Infection

Question 1

What type of bacteria colonise the lower end of urethra?

Answer 1

Coliforms and enterococci from large bowel

Question 2

What does it mean by complicated UTI?

Answer 2

UTI complicated by sepsis (NEWS>=5) OR urinary structural abnormality/stone

Question 3

Does bacteriuria necessarily mean infection?

Answer 3

No, it doesn’t necessarily mean infection

It is important to determine if patient is symptomatic

Question 4

When does staph aureas come into play as the pathogenic organism in UTI?

Answer 4

It doesn’t get involved via the more common “ascending” route of UTI infections

It causes UTI via bloodstream spread (rare)

Question 5

What do coliforms look like under microscope?

Answer 5

Gram -ve bacilli

Examples include E.Coli (aerobic), Proteus sp., enterobacterales sp., etc

Question 6

What is another gram -ve bacilli classically involved in UTI?

Answer 6

Pseudomonas aeruginosa (not common, but hard to treat) - it is anaerobic

Question 7

What are some characteristics of Proteus UTI?

Answer 7

Foul smelling urine

Swarming culture (concentric circles)

Produces urease which breaks down urea and increases blood pH - tendency for salt precipitation

Struvite caliculi (large, “stag-horn” shaped)

Question 8

What antibiotic is used for pseudomonas-caused UTI?

Answer 8

Ciprofloxacin (as it is intrinsically resistant to most oral Abx)

Usually associated with catheters and instrumentation

Question 9

What is the most common gram +ve bug that causes UTI?

Answer 9

Enterococcus spp.
eg.enterococcus faecalis, enterococcus faecium

Question 10

What are two other gram +ve bugs that cause UTI worth noting?

Answer 10

Question 11

What are the red-cap urine containers?

Answer 11

They are boricon containers that contain boric acid to stop bacterial multiplying (works for about 24 hrs)

Usual universal sterile containers need to be sent to lab within 2 hrs

Question 12

What is the antibiotic to keep in mind for hospital complicated UTI/pyelonephritis?

Answer 12

Gentamicin

Question 13

What to think about when looking at a case of potential infection?

Answer 13

preliminary diagnosis?
dip stick?
sample?
will you treat this? how?
any other advice?

Question 14

Does smelly urine without any other urinary symptoms indicate investigations?

Answer 14

If you clinically don’t think a patient has UTI, there is no point doing a dipstick or urine sample

Question 15

Would you do a dipstick in a men presenting with likely lower UTI?

Answer 15

You wouldn’t really do it, it doesn’t add much information

BUT you would always always send a urine sample in a man presenting this way

Question 16

What is a difference in male/female antibiotic prescription for UTI?

Answer 16

For female you usually start with a 3-day course, whereas for male you would give a 7-day course

Also for men you’d want to keep likelihood of prostatitis in mind

Question 17

In clinically suspected pyelonephritis, would you send for a urine sample?

Answer 17

Yes, there can be chance where the kidney is damaged

And this is regardless of whether or not they have catheter in