urinary tract infections

Question 1

cystitis

Answer 1

infection of the bladder mucosa

low urinary tract infection

Question 2

pyelonephritis

Answer 2

infection of the parenchyma and collecting system of the kidney (upper urinary tract infection

Question 3

asymptomatic bacteriuria

Answer 3

significant bacteriuria present in the urine with no symptoms
bacteria present in the urine in significant numbers without signs or symptoms of UTI
presence of the same organism in counts of >10^8/L in two consecutive samples

Question 4

cytistis and pyelonephritis may

Answer 4

coexist
may need cystitis before getting pyelonephritis
may also have sunclinical pylonephritis

Question 5

asymptomatic bacteriuria usually seen in

Answer 5

children, pregnant and the elderly

Question 6

asymptomatic bacteriuria defined by

Answer 6

presence of the same organism in counts of >10^8 /L in two consecutive samples

Question 7

uncomplicated urinary tract infection

Answer 7

infection of bladder or kidney occurring in a normal host without structural or functional abnormality of the urinary tract

Question 8

complicated urinary tract infection

Answer 8

infection associated with factors increasing colonisation and decreasing efficacy of therapy
- anatomic or functional abnormality of urinary tract
- immunocompromised host
- multi-drug resistant bacteria
more severe, is diffucult to treat and recurrent

Question 9

burden of UTI

Answer 9

common 
common HAI
most are catheter related 
more hospitalisations in 
- remote areas 
- lower socioeconomic standing 
- aboriginal and Torres straight islanders

Question 10

UTI risk factors

Answer 10

• very young or very elderly
• female
• pregnancy
• sexual activity
• spermicides
• menopause

Question 11

UTI in children

Answer 11

associated with a high incidence of urinary tract abnormalities

• vesoci-uriteric reflux
• ureteral duplication
• trabeculated bladder
• hydrometer
• uretopelvic junction obstruction

Question 12

vesico-ureteric reflux

Answer 12

abnormalities in the way that the ureter inserts into the bladder
when the bladder contracts some urine flows backward into the ureter and toward the kidney

Question 13

consequences of vesico-ureteric reflux

Answer 13

reflux nephropathy

leads to renal scarring which causes hypertension and renal failure

Question 14

consequences of UTI

Answer 14

also result in hypertension and renal failure

Question 15

UTI and vesicle-ureteric reflux

Answer 15

severely increased likelihood of reflux nephropathy and renal scarring leading to hypertension and renal failure

Question 16

treatment of VUR

Answer 16

urinary tract abnormalities such as VUR may require surgical correction
children experiencing urinary tract infection should have their urinary tract evaluated by radiological imaging

Question 17

UTi in pregancy

Answer 17

asymptomatic bacteriuria (especially recurrent) is more common in pregnancy - making cystitis more likely and pyelonephritis 
pyelonephritis has adverse pregnancy outcomes incr]luing maternal morbidity and preterm birth

Question 18

adverse pregnancy outcomes in asymptomatic bacteriuria

Answer 18

preterm birth
low birth weight
perinatal mortality

Question 19

screening for ASB

Answer 19

pregnant women should be screening for ASB at least once in pregnancy
treatment with antibiotics

Question 20

most UTIs result from

Answer 20

ascending infection

Question 21

other cause of UTI

Answer 21

haematogenous seeding of the kidneys may occur when a patient is bacteraemic with organisms such as S aureus and candida - rare with gram negative enteric bacteria

Question 22

most bacteria causing UTIs originate in

Answer 22

the bowel 
colonise the lower vagina and periurethral mucosa 
colonise the distal urethra 
ascend the urethra into the bladder 
up the ureters into the renal parenchyma

Question 23

causative bacteria of UTI

Answer 23

most UTIs caused by a few serotypes of E coli - uropathogenic clones
selected from the colonic flora by virulence factors that enhance adhesion and invasion of the urinary tract
vary according to clinical and epidemiological setting
most are due to bacteria originating from the host’s colonic flora

