Lecture 27 - UTI

Question 1

Which term describes inflammation of the kidney?

Answer 1

Chronic/acute pyelonephritis

Question 2

Which term describes inflammation of the bladder?

Answer 2

Cystitis

Question 3

Which term describes inflammation of the urethra?

Answer 3

Urethritis

Question 4

Which term describes inflammation of the prostate?

Answer 4

Prostatitis

Question 5

Which term describes inflammation of the epididymis/testis?

Answer 5

Epididymo-orchitis

Question 6

How many times more likely is a woman to have a UTI than a man?

Answer 6

3x

Question 7

What is the most common HAI?

Answer 7

UTI (38%)

Question 8

What are some general predisposing factors to UTI?

Answer 8

Immunosuppression
Steroids
Malnutrition
Diabetes

Question 9

What are some more specific predisposing factors to UTI?

Answer 9

Female sex
Sex + poor voiding habits
Congenital abnormalities, e.g. duplex kidney
Stasis of urine, e.g. due to poor bladder emptying
FBs, e.g. stones, catheters
Oestrogen deficiency in post-menopausal women
Fistula between bladder + bowel
Spermicide coated condoms/diaphragms

Question 10

What is the most common organism causing UTIs?

Answer 10

E. coli

Question 11

What are other organisms that can cause UTIs?

Answer 11

Usually proteus, klebsiella, enterococci

Question 12

What are the different routes by which bacteria can spread and cause a UTI?

Answer 12

Transurethral - periurethral area contaminated
Urethra to bladder, e.g. intercourse, catheterisation
Bloodstream
Lymphatics

Question 13

What part of the bacteria allows it to attach to bladder epithelial cells?

Answer 13

Fimbrae

Question 14

What are features of UTIs in adults?

Answer 14

Flank pain
Dysuria (like passing broken glass)
Cloudy offensive urine
Urgency
Chills
Strangury
Confusion (elderly)

Question 15

What are features of UTIs in kids?

Answer 15

Diarrhoea
Excessive crying
Fever
NV
Not eating

Question 16

What are the clinical features of acute pyelonephritis?

Answer 16

Pyrexia
Poor localisation 
Loin tenderness (renal angle)
Signs of dehydration 
Turbid urine

Question 17

What investigations shouldbe done for suspected UTI?

Answer 17

MSSU

Urinalysis

Question 18

What is done to the MSSU in the lab?

Answer 18

Microscopy + gram staining

Culture + sensitivity

Question 19

What do you tend to see on urine dipstick in UTI?

Answer 19

Blood
Leucocytes
Protein
Nitrates

Question 20

What other investigations should be done for UTI in children, men or when UTI are frequent?

Answer 20

UV/IVU

Isotope studies to rule out reflux/scarring

Question 21

What are the principles of managing UTIs?

Answer 21

Identify organism + start treatment

Identify predisposing factors + treat

Question 22

What is the treatment of UTIs?

Answer 22

Amoxicillin (3-5d course)
Cephalosporin
Trimethoprim
Fluids

Severe - IV antibiotics

Question 23

Who tends to get reflux nephropathy?

Answer 23

Kids

Question 24

What is the damage in reflux nephropathy due to?

Answer 24

Reflux + infection

Question 25

How should you investigate a suspected reflux nephropathy?

Answer 25

Micturating cystogram | Assess progression by US and biochemistry

Question 26

How is reflux nephropathy treated?

Answer 26

Surgery

Question 27

What advice should you give to people who are getting recurrent UTIs?

Answer 27

Fluid intake 2L/day Void every 2-3 hours every day Void before bed and before + after sex

Question 28

How should you treat UTI with a catheter in situ?

Answer 28

Antibiotics if symptomatic + replace catheter

Question 29

Define bacteriuria

Answer 29

>10^5 CFU

Question 30

How is chronic pyelonephritis diagnosed?

Answer 30

Radiologically

Question 31

What can you see in the kidney of someone who has chronic pyelonephritis?

Answer 31

Scarring + clubbing

Question 32

What can chronic pyelonephritis cause?

Answer 32

Chronic renal failure | HTN

Question 33

What are the features of lower UTIs in adults?

Answer 33

``` Dysuria Urinary frequency Urinary urgency Cloudy/offensive smelling urine Lower abdominal pain Low grade fever Malaise ```

Question 34

How do UTIs present in infants?

Answer 34

Poor feeding, vomiting, irritability

Question 35

How do UTIs present in younger children?

Answer 35

Abdominal pain, fever, dysuria

Question 36

How do UTIs present in older children?

Answer 36

Dysuria, frequency, haematuria

Question 37

What features of UTIs in children may suggest an upper UTI?

Answer 37

Temperature >38 | Loin tenderness/pain

Question 38

When should you check a urine sample in a child?

Answer 38

Signs/symptoms suggestive of UTI Unexplained ever of 38+ Alternative site of infection but who remains unwell

Question 39

What is the preferable urine collection method in kids?

Answer 39

Clean catch If not possible urine collection pads should be used ONLY use in invasive methods like suprapubic aspiration if non-invasive methods not possible

Question 40

How are UTIs in children managed?

Answer 40

<3 months --> refer immediately to paediatrician >3 months + upper UTI --> refer to hospital or give cephalosporin/co-amoxiclav for 7-10 days >3 months + lower UTI - 3 days trimethoprim, nitrofuratoin etc. Ask parents to bring child back if still unwell after 24-48h

Question 41

Should you investigate a UTI in a child?

Answer 41

Yes - you should try and find the underlying cause

Question 42

What are the common organisms causing UTIs in kids?

Answer 42

E. coli (80%) Proteus Pseudomonas

Question 43

What are predisposing factors to UTIs in kids?

Answer 43

Incomplete bladder emptying - infrequent voiding, hurried micturition, obstruction by full rectum due to constipation, neuropathic bladder VUR Poor hygeine

Question 44

How are lower UTIs managed in non-pregnant women?

Answer 44

Trimethoprim/nitrofuratoin for 3 days

Question 45

When should you send a urine culture for a non-pregnant women presenting with a lower UTI?

Answer 45

Only if age >65 or visible/nonvisible haematuria

Question 46

How should a pregnant woman presenting with a UTI be managed?

Answer 46

Urine culture sent | Antibiotics for 7 days - nitrofuratoin (avoid near term), amoxicillin or cefalexin

Question 47

How should asymptomatic bacteruria be treated in pregnancy?

Answer 47

Treat as UTI to prevent progression to acute pyelonephritis | Send off culture after treatment is finished as test of cure

Question 48

Should you treat asymptomatic bacteruria in a catheterised patient?

Answer 48

No

Question 49

Should should symptomatic UTI in a catheterised patient be managed?

Answer 49

7 day antibiotic course

Question 50

How is acute pyelonephritis managed?

Answer 50

Hospital admission | Broad spectrum cephalosporin/quinolone for 10-14 days

Question 51

What is the most common cause of acute pyelonephritis?

Answer 51

Ascending infection (usually E. coli) from lower urinary tract Can also occur from bloodstream spread of infection

Question 52

What clinical features are associated with acute pyelonephritis?

Answer 52

Fever, rigors Loin pain Vomiting White cell casts in urine