Urinary Tract Infection (UTI)

Question 1

What is bacteriuria.

Answer 1

Bacteria in the urine.

Question 2

Is bacteriuria symptomatic.

Answer 2

It may be symptomatic or asymptomatic.

Question 3

What is a UTI.

Answer 3

The presence of a pure growth of >10^5 organisms per mL of fresh MSU.

Question 4

Where does a lower UTI occur. (3)

Answer 4

Urethra (urethritis).
Bladder (cystitis).
Prostate (prostitis).

Question 5

Where do upper UTIs occur.

Answer 5

Renal pelvis (pyelonephritis).

Question 6

What percentage of women with symptoms have negative MSUs. (2)

Answer 6

Up to a third of women with symptoms have negative MSU.

Abacterial cystitis or the urethral syndrome).

Question 7

What are UTIs classified as. (2)

Answer 7

Complicated.

Uncomplicated.

Question 8

What are the characteristics of an uncomplicated UTI. (2)

Answer 8

Normal renal tract and function.

Question 9

What are the characteristics of a complicated UTI. (5)

Answer 9

Abnormal renal/GU tract. 
Voiding difficulty/obstruction. 
Impaired renal function. 
Impaired host defences. 
Virulent organism (eg Staph aureus).

Question 10

What are the risk factors for UTIs. (7)

Answer 10

Female.
Sexual intercourse.
Exposure to spermidice in women.
Pregnancy.
Menopause.
Reduced host defence (immunosuppression, DM).
Urinary tract obstruction (stones, catheter, malformation).

Question 11

What are the characteristics of UTIs in pregnancy. (2)

Answer 11

UTI is common and often asymptomatic, until serious pyelonephritis or premature delivery supervenes.

Question 12

What organisms cause UTIs. (4)

Answer 12

E.coli (75-95% in the community, but >41% in hospitals)
Proteus mirabilis.
Klebsiella pneumonia.
Staphylococcus saprophyticus.

Question 13

What are the symptoms of acute pyelonephritis. (6)

Answer 13

High fever. 
Rigors. 
Vomiting. 
Loin pain and tenderness. 
Oliguria (if AKI).

Question 14

What are the symptoms of cytitis. (5)

Answer 14

Frequency. 
Dysuria. 
Urgency. 
Haematuria. 
Suprapubic pain.

Question 15

What are the symptoms of prostatis. (4)

Answer 15

Flu like symptoms.
Low backache.
Few urinary symptoms.
Swollen or tender prostate on PR.

Question 16

What are the physical signs of UTIs. (5)

Answer 16

Fever. 
Abdominal or loin tenderness. 
Foul-smelling urine. 
Occasionally distended bladder. 
Enlarged prostate.

Question 17

What tests should be carried out in a patient with a UTI. (3)

Answer 17

Urine dipstick.
Send an MSU.
MC and S.

Question 18

When should you always send a lab MSU in UTIs. (5)

Answer 18

Male. 
Child. 
Pregnant. 
Immunosuppressed. 
Ill.

Question 19

What are some causes of sterile pyuria. (10)

Answer 19

Treated UTI

Question 20

What blood tests should be carried out in patients with suspected UTIs. (6)

Answer 20

FBC, UandE, CRP and blood cultures if systemically unwell (urosepsis).
Consider fasting glucose and PSA.

Question 21

What can cause a false positive PSA test.

Answer 21

UTI.

Question 22

What imaging is conducted in a patient with a UTI. (2)

Answer 22

Ultrasound and referral to urology for assessment (CTKUB, cystoscopy, urodynamics).

Question 23

When would you consider imaging techniques in a patient with a UTI. (7)

Answer 23

Children. 
Men. 
Failure to respond to treatment. 
Recurrent UTI (>2/year). 
Pyelonephritis. 
Unusual organism. 
Persistent haematuria.

Question 24

How can UTIs be prevented. (4)

Answer 24

Drink more water.
Antibiotic prophylaxis (continuously or post-coitally).
Self treatment with a single antibiotic dose as symptoms start.
Drinking cranberry juice.

Question 25

What is the treatment for a UTI.

Answer 25

Treat with antibiotics (eg co-amoxiclav).