Urinary Tract Infections

Question 1

inflammation of upper urinary tract is called

Answer 1

pylenephritis

Question 2

inflammation of lower urinary tract is called

Answer 2

cystitis

Question 3

risk factors for uncomplicated UTIs

Answer 3

females
those with previous UTIs
sexual activity
vaginal infection
diabetes
obesity
genetic susceptibility
older age

Question 4

why are diabetics more susceptible to UTIs

Answer 4

sugar in urine which good for bug growth

Question 5

who is at risk of complicated UTIs

Answer 5

those with compromised urinary tract or host defence such as
urinary obstruction
urinary retention
immunosuppression
renal failure
renal transplant
pregnancy
presence of foreign bodies
antibiotic exposure
indwelling catheters

Question 6

what is the most common cause of secondary bloodstream infection

Answer 6

complicated UTI

Question 7

most common organism to cause UTI

Answer 7

uropathogenic e.coli (UPEC)

Question 8

why is kidney infection likely to lead to blood infection

Answer 8

kidneys are very vascular

Question 9

steps of UTI infection

Answer 9

1. contamination of the periurethral area with uropathogen from the gut
2. colonisation of the urethea and migration to the bladder
   3a. colonisation and invasion of the bladder. mediated by pili and adhesins
   3b. inflammatory response in the bladder and fibrinogen accumulation in the catheter
3. neutrophil infiltration
4. bacterial multiplication and immune system subversion
5. biofilm formation
6. epithelial damage by bacterial toxins and proteases
7. ascension to the kidneys
8. colonisation of the kidneys
9. host tissue damage by bacterial toxins
10. bacteraemia

Question 10

what are the bacterial virulence factors

Answer 10

adherence - pili and adhesins
toxin production
immune evasion
iron aquisition
other - e.g. flagella

Question 11

why do bacteria require pili and adhesins to colonise a bladder

Answer 11

to resist flushing out when someone urinates

Question 12

what host defences do humans have to avoid

Answer 12

low pH of urine
high urea conc. of urine
urine flow and micturition
urinary tract mucosa
urinary inhibitors of bacterial adherence
inflammatory response

Question 13

where do pathogens come from to cause UTIs

Answer 13

uropathogen from gut
intracellular bacterial communities/quiescent intracellular reseviors
haematogenous - rrare

Question 14

where can the infection go from a UTI

Answer 14

bacteraemia
perinephric abscesses
remote deep seated infection (e.g. spinal) - rare

Question 15

presentation of pyelonephritis

Answer 15

loin pain/flank tenderness
fever/rigors
sepsis

Question 16

presentatio of cystitis

Answer 16

dysuria
frequency
urgency
suprapubic tendernesa

Question 17

what is dysuria

Answer 17

pain or burning sensation when urinating

Question 18

when is dipstick useful

Answer 18

in <65s
in presence of clinical UTI symptoms

Question 19

what % of older people have bacteria in urine which is not harmful

Answer 19

50%
100% if long term urinary catheter

Question 20

when is asymptomatic bacteriuria treated

Answer 20

in pregnancy

Question 21

what type of bacturia is a UTI

Answer 21

symptomatic
(signifcant but asymptomatic isn’t)

Question 22

purpose of Abx in cystitis

Answer 22

improving and shortening symptom duration

Question 23

how does UTI treatment differ if the prostate is involved

Answer 23

longer treatment required and specfic Abx to penetrate prostate

Question 24

what needs to be consider in children with UTI

Answer 24

vesicoureteric reflux
needs corrected to avoid need for dialysis

Question 25

risk factors for recurrent UTI

Answer 25

women
antibiotic use