Urinary Tract Infection (Lecture)

Question 1

What is the M:F of UTI?

Answer 1

1:3 - M:F

Question 2

What proportion of women are affected by UTI?

Answer 2

30%

Question 3

Why are UTIs in children so serious?

Answer 3

Important cause of CRF

Question 4

What is the incidence of pyelonephritis in women?

Answer 4

3 per 1000/y

Question 5

What is the incidence of symptomatic UTI in men?

Answer 5

5 per 10,000

Question 6

What are the most common hospital acquired infections?

Answer 6

Urinary tract 38%
Surgical wound 22%
LRTI 15%
Blood 5%

Question 7

What factors predispose an individual to UI?

Answer 7

Immunosuppression
Steroids
Malnutrition
Diabetes

Question 8

What urinary-tract specific factors increase the risk of UTI?

Answer 8

Female sex
Sexual intercourse
Poor voiding habits
Congenital abnormalities 
Stasis of urine
Foreign bodies 
Oestrogen deficiency in post-menopausal women
Bladder-bowel fistula

Question 9

What is the most common pathogen in UTI?

Answer 9

E. coli

Question 10

What are the most common gram -ve organisms in UTI?

Answer 10

E. coli
Proteus mirabilis
Klebsiella spp

Question 11

What are the most common gram +ve organisms in UTI?

Answer 11

Coagulase -ve staphylococci (S. saprophyticus)

Enterococci

Question 12

What are the 4 most common organisms in UTI?

Answer 12

E. coli
Proteus
Klebsiella
Entercoccus

Question 13

What are the clinical features of UTI in children?

Answer 13

Diarrhoea 
Excessive crying
Fever
N+V
Not eating

Question 14

What are the clinical features of UTI in adults?

Answer 14

Flank pain
Dysuria 
Cloudy offensive urine
Urgency 
Chills
Strangury
Confusion

Question 15

What are the clinical features of acute pyelonephritis?

Answer 15

Pyrexia
Poor localisation
Loin tenderness
Signs of dehydration
Turbid urine

Question 16

What is turbid urine?

Answer 16

Cloudy/foamy urine which doesn’t disappear with hydration - associated with UTI

Question 17

How is UTI investigated?

Answer 17

MSSU
Urinalysis 
Microscopy
Gram staining
Culture

Question 18

How should recurrent UTIs in children and men be investigated?

Answer 18

USS or IVU
Isotope studies for reflux and scarring
Structural abnormalities, renal calculi, prostate issues

Question 19

How is UTI managed?

Answer 19

Identify infecting organism & treat

Identify/treat disposing factors

Question 20

How is UTI treated?

Answer 20

Fluids

Antibiotics

Question 21

What antibiotics are indicated in UTI?

Answer 21

Amoxicillin
Cephalosporin
Trimethoprim 
3-5d course 
Serious infection:
IV antiB

Question 22

When are UTIs associated with renal damage?

Answer 22

When the patient has recurrent UTIs and an abnormal urinary tract

Question 23

How does reflux nephropathy present?

Answer 23

UTIs in children

Damage caused by reflux and infection

Question 24

How is reflux nephropathy assessed?

Answer 24

Micturating cystogram (99Tc)
USS + biochemistry

Question 25

How is reflux nephropathy managed?

Answer 25

Surgery

Question 26

What advice is given to patients to reduce the likelihood of recurrent UTI?

Answer 26

> 2L fluids/day
Void every 2-3 hours
Void before bed
Void before/after intercourse

Question 27

How can you reduce the risk of UTI when using indwelling catheters?

Answer 27

Aseptic technique
Fluid intake
Antibiotics & replacement if symptomatic

Question 28

What is the treatment for asymptomatic bacteriuria associated with an indwelling catheter?

Answer 28

None

Question 29

What proportion of pregnant women with bacteriuria progress to symptomatic illness?

Answer 29

30%

Question 30

How is bacteriuria defined?

Answer 30

> 10^5

Question 31

When should asymptomatic bacteriuria be treated?

Answer 31

In pregnant women

Question 32

What proportion of patients with chronic pyelonephritis progress to renal failure?

Answer 32

15%