Kidney and Urinary Tract Disease - Urinary Tract Infections (33)

Question 1

Where is sterile flora in urinary tract?

Answer 1

Kidneys, ureters, bladder (except in UTI)

Question 2

What flora is in urethra?

Answer 2

Perineal flora - skin/lower GI tract

Question 3

Skin flora

Answer 3

Coagulase-negative staphylococci

Question 4

Lower GI tract flora

Answer 4

(Anaerobic bacteria), Aerobic bacteria (Enterobacteriaceae - gram -ve bacilli/coliforms), gram positive cocci (eneterococcus)

Question 5

Clinical classification of UTI

Answer 5

1. Cystitis
2. Pyelonephritis
3. Urethral syndrome

Question 6

Microbiological classification of UTI

Answer 6

1. Significant bacteriuria
2. Asymptomatic bacteruria
3. Sterile pyuria

Question 7

Where does cystitis effect?

Answer 7

Lower urinary tract - bladder

Question 8

Cystitis symptoms

Answer 8

Dysuria, urinary frequency, urgency, supra-pubic pain/tenderness, polyuria, nocturia, haematuria

Question 9

Where does pyelonephritis effect?

Answer 9

Upper urinary tract - kidneys/renal pelvis

Question 10

Pyelonephritis symptoms

Answer 10

Lower UTI, loin/abdominal pain/tenderness, fever, systemic infection (rigors, nausea, vomiting, diarrheoa, elevated CRP, WBC)

Question 11

What is urethral syndrome?

Answer 11

Symptoms of lower UTI without infection

Question 12

Who does urethral syndrome common effect?

Answer 12

Women 30-50 years

Question 13

Urethral syndrome can also be called

Answer 13

Abacterial cystitis or frequency-dysuria syndrome

Question 14

Significant bacteriuria

Answer 14

Kass criteria, 10^5 cfu/mL

Question 15

Limitations of significant bateriuria criteria

Answer 15

• Count is on a normal curve

- Symptomatic females bacterial counts

Question 16

Asymptomatic bacteriuria

Answer 16

Significant bacteriuria (single organism), no symptoms

Question 17

Sterile pyuria

Answer 17

Pus cells in urine, no organisms grown (antibiotics inhibit bacterial growth)

Question 18

Causes of sterile pyuria

Answer 18

Inflammation (kidney stones, trauma, polycystic kidney disease, ‘fastidious’ organisms

Question 19

Causative organisms of sterile pyuria

Answer 19

M. TB, haemophilus, N.gonorrhoea, anaerobes

Question 20

Predisposing factors

Answer 20

• Female 10:1
• Pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
• Instrumentation
• Sex
• Fisutale (recto-vesical/vesico-vaginal)
• Congenital abnormalities (Vesico-ureteric reflux)

Question 21

Sources of infection

Answer 21

• Perineum
• Fistulae
• Haematogenous

Question 22

Organisms that cause UTI

Answer 22

• E. coli (80%)
• Staph saprophyticus (honeymoon cystitis)
• Proteus mirabilis
• Enterococcus
• Klebsiella
• Coliforms
• Pseudomonas aeruginosa

Question 23

Investigations

Answer 23

1. Dipstick testing
2. Blood tests
3. Microbiology
4. Imaging

Question 24

Dipstick

Answer 24

Test for blood, protein, nitrite, WBC (leucocyte esterase)

Question 25

Microbiology - urine

Answer 25

Mid-stream, catheter, ‘clean catch’, supra-pubic aspirate (M, C&S)

Question 26

Bloods

Answer 26

Suspected pyelonephritis

Question 27

Imaging

Answer 27

Renal tract USS, isotope scan (DMSA, DTPA, MAG3), micturating cystourethrogram

Question 28

Early morning urine

Answer 28

(EMU) X 3, whole contents of bladder, if suspected TB

Question 29

Examples of UTI antibiotics

Answer 29

Nitrofurantoin, Pivmecillinam, Trimethoprim, Fosfomycin

Question 30

Cystitis treatment

Answer 30

Females - 3 days, Males - 7 days

Question 31

Pyelonephritis treatment

Answer 31

IV antibiotics - Cefuroxime, ciprofloxacin, Piperacillin-tazobactam (>65 years)

7-14 days

Question 32

When should you treat asymptomatic bacteriuria?

Answer 32

Pregnant - associated with upper UTI, pre-term delivery, low birth weight

Infant - prevent pyelonephritis and renal damage

Prior to urological procedures - prevent UTI

Question 33

When should you not treat asymptomatic bacteriuria?

Answer 33

Elderly or catherterised