Renal & Urology _ UTIs

Question 1

Lower UTIs include infections of which structures?

Answer 1

• urethra(urethritis)
• bladder (cystitis)

Question 2

What are some the common risk factors for UTIs?

Answer 2

• sexual activity
• diaphragm and spermicide use
• previous UTI
• catheter or urologic instrumentation
• Obstruction (BPH, Stones, adhesions)
• Pregnancy
• diabetes
• immunosuppression

Question 3

How is the diagnosis of UTI established?

Answer 3

Characteristic clinical symptoms and urinalysis

Question 4

When would you consider ordering a urine culture?

Answer 4

• when there is an unclear diagnosis
• a concern for antibiotic resistance or
• a treatment failure

Question 5

What are typical symptoms of UTIs?

Answer 5

• dysuria
• frequency
• urgency
• suprapubic pain and/or
• gross hematuria

Question 6

What symptoms might you also see in a child with a UTI?

Answer 6

• bed-wetting
• poor feeding
• irritability and/or
• fever

Question 7

What etiology should you suspect in a child with recurrent UTIs?

Answer 7

Vesicoureteral reflux

Question 8

What test do you order to evaluate Vesicoureteric reflux?

Answer 8

Voiding cystourethrogram (VCUG)

Question 9

UTIs may cause several changes in the urine detectable by gross examination. What are some of these changes?

Answer 9

• cloudy urine
• pungent odor
• gross hematuria

Question 10

UTIs present with what findings on urinalysis?

Answer 10

• pyuria
• positive leukocyte esterase
• positive urinary nitrite
• hematuria and/or
• proteinuria

Question 11

What kinds of cells produce leukocyte esterase?

Answer 11

Neutrophils

Question 12

When are nitrites found in the urine?

Answer 12

When organisms (many Gram-negative and some Gram-positive bacteria) that can reduce urinary nitrates to nitrites are present in significant numbers (at least 10,000 per mL)

Question 13

A negative test for nitrites rules out a urinary tract infection. True or false?

Answer 13

• False. A test for nitrites is very specific but not highly sensitive.
• However, keep in mind that air reacts with the dipstick reagent for nitrites and so the strips will produce false-positive results if overexposed to air.

Question 14

What is the only group of persons that should be treated for asymptomatic bacteriuria?

Answer 14

Pregnant women

Question 15

What are the most common UTI pathogens?

Answer 15

• Escherichia coli (80%)
• Staphylococcus saprophyticus (4.4%)
• Klebsiella pneumoniae (4.3%)
• Proteus mirabilis (3.7%)

Question 16

What organisms can cause urinary tract infections (as evidenced by pyuria) but produce negative urine cultures?

Answer 16

• viruses
• tuberculosis
• Chlamydia
• Ureaplasma urealyticum

Question 17

What are complicated UTIs?

Answer 17

• UTIs that occur in patients who have conditions that increase the risk for treatment failure
  
  • functional/anatomic abnormalities
  • pregnancy
  • hospitalization
  • indwelling catheters

Question 18

What antibiotic regimens may be used as first-line treatment of an uncomplicated UTI?

Answer 18

• Trimethoprim/sulfamethoxazole double-strength tablet (160 mg/800 mg) PO daily for 3 days
• Nitrofurantoin 100 mg twice daily for 5 days
• Cefpodoxime 100 mg twice daily for 3 days
• Ciprofloxacin 250 mg twice daily for 3 days

Question 19

What antibiotic regimens may be used as first-line treatment of a complicated UTI?

Answer 19

Ciprofloxacin 500 mg twice daily or levofloxacin 500 mg once daily for 7-14 days

Question 20

What recommendations would you make for a woman who has recurrent urinary tract infections?

Answer 20

• void after intercourse (though no randomized controlled trials have evaluated this practice)
• antimicrobial prophylaxis (eg, nitrofurantoin) daily or after intercourse
• topical estrogen therapy in postmenopausal women
• cranberry juice (150-750 mL daily)