Urinary Tract Infections

Question 0

Cystitis

Answer 0

Urethral syndrome and bladder infection

Heavy feeling suprapubically that is relieved by peeing

Question 1

Urethral syndrome

Answer 1

Urethral infection only

Severe dysuria and urgency

Question 2

Pyelonephritis

Answer 2

Infection involving kidney parenchyma
Loin pain, fever
Rigours, bacteriaemia

Question 3

Host defences against UTI

Answer 3

Urinary tract normally sterile above distal urethra
Washout dilutes and removes bacteria
IgA and IgG excreted in urine
IgA in urethra

Question 4

Predisposing factors for UTI

Answer 4

Interruption of washout-> catherisation, infrequent emptying, reduced fluid intake, obstruction
Resicouretic reflux-> bladder contracts-> urine goes back up ureter
Neurological problems-> multiple sclerosis-> don’t excrete all their urine
Congenital abnormalities-> horse shoe kidney, congenital uretopelvic obstruction, partial, complete ectopic insertion duplicated urethra
Diabetes
Pregnancy-> retention due to weight of uterus! progesterone induced smooth muscle relaxation

Question 5

Common organisms causing UTI

Answer 5

Ability to bind urothelium
Resistant to serum bactericidal activity
Resistant to urea
Break down mucin-> helps them ascend
E.coli-> hospital and community
P.mirabalis-> community
Klebsiella sp-> hospital
S. Saprophytcus-> community, young women
S.epidmis, enterococci, p. aeruginosa, other-> hospital

Question 6

Symptoms of UTI

Answer 6

Symptoms related to site
Pyelonephritis-> loin pain, fever, dysuria, confusion, not eating
Bladder-> frequency, dysuria
Urethra-> urgency
Young children-> sepsis, irritability, vomiting, failure to thrive

Question 7

Lab diagnosis UTI

Answer 7

Contaminated by commensal bacteria-> isolate pathogens-> clean area, mid steam

Question 8

Microscopy UTI

Answer 8

Pyuria-> white blood cells in urine 
Red cells
Bacteria
Casts-> abnormal structures such as pus
Epithelial cells-> bad sample 
Could be other reasons:
Post surgery 
Catheter-> normal
Fever in children 
Contamination from vagina

Question 9

Culture UTI

Answer 9

Lactose fermenter
Non lactose fermenter
Staph-> DNase, novobiocin resistant
Streptococcus-> aesculin positive, group

Question 10

UTI treatment

Answer 10

Only treat symptomatic people and those most at risk of pyelonephritis and renal damage-> young, pregnant, renal tract abnormalities
Cystitis in young and healthy may resolve with water alone
Increase fluids
Antibiotics:
Simple-> trimethoprim, nitofurantoin 3 days
Complicated -> 10-14
-> recurrent, renal involvement, male, pregnant, abnormalites, urogenital surgery, diabetes, catheter
-> cephalosporins, co-amoxiclav, gentamicin, ciproflaxacin
Prophylaxis in chronic

Question 11

Sepsis

Answer 11

Bodies response to infection 
Fever and shaking cells
Reduced mental altertness
N+v+d
HR>90
Resps >30
High or low white cell count
Altered kidney or liver function
High morality

Question 12

Catheter

Answer 12

1 in 300 morality 
Consider alternative methods
Review regularly 
Smallest gauge catheter
Aseptic procedure 
Closed drainage system 
Obtain samples from sampling pot
Don't change regularly 
Bladder washouts don't prevent infection