Diebel: UTI

Question 1

What is the difference between an upper and lower UTI?

Answer 1

Upper- kidneys

Lower- bladder, urethra, prostate

Question 2

What type of bacteria cause most UTIs?

Answer 2

Enteric

Question 3

What are the most common sxs of UTIs?

Answer 3

1. asymptomatic (ABU)
2. increased freq/urgency
3. dysuria
4. lower abdominal pain
5. flank pain

Question 4

When are systemic sxs and sepsis possible when related to a UTI?

Answer 4

Kidney infection

Question 5

How do you dx UTI?

Answer 5

UA

Urine culture

Question 6

How are UTI and ABU diagnostically defined?

Answer 6

Presence of bacteria in the urine accompanied by WBC/inflammatory cytokines

Question 7

What is the difference between ABU and UTI?

Answer 7

Absence of sx

UTI symptomatic and warrantes antimicrobial therapy

Question 8

What is the gold standard of detection of UTI? how long does it take?

Answer 8

Bacteria in the urine

24 hrs to obtain results
additional 24 for specific organism

Question 9

What is used to tx UTI in women?

Answer 9

1. nitrofurantoin

2. TMP-SMX

Question 10

What is used to tx UTI in men?

Answer 10

1. fluoroquinolone

2. TMP-SMX

Question 11

What natural mechanisms help to prevent UTI in the body?

Answer 11

1. acidity of the urine
2. act of urinating
3. immunological/physical barriers to infection (mucosal lining of urinary tract and urethral sphincter)

Question 12

What causes 90% of UTIs?

Answer 12

Bacteria ascend the urethra to the bladder

Question 13

What causes a complicated UTI?

Answer 13

Underlying factors that predispose an individual to a UTI

1. catheter
2. obstruction of flow
3. poor bladder emptying (calculi, tumors, neurogenic disorder, pregnancy, prostatic enlargement, uterine prolapse, cystocele)

Question 14

What causes an uncomplicated UTI?

Answer 14

No underlying sx or impairment to flow

Men: unprotected sex, uncircumcised penis

Women: sex, diaphgram/spermacide use, antibiotic use, hx of recurrent UTIs

Question 15

Why does antibiotic and spermacide use increase your chance of getting a UTI?

Answer 15

Alters vaginal flora and can lead to an overgrowth of e. coli

Question 16

What causes most bacterial infections?

Answer 16

Commensal enteric gram - aerobic/facultative bacteria

Question 17

What are common causes of uncomplicated UTI?

Answer 17

e. coli (75%)
s. saprophyticus (5-15%)
other enteric organisms (5-10%)

Question 18

What cause copmlicated UTI?

Answer 18

E. coli and a WIDE variety of other organisms

Question 19

What are the three major contributing factors to UTI?

Answer 19

1. environment- any condition taht cuases urinary stasis (stones/catheters)
2. host- familial disposition (women with recurrent UTI are more likely to have it before age 15 and have a maternal hx- e. coli can attach easier or decreased immune response)
3. microorganism- strains of e. coli that cause symptomatic UTI have certain VFs

Question 20

What are the most important VFs related to E. coli?

Answer 20

Surface adhesions (facilitate binding to epithelial cells to initiate colonization)

Question 21

What is the p fimbriae? What pathogenesis does p fimbriae play a critical role in?

Answer 21

An adhesion that is a hair like protein structure that interacts with a specific receptor on RENAL epithelial cells.

Particularly important in pathogenesis of pyelonephritis and subsequent blood stream invasion of kidney.

Question 22

What is a type 1 pilus important for establishing bladder infection? Is it always expressed?

Answer 22

Play a key role in initiating e. coli bladder infection- mediate binding to uroplakins on luminal surface of BLADDER uroepithelial cells.

adhesion with all e coli strains possess genetically but not all e coli strains express.