut bacteria from anus)

Haematogenous route
• Blood-borne bacteria leading to infection of renal parenchyma

Direct
• E.g. catheter with poor non-touch technique

Question 9

What bacterium causes ‘haematogenous pyelonephritis ‘?

Answer 9

Staph aureus

Question 10

Where do bacteria causing UTIs usually come from

Answer 10

• Colonic flora
  
  • Perineal flora
  • Bacteria on HCPs hands

Question 11

What is CAUTI?

Answer 11

Catheter-acquired UTI
• Bacteria ascend via capillary action around the outside of the catheter
• Bacteria come from the catheter not being sterilised
• Bacteria enter via reflux of urine

Question 12

What are the most common bacteria which cause UTIs?

Answer 12

E. coli

S. saprophyticus in young sexually active females

Question 13

What defences do humans have against UTIs?

Answer 13

• Urine (osmolality, pH, organic acids) and urine flow
  
  • Mucosal bactericidal activity
  • Inhibition of bacterial adherence
  • Immune system (humoral and CMI) and inflammatory response
  • Prostatic secretions

Question 14

What are the predisposing factors for UTI?

Answer 14

• Obstruction to urine flow or incomplete bladder emptying
  
  • Vesicoureteral reflux (IMG 112)
  • Faecal incontinence (e.g. in demented patient
  • Catheter disease

Question 15

UTI is more common in which gender?

Answer 15

≤ 3 months:
• Males

≥ 3 months
• Females

Question 16

What is urethritis?

Answer 16

UTI of urethra only, burning with urination but no other symptoms

Question 17

How does UTI present in the elderly

Answer 17

Often asymptomatic

Question 18

What lab tests can identify UTI?

Answer 18

• 50-100 WBC/mm3
  
  • Dipsticks - Nitrite and leukocyte esterase test must both be positive to make UTI diagnosis
  • Culture
  • Also radiography/ultrasound

Question 19

Who should dipsticks be used for

Answer 19

• Healthy women under 65 years presenting with mild or ≤2 symptoms of UTI
  
  • NOT CAUTI
  • Men
  • Pregnant women

Question 20

What is the treatment for:

1) Uncomplicated cystitis?
2) Acute pyelonephritis?
3) Asymptomatic bacteruria in elderly?
4) CAUTI?

Answer 20

1) 3 days of antibiotics (1-2 weeks if child, male or pregnant woman)
2) 2 weeks antibiotics
3) Do not treat - benign
4) Do not treat

Question 21

What is male UTI often associated with

Answer 21

Anatomical or functional abnormality:
  •  Benign prostatic hyperplasia (slows urine flow) 
  •  Stones
  •  Prostate cancer
  •  Urethral strictures

Question 22

What antibiotics can be used to treat UTIs?

Answer 22

• Trimethoprim
  
  • Nitrofurantoin
  • Amoxicillin
  • Co-amoxiclav
  • Cefalexin
  • Ciprofloxacin

Question 23

Why is CAUTI not treated?

Answer 23

Most are asymptomatic, do not result in urosepsis