Question 24

community acquired UTI

Answer 24

• e coli most common

- staph saprophiticus is common in young adult females

Question 25

less common causes of community acquired urinary tract infection

Answer 25

``` proteus klebsiella enterbacter serratia morganella citrobacter pseudomonas auruginosa enterococcus ```

Question 26

hospital acquired

Answer 26

rapid colonisation of the resident microflora debilitated host urinary tract intramentalisation - catheterisation indwelling urinary catheters universally become colonised by bacteria hospital bacteria generally quite resistant to antibiotics

Question 27

clinical features of cystitis

Answer 27

dysuria - painful passage of urine frequency - passing urine more often urgency - need to pass urine, although bladder may be empty suprapubic heaviness or tenderness urine Is turbos and may be bloody, may smell offensive fever usually absent, if lower UTI only

Question 28

acute pyelonephritis

Answer 28

flank or back pain fever, chills, riggers suggest bacteraemia headache, nausea, vomititng, prostration often with dysuria, freuqnecu, urgency

Question 29

atypical presentations of UTI

Answer 29

infants, children - fever, nausea, vomiting, abdominal pain elderly - bacteraemia and shock sublcinctal pyelonephritis - seen in some women, dysuria, bacteria, with minimal or no symptoms of pyelonephritis, yet upper tract infection is present

Question 30

types of urine specimens

Answer 30

- MSU - midstream urine - suprapubic aspirate - unlikely to be contaminated - needle goes into the full bladder - CSU - sample collected through catheter - bag urine - very easily contaminated

Question 31

CSU urine specimens

Answer 31

in-out - don't get colonised by bacteria | indwelling catheters - get colonised always, sample collected from this is meaningless

Question 32

urine microscopy

Answer 32

- cells and other components of the urine are assessed by the lab - white cells (<10/ul) - red cells - squamous epithelial cells elevated WCC in urine = pyuria

Question 33

red cell count in urine

Answer 33

red cells got into the urine from sources of bleeding in the urinary tract - calculi, inflammation, tumours, infection) or from being extruded through damaged glomeruli extruded red cells have bizarre morphologies which can be recognised using phase contract microscopy reported glomerular red cells, presence indicated further investigations of the kidney are indicated

Question 34

squamous epithelial cells

Answer 34

originate outside the urinary tract presence indicates contamination may be expressed semiquantitatively , or quantitatively

Question 35

other things reported on microscopies

Answer 35

- crystals - casts - have been formed within a glomerulus and take on the shape of the golmerulus, protenacioous or cellular, may indicate glomerular nephritis - bacteria - yeasts, usually indicate contamination from vagina

Question 36

qualitative culture

Answer 36

specimen processed in such a way that the number of bacterial colonised growing on the agar medium can be extrapolated back to indicate the number of bacteria per unit volume of original specimen expressed on the report as per ml or per microlitre

Question 37

kass criterion

Answer 37

studies done determined that significant bacteriuria was defined by the presence of a single species of bacterium in the urine at a concentration of >10^2/ml in females >10^3/ml in males

Question 38

when more that one microorganisms is cultured from urine, it is more likely to indicate

Answer 38

contamination

Question 39

antibiotic treatment of UTI

Answer 39

- amoxycillin - augmentin - cephalexin - nitrofurantoin - trimethoprim - norfloxacin

Question 40

lab testing is important if

Answer 40

- recent overseas travel - recent antibiotic use - aged care facility

Question 41

measures to prevent UTIs

Answer 41

- extra fluid intake - frequent bladder emptying - bladder emptying after intercourse - wipe front to back - oestrogen cream for elderly women - shower rather than bath - prophylactic antibiotics

Question 42

problems with prophylactic antibiotics

Answer 42

selection of resistant bacteria | antibiotic side effects

Question 43

cranberry juice

Answer 43

some adhesion factors that uroeethogenic e coli use can be inhibited by components of cranberry juice

Question 44

probiotics

Answer 44

not well studied for prevention of UTIs