Microbiology

Question 1

The lower end of the urethra is colonised by:

Answer 1

Coliforms and Enterococci from large bowel

Question 2

Definition of UTI

Answer 2

Microorganisms in urinary tract causing infection

Question 3

Define pyelonephritis

Answer 3

Inflammation of kidneys due to infection

Question 4

Complicated UTI

Answer 4

UTI complicated by sepsis, structural abnormality or stones = longer course of antibx

Question 5

Bacteriuria

Answer 5

Presence of bacteria in urine, but no infection

Question 6

Cystitis

Answer 6

Inflammation of bladder (not always due to LUTI)

Question 7

Causal organisms

Answer 7

Coliforms: E. coli, Klebsiella, Enterobacter, Proteus
Enterococcus (GI Strep)
Staph saphrophyticus
Staph aureus
Pseudomonas aeruginosa

Question 8

Proteus

Answer 8

Coliform associated with renal stones
Foul smelling urine
Produces ammonia = increased pH

Question 9

Staph saphrophyticus

Answer 9

Women child bearing age

Question 10

Pseudomonas aeruginosa

Answer 10

Associated with catheters

Tx: Ciprofloxacin

Question 11

Symptoms and signs of UTI

Answer 11

Dysuria, frequency, nocturia, haematuria

Fever, rigors, loin pain (UUTI)

Question 12

MSSU

Answer 12

Mid stream specimen urine

Wash perineum, middle stream

Question 13

Clean catch urine

Answer 13

Nurse catches MSSU, kids and elderly

Question 14

Bag urine

Answer 14

Mini bag over urethra in babies, often contaminated

Only negative results useful

Question 15

CSU

Answer 15

Catheter specimen urine - often colonised, only send if symptoms

Question 16

Suprapubic aspiration

Answer 16

Babies if positive bag urine

Question 17

Boricon container

Answer 17

Red top
Boric acid stops bacteria multiplying
24 hours

Question 18

Sterile universal container

Answer 18

White top

2 hours

Question 19

Leukocyte esterase

Answer 19

Indicates presence of WBCs or pus

Question 20

Nitrites

Answer 20

Indicates presence of bacteria - Coliforms (NOT Enterococcus)

Question 21

Which bacteria does not give positive nitrites?

Answer 21

Enterococcus

Question 22

What to look for on microscopy?

Answer 22

Polymorphs - pus cells (multi-lobed nucleus)
Bacteria
RBCs

Question 23

Less than 104

Answer 23

Not significant

Question 24

104

Answer 24

May be contamination
Early UTI
= repeat

Question 25

>105

Answer 25

Significant

Question 26

Mixed growth >105

Answer 26

Probably not significant

Question 27

ESBL

Answer 27

Extended Spectrum Beta Lactamase | Makes bacteria resistant to Cephalosporins and almost all Penicillins

Question 28

Useful antibiotics for ESBL strains

Answer 28

Nitrofurantoin Pevmecillinam Fosfomycin Merepenem

Question 29

CPE

Answer 29

Carbapenemase Producing Enterobacteriae Coliforms (gram neg bacilli) resistant to merepenem (last choice antibx) India travel

Question 30

Length of antibx course in uncomplicated UTI in women and men

Answer 30

Women: 3 days Men: 7 days

Question 31

1st line for UTI

Answer 31

Amoxicillin Trimethoprim Nitrofurantoin Gentamicin

Question 32

2nd line for UTI

Answer 32

Pevmecillinam Temocillin Co-amoxiclav Ciprofloxacin

Question 33

Trimethoprim inhibits:

Answer 33

Folic acid synthesis = avoid 1st trimester

Question 34

Trimethoprim can also be given as:

Answer 34

Co-trimoxazole BUT risk of SJS

Question 35

Nitrofurantoin is only useful in:

Answer 35

Uncomplicated LUTI

Question 36

When should you avoid nitrofurantoin?

Answer 36

Third trimester Breast feeding Kids

Question 37

Gentamicin risks

Answer 37

Renal and VIII toxicity

Question 38

Gentamicin can only be given for:

Answer 38

3 days

Question 39

Risk of using Co-amoxiclav

Answer 39

C.diff

Question 40

Risks of Ciprofloxacin

Answer 40

``` C. diff Damages cartilage (not used in kids/pregnancy) ```

Question 41

Female LUTI Tx

Answer 41

Trimethoprim or Nitrofurantoin 3 days

Question 42

Uncatheterised male UTI Tx

Answer 42

Trimethoprim or Nitrofurantoin 7 days

Question 43

Complicated UTI or pyelonephritis Community Tx

Answer 43

Co-amoxiclav or Co-trimoxazole (14 days)

Question 44

Complicated UTI or pyelonephritis Hospital Tx

Answer 44

Amoxicillin and Gentamicin (3 days) - cotrimoxazole and gen in pen allergic

Question 45

Bacteriuria in pregnancy

Answer 45

TREAT - many progress to pyelonephritis = IUGR

Question 46

Abacterial cystitis/urethral syndrome

Answer 46

Symptoms but no growth on culture Early phase UTI Urethral trauma (honeymoon cystitis) Chlamydia/Gonorrhoea cystitis

Question 47

Treatment of abacterial cystitis

Answer 47

Alkalinise urine - lemon bicarbonate of soda Empty bladder before/after sex Cotton/loose pants

Question 48

When do you give antibiotics in catheterised patient?

Answer 48

>105 and supporting evidence (fever, symptoms)

Question 49

Dose of gentamicin

Answer 49

``` 7mg/kg Online calculator (height, weight, creatinine) ```

Question 50

How to treat C.diff

Answer 50

``` Oral Metronidazole (10 days) No improvement = Oral Vancomycin (10 days) ```