Microbiology of the urinary tract

Question 1

Ex of lower urinary tract infection:

Answer 1

Cystitis

Urethritis

Question 2

Places of acquisition of UTIs

Answer 2

Community acquires

Nosocomial

Question 3

Route of acquisition:

Answer 3

Ascending

Haematogenous

Question 4

Risk factors for UTIs:

Answer 4

• Female sex
• Sexual activity
• Diabetes mellitus
• Urinary stasis
• Urinary retention
• Not fully emptying bladder
• Urinary catether
• Congenital abnormalities
• Reflux

Question 5

Most common bacterial cause of UTI:

Answer 5

E.coli

Question 6

E.coli:

Answer 6

Gram negative, rod shaped

Question 7

Other bacterial causes:

Answer 7

Proteus species
Enterobacter
Staphlococci

Question 8

Fungi causes:

Answer 8

Candida

Question 9

Viral causes;

Answer 9

• Adenoviruses

- BK, JC viruses

Question 10

Adenoviruses are associated with:

Answer 10

Haemorrhagic cystitis

Question 11

BK and JC viruses:

Answer 11

Associated with infection and graft failure in patient following kidney transplant

Question 12

Parasitic infection that can cause UTI:

Answer 12

Schistosoma haematobium

Question 13

Ex of upper urinary tract infections:

Answer 13

Pyelonephritis

Question 14

Innate host defences against UTI:

Answer 14

• Urine flow and mictuition

- Urine pH, osmolarity and urea

Question 15

Active host defences against UTI:

Answer 15

• Secretory IgA

- Mucosal defences

Question 16

Why are females more likely to get UTIs?

Answer 16

Shorter urethra

Urethra closer to anus

Question 17

Bacteria and lower UTI in pregnancy can cause:

Answer 17

• Lower birth rate
• Premature delivery
• Increased perinatal morbidity
• Increased risk of developing pyelonephritis

Question 18

Pyelonephritis in pregnancy:

Answer 18

• Lower birth weight
• Prematurity
• Foetal loss

Question 19

What is screened for during pregnancy?

Answer 19

Asymptomatic bacteriuria

Question 20

Common symptoms of cystitis:

Answer 20

Frequency
Urgency
Dysuria

Question 21

What is usually absent or low in cystitis?

Answer 21

• Systemic symptoms

- Fever

Question 22

Symptoms of UTI in infants:

Answer 22

Fussy, reduced feeding, failure to thrive

Question 23

Symptoms of UTI in elderly:

Answer 23

Normal signs may be absent, sudden onset of confusion

Question 24

Symptoms of pyelonephritis:

Answer 24

• Frequency, urgency, dysuria
• Loin pain
• Fever
• Rigors
• Renal angle tenderness
• Nausea, vomiting

Question 25

Diagnosis of UTI:

Answer 25

- Urinealysis - Urine microscopy - Urine culture

Question 26

Urinealysis to look for:

Answer 26

Protein, blood leukocyte esterase, nitrites

Question 27

Leukocyte esterase may be ... due to ...

Answer 27

False negative | Taking antibiotics, high glucose in urine

Question 28

Nitrites are formed by:

Answer 28

Gr- bacteria

Question 29

Why might nitrities be falsly negative?

Answer 29

- Some bacteria don't product | - Low numbers of bacteria

Question 30

Urine microscopy looks for:

Answer 30

WBCs, epithelial cells, red cells, casts

Question 31

Gold standard for diagnosis:

Answer 31

Urine culutre to look for organism and sensitivities

Question 32

Urethral syndrome:

Answer 32

symptoms with negative urine cultures

Question 33

Why might someone have clinical features but negative urine cultures?

Answer 33

- Too few bacteria - Culturing wrong organisms - Non-infective inflammation - STI (chlamydia, gonorrhoea)

Question 34

Uncomplicated UTI:

Answer 34

Lower UTI in young, otherwise fit woman

Question 35

Management of uncomplicated UTI:

Answer 35

- Good hydration | - Short course of antibiotics if indicated

Question 36

Antibiotics used for UTI:

Answer 36

Trimethoprim: cheap, active against most uropathogens of uncomplicated UTI Nitrofurantoin: high urine conc

Question 37

Nitrofuratoin cannot be used on:

Answer 37

Proteus species | Upper urinary tract infection

Question 38

Amoxicillin and uncomplicated UTIS:

Answer 38

High rates of resistance

Question 39

Recurrent UTI:

Answer 39

>3 UTIs annually

Question 40

Management of recurrent UTI:

Answer 40

- voiding post-intercourse - Double voiding - HRT - Prophylactic antibiotics

Question 41

Way of getting a sterile urine sample:

Answer 41

Suprapubic aspirate

Question 42

Diagnosing UTI in children:

Answer 42

<3mnths: less reliance on dipstick 3mnths-3yrs: microscopy and culture like adult 3 yrs+: lukocytes esterase and nitrites

Question 43

What does a UTI in a child may indicate?

Answer 43

Congential abnormality, should image

Question 44

Treatment of lower tract infections in a child:

Answer 44

- Amoxicillin, trimethoprim, cephalexin

Question 45

Treatment of mild UUTI in child:

Answer 45

Co-amoxiclav

Question 46

Treatment of severe UUTI in child:

Answer 46

Cefotaxime, gentamicin