Urinary Tract Infections

Question 1

Upper Urinary tract Define

Answer 1

• kidney
• renal pelvis
• ureter

Question 2

Lower Urinary tract define

Answer 2

• bladder

- urethra

Question 3

Urothelium lining

Answer 3

• transitional epithelium in upper tract and bladder

- pseudostratified columnar in membranous and spongy urethra

Question 4

UTI

Answer 4

• inflammatory response of urothelium to bacterial invasion

- inflammatory response causes symptoms

Question 5

UTI prevalence in which age groups

Answer 5

• females >
• elderly >, then reproductive, then school, then infants
• more male infants than female

Question 6

Routes of infection

Answer 6

ASCENDING
- retrograde ascent of bacteria up urethra
- from large bowel colonise perineum and ascend to bladder
- may ascend to kidney via ureter from bladder
HAEMATOGENOUS
- uncommon
LYMPHATICS
- IBD
- retroperitoneal abscess

Question 7

What is the risk of infection ascending to kidney from bladder?

Answer 7

• vesicoureteric reflux

- impaired ureteric peristalsis

Question 8

Define bacteriuria

Answer 8

• presence of bacteria in urine
• may or may not be symptomatic
• if no pyuria but bacteriuria = colonised urine rather than active

Question 9

RF of bacteriuria

Answer 9

• female
• menopause/pregnancy (low oestrogen states)
• age
• diabetes
• in dwelling catheters
• stone disease
• congenital malformation
• voiding dysfunction

Question 10

Define pyuria

Answer 10

• presence of WBC in urine
• implies inflammatory response of urothelium to bacterial infection
• if pyuria but no bacteriuria = carcinoma in site, TB infection, bladder stone

Question 11

Define uncomplicated UTI

Answer 11

• patient structurally and functionally normal urinary tract
• mainly women
• respond quick to AB
• Escherichia coli main cause = 85% community acquired, 50% hospital

Question 12

Other causes of uncomplicated UTI

Answer 12

• staph saprophyticus
• strep faecalis
• proteus
• klebsiella

Question 13

Define complicated UTI

Answer 13

• underlying anatomical/functional abnormality
• longer to respond to AB
• often recur
• E Coli 50%

Question 14

Other causes of complicated UTI

Answer 14

• strep faecalis
• staph aureus
• staph epidermidis
• pseudomonas

Question 15

Types of UTI

Answer 15

ISOLATED
- 6m between infections
RECURRENT
- >2 in 6 months or 3 within 12
- re-infection (by diff. organism)
- persistence (infection by same organism from focus in tract)
UNRESOLVED
- inadequate therapy
- may be due to bacterial resistance

Question 16

Cystitis (symp, investigations, treatment)

Answer 16

• lower UTI
• frequent small volume voids
• urgency
• suprapubic discomfort
• dysuria
• dipstick mid stream urine
• urine microscopy
• further = abdominal X ray, renal US, IV/CT urogram
• uncomplicated = trimethoprim (short course AB)
• complicated = 7-10day course (augmentin and further invest.)

Question 17

Dipstick mid stream urine findings for cystitis

Answer 17

• leucocytes (pyuria indirect testing)

- nitrite (bacteriuria indirect testing)

Question 18

Pyelonephritis (symptoms/signs, invest, microbiology, treatment)

Answer 18

• flank/loin pain
• nausea and vomiting
• fever and chills
• LUTS
• MSU (dipstick and culture)
• bloods (FBC, U&E, cultures)
• AXR, renal USS, CT urogram
• E coli 80%
• less common = enterococci, klebsiella, proteus, pseudomonas
• 10 day oral AB if not systemically unwell
• IV AB admission if systemically unwell

Question 19

Complications of pyelonephritis

Answer 19

• perinephric abscess (in gerota’s fascia) = infection extends outside parenchyma
  RF = diabetes, obstructing calculus
• S. aureus, E coli, proteus
• drainage of collection (open incision or radiologically)
• AB until resolution of infection