SHOULD BE IN CLINICAL- Urinary Tract Infection (UTI)

Question 1

What is inflammation/infection of the kidneys called?

Answer 1

Pyelonephritis

Question 2

What is inflammation/infection of the bladder called?

Answer 2

Cystitis

Question 3

What is inflammation/infection of prostate called?

Answer 3

Prostatitis

Question 4

What if inflammation/infection of urethra called?

Answer 4

Urethritis

Question 5

Why are UTIs more common in women?

Answer 5

*vaginal colonisation
*urethra shorter in women (4cm)

Question 6

What is the pathogenesis of a UTI?

Answer 6

*most urinary pathogens originate in rectal flora and enter bladder via urethra
*lower urethra contaminated with microorganisms
*disturbances to host defences allows ascending infection
*microbes have virulence factors to overcome host defences

Question 7

What are virulence factors for E. coli?

Answer 7

*flagella- motility
*aerobactin- Fe acquisition in Fe poor urinary tract
*haemolysin- form pores in target cells
*presence of adhesions on fimbriae and cell surface
(Two types of E. coli- type 1 fimbriae =cystitis, type P fimbriae= pyelonephritis)

Question 8

What are some host defences?

Answer 8

*urine flow- washes out bacteria
*urine osmolarity and pH
*commensal bacteria- lactobacilli

Question 9

What is uncomplicated UTI infection?

Answer 9

*confined to lower tract
*women
*responds to minimal therapy
*urethral trauma usually sex

Question 10

What is complicated UTI infection?

Answer 10

*abnormalities affecting urine flow
*presence of foreign bodies- catheter
*resistant pathogens
*immunosuppression

Question 11

What is a UTI relapse?

Answer 11

Second isolation of ORIGINAL infecting strain following apparent eradication

Question 12

What is a UTI re-infection?

Answer 12

Isolation of new pathogen strain

Question 13

What are risk factors for UTIs?

Answer 13

*pre menopausal- sex, uti history in childhood, antibiotics
*post menopausal- urinary incontinence, factors effecting bladder emptying
*pregnant
*elderly
*diabetes, gout

Question 14

What are symptoms of uncomplicated lower tract infection?

Answer 14

*dysuria- burning and stinging on urination
*increased frequency
*nocturia-need to get up in night frequently
*haematuria-blood in urine

Question 15

What are symptoms of upper tract/ pyelonephritis infection?

Answer 15

*fever, chills, tenderness
*nausea
*haematuria
(Hard to determine between upper and lower based on symptoms)

Question 16

How are UTI’s diagnosed?

Answer 16

*dipstick test for nitrite in urine- pathogens catalyse reduction of nitrate to nitrite (urine must be in bladder for >4 hours)
*test for leukocyte esterase (LE)- esterase released by Leukos when pyuria (puss in urine) present
NB negative nitrite test doesn’t mean no UTI- need to test LE
*in under 65’s- 2 or more symptoms plus positive dipstick nitrite test

Question 17

When is pyelonephritis common?

Answer 17

Asymptomatic bacteriuria in pregnant women
Failure to treat= premature labour

Question 18

What is first line treatment of acute uncomplicated lower UTI?

Answer 18

Ibuprofen 400mg one three times daily for 3 days
Antibiotic- nitrofurantonin 100mg MR tabs twice daily
Or
Trimethoprim 200mg twice daily for 3 days

Question 19

What are reserved 2nd line treatments for acute uncomplicated lower UTI?

Answer 19

Amoxicillin
Co-amoxiclav
Pivemecillinam

Question 20

How is acute upper pyelonephritis treated?

Answer 20

Non pregnant- 7 day course of ciprofloxacin or 14 day course of co-amoxiclav

Question 21

How are recurrent UTI’s treated?

Answer 21

Relapse- search for cause. Oral antibiotics for 4-6 weeks or long term
Reinfection- low dose prophylaxis of trimethoprim 100mg or nitrofuratonin 50mg for 6-12 months

Question 22

What are tips for prophylaxis of UTI’s?

Answer 22

*2.5L water daily
*avoid constipation
*cranberry juice
*paracetamol/ibuprofen for pain
*urinate at bedtime and after sex

Question 23

What condition does asymptomatic bacteriruia have a much higher chance of causing in pregnant women?

Answer 23

Pyelonephritis

Question 24

Above what age do children usually present classical symptoms of UTI?

Answer 24

2