Definitions/Pathogenesis

Question 1

definition of uti

Answer 1

bacterial invasion of the urothelium

Question 2

uncomplicated uti

Answer 2

associated with health individuals

no structural or neurological abnormalities of urinary tract

Question 3

complicated uti

Answer 3

associated with factors that compromise urothelial tract and or host defenses
all men
pregnant women
catheters, stents
all hospital acquired infection

Question 4

recurrent uti

Answer 4

2 in 6 months or 3 in a year

Question 5

risk factors for symptomatic uti

Answer 5

female
menopause
sexually active 
pregnancy
spermicide
reflux
obstruction
residual urine
immunosuppression
catheter
renal impairment

Question 6

pathogenesis of UTI

Answer 6

contanmination /colonisation of periurethral area with pathogen from bowel
ascension through urethra to bladder
penetration and colonisation bladder epithelium
ascension to kidney via ureters
inflammation and damage of kidney epithelium
bacterai cross epithelial cell barrier - bacteraemia

Question 7

risk factors young women 6

Answer 7

Sexual intercourse

Use of spermicide
A new sexual partner

A mother with a history of UTI

History of UTI during childhood

Blood group antigen secretory status

Question 8

risk factors post menopausal women 8

Answer 8

History of UTI before menopause

Urinary incontinence

Atrophic vaginitis due to oestrogen deficiency

Cystocele

Increased post-void urine volume

Blood group antigen secretory status

Urine catheterisation

and functional status deterioration in elderly institutionalised women

Question 9

uncomplicated uti organisms

Answer 9

75% UPEC
around 5% each of kleb, staph sapro, enterococus
then GBS, proteus, pseudo, staph a, candida

Question 10

bacteria in complicated uti

Answer 10

65% UPEC
then 8% kleb
11% enterococcus
7% candida
then
gbs, proteus, pseudo, staph a

Question 11

bacterial adherence mechanisms afimbrial

Answer 11

afimbrial adhesions
attach organism to target cell
polymers
polysaccharides
glycocalix

Question 12

bacterial adherence mechanism fimbrial

Answer 12

or pilli

mediate attachment host tissues

Question 13

type 1 pilli

Answer 13

produced by all strains ecoli
mannose sensitivie
combine with mannose receptors on uromucoid

Question 14

type 1 pilli

Answer 14

produced by all strains ecoli
mannose sensitivie
combine with mannose receptors on uromucoid

Question 15

type 2 (p) pilli

Answer 15

mannose resistant
bind to glyolipids of blood group substances secreted by host urothelium
important in pyelonephritis

Question 16

type s pilli

Answer 16

associated with sepsis, meningitis, ascending uti

Question 17

antimicrobial resistance

2 types

Answer 17

intrinsic
enzyme - beta lactamase
impenetrable wall

acquired
evolution of new or altered genetic materal through mutations or gene transfer

Question 18

mechanisms of resistance 3

Answer 18

enzyme inactivation
lactamase hydrolyses beta lactam bond in the antibiotic structure rendering it inactive

altered permeability
receptor activity and transport mechniasms altered to prevent access of antibiotics

alteration of binding site
alter or delete the antibiotic target leading to drug resistance

Question 19

urinary tract host defence mechanisms in urine 3

Answer 19

ph acid
osmol
mechanical flushing

Question 20

host defence mechanisms mucosal epithelial 9

Answer 20

commensal bacteria
GAG mucin layer
TH protein 
mucosal shedding
lactoferrin - chelates irone
lipocalin
toll like receptors
inflammtory response
AMPs  - defensins

Question 21

ABU definition

Answer 21

Asymptomatic bacteriuria in an individual without urinary tract symptoms is defined by a mid-stream sample of urine showing bacterial growth ≥ 105 cfu/mL in two consecutive samples in women and in one single sample in men

In a single catheterised sample, bacterial growth may be as low as 102 cfu/mL to be considered representing true bacteriuria in both men and women

Question 22

% of pregnant women with ABU and % having pyelonephritis

Answer 22

4-7% of pregnant females have ABU – same as normal population
However 20-40% will develop pyelonephritis in pregnancy, usually in third trimester, so ABU should be treated

Question 23

changes in pyelonephritis

Answer 23

Initially patchy infiltration of neutrophils and bacterial in the parenchyma
Later changes include formation of inflammatory bands extending from renal papilla to cortex