Session 10 B UTIs

Question 1

Urinary tract is normally

Answer 1

Sterile and resistant to bacterial colonisation

Question 2

Urinary tract defences

Answer 2

Emptying of bladder during micturition
Vesico-ureteral valves
Immunological factors
Mucosal barriers
Urine acidity

Question 3

Ascending colonisation of bacteria from urethra can cause

Answer 3

Cystitis: bladder
Pyelonephritis: kidney

Question 4

Risk factors for UTIs

Answer 4

Question 5

Causative agents for UTIs

Answer 5

Most caused by coli forms (gram negative organisms)

E. Coli is most common

Question 6

E. coli stands for

Answer 6

Escherichia coli

Question 7

Features of E. coli

Answer 7

Flagellar: movement
Pili: attachment
Capsular polysaccharide: colonisation
Haemolysin, toxins: damages host membranes and causes renal damage

Question 8

Clinical presentation of Cystitis (lower UTI)

Answer 8

Question 9

Clinical presentation of Pyelonephritis (upper UTI)

Answer 9

Question 10

Dysuria may be due to other causes of inflammation (urethritis) such as

Answer 10

STIs
Post sexual intercourse
Contact with irritants
Symptoms of menopause, atrophic vaginitis or vaginal atrophy

Question 11

Define an uncomplicated UTI

Answer 11

Infection by a usual organism
Patient with normal urinary tract
Normal urinary function

Question 12

Factors that predispose to persistent infection, recurrent infection or treatment failure

Answer 12

Abnormal urinary tract
Virulent organism (staph aureus)
Impaired host defence (immunosuppression, poorly controlled diabetes)
Impaired renal function
Suspected pyelonephritis

Question 13

Investigations for UTI

Answer 13

Urine culture, dipstick, visual inspection

Question 14

There is no need for urine culture in

Answer 14

Healthy, non-pregnancy women of child bearing age

Question 15

Culture in complicated UTI

Answer 15

Mid-stream urine- cleansing not required, ideally holding labia apart in women

Clean catch in children

Culture urine within 4 hours of collection, refrigerate or use boric acid preservative

Question 16

What can be used as an aid to diagnosis

Answer 16

Urine dipstick

Question 17

urine dipstick is not useful in

Answer 17

Patient over 65 as commonly have asymptomatic infections

Catheterised patients

Question 18

Urine dipstick is useful if patient presents with 1 of the following

Answer 18

Dysuria
New nocturia
Cloudy urine present

Question 19

If negative for nitrites, positive for LE, suggests

Answer 19

Staphlococcus saprophyticus

Question 20

Imaging of urinary tract

Answer 20

Considered in all children with UTI

Valuable in septic patients to identify renal involvement (i.e. pyelonephritis)

Question 21

Treatment of UTI

Answer 21

Increased fluid intake
Regular analgesia
Address underlying disorders
Antibiotics e.g. Trimethoprim

Question 22

Antibiotic treatment of UTIs

Answer 22

3 day course for uncomplicated

5-7 day cause for complicated lower UTI e.g. pregnant, male, underlying disorders

Question 23

Treatment of cystitis

Answer 23

Nitrofurantoin, trimethoprim, pivmecillinam or fosfomycin

Question 24

Treatment for uncomplicated cystitis

Answer 24

3 day course as effective as 5-7

Limiting prescription to 3 days reduces selection pressure for resistance

Question 25

Treatment for complicated UTI e.g. male, pregnant, catheter

Answer 25

5-7 day course

Question 26

General Treatment of pyelonephritis/septicaemia

Answer 26

7-10 day course

Use agent with systemic activity (NOT nitrofurantoin, fosfomycin)

Question 27

Specific treatment for pyelonephritis

Answer 27

Possibly IV initially unless good oral absorption and patient well enough

Co-amoxiclav
Ciprofloxacin (7 day course)
Gentamicin (IV only, nephrotoxic)