Microbiology 2

Question 1

What are the common signs/symptoms of UTI’s ?

Answer 1

• Dysuria (pain passing urine)
• Frequency of urination / nocturia
• Haematuria

Question 2

What additional signs/symptoms would suggest more of an upper UTI?

Answer 2

• Fever
• Loin pain
• Rigors

Question 3

Why when taking a urine sample from someone do you want a mid-stream sample ?

Answer 3

As the first urine someone passes is likely to be contaminated

Question 4

How are UTI’s diagnosed ?

Answer 4

• Urine dipstick
• Urine microscopy - this is more for urgent cases that need to be diagnosed more quickly
• Urine culture and sensitivity - best one for diagnosis

Question 5

What are the signs on a urine dipstick that someone has a UTI?

Answer 5

Presence of:

• Leukocytes (WBC’s)
• Nitrites
• Protein
• Blood

Question 6

What are the chances if urine is cloudy that it is infected ?

Answer 6

Upto 95% chance if married with other clinical signs and symptoms of UTI (according to Mr De-souza)

Question 7

Which is better for the diagnosis of UTI’s culture or microscopy ?

Answer 7

Culture - it is the most sensitive and specific

Question 8

For diagnosing UTI’s what criteria is used ?

Answer 8

Kass criteria:

• >10⁵ organisms / ml - significant =probable UTI
• 10⁴ organisms / ml - repeat specimen as result may be due to contamination
• <10³ organisms / ml - not significant bacteriuria

Question 9

Using Kass criteria what would be diagnostic of a genuine UTI in an uncathersterised patient ?

Answer 9

>10⁵ orgs/mL of a pure growth of a single organism

Question 10

Is A mixed growth of 2 or more organisms, even if >10⁵ diagnostic of a UTI ?

Answer 10

No it is probably not significant

Question 11

ESBL (extended spectrum beta-lactamase) bacteria are resistant to what antibiotics ?

Answer 11

ALL cephalosporins and to almost all penicillins

Question 12

What is the class of bacteria which are resistant to ALL current antibiotics ?

Answer 12

Carbapenemase-producing Enterobacteriaceae (CPE)

Question 13

When should use of trimethoprim be avoided ?

Answer 13

In 1st trimester (3 months) of pregnancy

Question 14

When should the use of Nitrofurantoin be avoided ?

Answer 14

In late pregnancy (can cause neonatal haemolysis), breast feeding and children <3 months old

Question 15

Is gentamicin safe to use in pregnancy ?

Answer 15

NO

Question 16

What is the potential side effect of using gentamicin ?

Answer 16

Can cause renal and VIIIth nerve damage (deafness and balance problems)

Question 17

What are the 4 C antibiotics avoided in tayside and why are they avoided ?

Answer 17

• Clindamycin
• Cephalosporins
• Co-amoxiclav
• Ciprofloxacin

They are avoided because they are broad spectrum antibiotics which carry a risk of C.diff infections

Question 18

Do we treat patients with asymptomatic bacteriuria ?

Answer 18

• No - especially not elderly
• For UTI’s to often be treated you need the patient to be symptomatic

Question 19

What is the exception to asymptomatic bacteruria - i.e. which patients would you treat if they had asymptomatic bacteriuria ?

Answer 19

Pregnanct women

Question 20

Would you do urinanalysis to help diagnosis a UTI in an elderly patient or someone with a catheter in ?

Answer 20

NO!

Question 21

What is the treatment of female lower UTI’s ?

Answer 21

Trimethoprim or nitrofurantoin orally (3 days)

Question 22

What is the treatment for uncomplicated male UTI’s ?

Answer 22

Trimethoprim or nitrofurantoin orally (7 days)

Question 23

What is the treatment of complicated UTI’s or pylonephritis in GP setting?

Answer 23

Co-amoxiclav or co-trimoxazole

Question 24

What is the treatment of complicated UTI’s or pylonephritis in hospital setting ?

Answer 24

Amoxicillin and gentamicin IV