Module 9 Part 2 Acute cystitis

Question 1

Question

Answer 1

Answer

Question 2

What is acute cystitis?

Answer 2

Acute cystitis is an inflammation of the bladder and is the most common type of urinary tract infection (UTI).

Question 3

What can cystoscopy reveal about the bladder during cystitis, and how does the appearance vary with severity?

Answer 3

Cystoscopy can reveal different appearances of the bladder during cystitis, including hyperemic mucosa, hemorrhagic cystitis, suppurative cystitis, and ulcerative cystitis.

Question 4

What are the most common microorganisms that cause acute cystitis?

Answer 4

The most common infecting microorganisms are uropathic strains of Escherichia coli, followed by Staphylococcus saprophyticus.

Question 5

What are some less common microorganisms that can lead to acute cystitis?

Answer 5

Less common culprits include Klebsiella, Proteus, Pseudomonas, fungi, viruses, parasites, or tubercular bacilli.

Question 6

What is Schistosomiasis, and how is it related to acute cystitis?

Answer 6

Schistosomiasis is a common cause of parasitic invasion of the urinary tract and is strongly associated with bladder cancer.

Question 7

How does bacterial contamination typically occur in acute cystitis?

Answer 7

Bacterial contamination usually happens through the retrograde movement of Gram-negative bacilli into the urethra, bladder, ureter, and kidney.

Question 8

How do uropathic strains of E. coli resist flushing during urination?

Answer 8

Uropathic strains of E. coli have specific structures, such as type-1 fimbriae and P fimbriae, that allow them to bind to the urinary tract’s surfaces and resist flushing during normal urination.

Question 9

What is the role of hematogenous infections in acute cystitis?

Answer 9

Hematogenous infections, where pathogens spread through the bloodstream, are rare and often follow septicemia. They can lead to acute cystitis.

Question 10

What triggers the symptoms of cystitis in response to infection?

Answer 10

Infection initiates an inflammatory response, causing symptoms of cystitis, including bladder fullness, urgency, and frequent urination.

Question 11

Are all individuals with bacteriuria (bacteria in the urine) symptomatic of cystitis?

Answer 11

No, many individuals with bacteriuria are asymptomatic, and older persons are at a higher risk of asymptomatic infections.

Question 12

What are the typical symptoms of cystitis, and what causes them?

Answer 12

Symptoms of cystitis usually include frequency (frequent urination), urgency, dysuria (painful urination), and suprapubic and low back pain. These symptoms are linked to the body’s inflammatory response to infection.

Question 13

What are more severe symptoms associated with cystitis?

Answer 13

More severe symptoms may include hematuria (presence of blood in the urine), cloudy urine, and flank pain.

Question 14

What percentage of individuals with bacteriuria have no symptoms, and what about symptomatic individuals?

Answer 14

Approximately 10% of individuals with bacteriuria have no symptoms, and 30% of individuals with symptoms do not have bacteriuria.

Question 15

How does cystitis typically affect older individuals, and what are their risk factors?

Answer 15

Cystitis in older persons may be asymptomatic, lead to confusion, or cause vague abdominal discomfort. Older individuals with recurrent UTIs and other concurrent illnesses have a higher risk of mortality.

Question 16

How is cystitis diagnosed in symptomatic individuals?

Answer 16

Cystitis in symptomatic individuals is diagnosed through urine culture, which identifies specific microorganisms when present at counts of 10,000/mL or more.

Question 17

Can urine dipstick testing be used to diagnose uncomplicated UTIs, and what does it check for?

Answer 17

Yes, urine dipstick testing can diagnose uncomplicated UTIs. It checks for the presence of leukocyte esterase or nitrite reductase, which are indicative of infection.

Question 18

What should be identified and treated in individuals with cystitis?

Answer 18

Risk factors, such as urinary tract obstruction, should be identified and addressed in individuals with cystitis.

Question 19

How is antibiotic treatment guided for cystitis?

Answer 19

Antibiotic treatment for cystitis is guided by evidence of bacteria from urine culture and antibiotic sensitivity testing. This helps choose a microorganism-specific antibiotic.

Question 20

Is an office visit or urine culture necessary to diagnose acute uncomplicated cystitis in nonpregnant women?

Answer 20

An office visit or urine culture may not be necessary for the diagnosis of acute uncomplicated cystitis in nonpregnant women.

Question 21

How long is the typical antibiotic treatment duration for uncomplicated cystitis, and what about complicated UTI?

Answer 21

Uncomplicated cystitis is often treated with 3 to 7 days of antibiotics, while complicated UTI may require 7 to 14 days of treatment.

Question 22

What percentage of women might experience relapsing infection, and what does this require?

Answer 22

Approximately 20-25% of women may experience relapsing infection within 7-10 days, necessitating prolonged antibiotic treatment.

Question 23

How often should follow-up urine cultures be conducted after treatment initiation, and why?

Answer 23

Follow-up urine cultures should be obtained 1 week after treatment initiation and at monthly intervals for 3 months to monitor progress. Clinical symptoms often improve, but bacteriuria may persist.

Question 24

Why might repeat cultures be needed after the initial treatment, and how long should they be conducted?

Answer 24

Repeat cultures may be necessary every 3-4 months for up to 1 year after the initial treatment for evaluation and treatment of recurrent infections.

Question 25

Why is antibiotic resistance in urinary tract infections (UTIs) a global concern?

Answer 25

Antibiotic resistance in UTIs is concerning because it increases healthcare costs, hospitalizations, morbidity, and mortality.

Question 26

What contributes to antibiotic resistance in UTIs?

Answer 26

Overuse of antibiotics plays a significant role in the emergence of antibiotic resistance in both community and hospital-acquired UTIs.

Question 27

Where are the risks for antibiotic resistance highest?

Answer 27

Risks for antibiotic resistance are highest in regions with high prescription rates and individuals with specific risk factors, such as recent use of trimethoprim-sulfamethoxazole (TMP-SMX), diabetes mellitus, recent hospitalization, and high community-specific antibiotic resistance rates (>20%).

Question 28

What is the most common cause of UTIs, and what is the primary treatment?

Answer 28

Escherichia coli is the leading cause of UTIs, and antibiotics are the primary treatment.

Question 29

How do bacteria develop resistance to antibiotics in UTIs?

Answer 29

Many bacteria, including E. coli, produce enzymes like β-lactamases and carbapenemases, which lead to resistance against antibiotics like penicillins, cephalosporins, and carbapenems.

Question 30

Why are antibiotics like TMP-SMX and fluoroquinolones a concern in UTI treatment?

Answer 30

These antibiotics commonly used to treat UTIs have high rates of resistance.

Question 31

What are multidrug-resistant extended-spectrum β-lactamase (ESBL)-producing E. coli, and why are they a concern?

Answer 31

ESBL-producing E. coli are bacteria resistant to multiple antibiotics and are emerging without known risk factors.

Question 32

How are uncomplicated and complicated UTIs typically treated?

Answer 32

Uncomplicated UTIs can be treated empirically with a 3-day antibiotic regimen, while complicated cases require individualized assessment.

Question 33

Is treatment required for asymptomatic bacteriuria?

Answer 33

Asymptomatic bacteriuria is generally not treated.

Question 34

What’s essential to address antibiotic resistance in UTIs, and what is being explored for treatment?

Answer 34

Raising awareness of antibiotic resistance and responsible prescribing is crucial. Researchers are exploring new medications and combinations to combat bacterial resistance.