Urinary tract infections

Question 1

what are the main sites of GU infection?

Answer 1

• blood borne - renal parenchyma
• ureter
• uretero-vesicular junction
• bladder
• urethra

Question 2

definition: upper urinary tract

Answer 2

above vesicoureteral valves

Question 3

definition: lower urinary tract

Answer 3

below vesicoureteral valves

Question 4

definition: complicated urinary tract infection

Answer 4

involvement of tissue structures, with instruments or co-morbidities

Question 5

definition: uncomplicated urinary tract infection

Answer 5

local effects only OR upper tract without co-morbidities

Question 6

pyelonephritis

Answer 6

kidney, calyces, pelvis

Question 7

definition: recurrence

Answer 7

3 or more UTIs per year

Question 8

definition: relapse

Answer 8

recurrence in a month with same organism

Question 9

definition: reinfection

Answer 9

relapse over a month, usually a different organism

Question 10

what are the main causative organisms of symptomatic UTIs?

Answer 10

e. coli (80%)
s. saprophyticus (15%)
other gram negative (5%)

Question 11

why is it important to know the epithelial cell : WBC ratio?

Answer 11

epithelium of urethra will contaminate early parts of the specimen

if specimen is reported as ratio of epi : WBCs roughly equal to WBCs then there is a possible contamination (especially if it is a dirty collection)

Question 12

what are the important things to look at in a urinalysis report?

Answer 12

WBC
RBC
epithelial cells
bacteria

Question 13

what does lactate measure?

Answer 13

tissue hypoperfusion

Question 14

is pyelonephritis a tissue infection or space infection?

Answer 14

tissue

Question 15

what should you avoid doing in a patient with pyelonephritis?

Answer 15

catheter

Question 16

pyelonephritis + stone should be checked for what major complication?

Answer 16

intraabdominal abscess

Question 17

chlamydia UTI: treatment

Answer 17

ceftriaxone, azithromycin

Question 18

what are the common infectious causes of urethritis?

Answer 18

e. coli 
chlamydia 
gonorrhea 
herpes 
trichomatis 
yeast

Question 19

signs / symptoms of cystitis

Answer 19

• over 10^5 CFUs with symptoms: pain, frequency
• usually afebrile
• UA shows many WBCs with few epis
• UA may show nitrites, leukocyte esterase