Urinary Tract Infections

Question 1

What is the most common cause of UTIs?

Answer 1

Bacterial

Question 2

What is pyuria?

Answer 2

Increased WBCs in urine

Inflammation which may or may not be associated with infection

Question 3

What is the most common route of infection?

Answer 3

Ascending

Question 4

What are most uropathogens derived from?

Answer 4

Faecal flora - coliforms

Question 5

What is the most common bacterial isolate in dogs and cats with UTIs?

Answer 5

E. Coli

Question 6

What is the most common bacterial isolate in cows and horses?

Answer 6

Corynebacterium sp

Question 7

What is the most important bacterial isolate in UTIs in pigs?

Answer 7

Uropathogenic MDR E. coli

Question 8

How can uropathogenic bacteria exist in the urinary tract?

Answer 8

Planktonic - free in urine

Biofilm - polysaccaride and water matrix

Intracellular communities - can invade cells

Question 9

What are some risk factors for UTI development?

Answer 9

Female 
Older
Anatomical/physiological LUT abnormality 
Incontinence 
Urolithiasis 
CKD 
Iatrogenic 
Immunosuppression 
Antibiotics
Inflammation

Question 10

What clinical signs are associated with LUTI?

Answer 10

Pollakiuria 
Stanguria/dysuria 
Haematuria
Inappropriate urination
Overgrooming genitalia esp. cats

Question 11

What clinical signs are associated with UUTI?

Answer 11

Renal/lumbar pain
PU/PD
Haematuria
Fever/sepsis

Question 12

How can you definitively diagnose a UTI ?

Answer 12

Urinalysis

Quantitative culture of urine

Question 13

How should you collect urine for bacteriology?

Answer 13

CYSTO

No antibiotics 5-7 days before sampling

Question 14

What are the facets of urinalysis?

Answer 14

Sediment examination
SG
Dipstick

Question 15

What information can be obtained from quantitative culture?

Answer 15

Number of colony forming units determined

Question 16

What is the fastest way of determining bacterial load in urine?

Answer 16

Point of care tests

Question 17

What do you determine from antimicrobial susceptibility testing?

Answer 17

Minimum inhibitory concentration of antimicrobial

Clinical breakpoint

Question 18

How can you classify the different types of bacterial UTI?

Answer 18

Sporadic bacterial cystitis 
Recurrent bacterial cystitis 
Upper UTIs
Bacterial prostatitis 
Subclinical bacteriuria

Question 19

Compare the incidence of sporadic bacterial cystitis in dogs and cats.

Answer 19

Common in dogs, rarer in cats

Question 20

What clinical presentation is associated with sporadic bacterial cystitis?

Answer 20

No more than 3 episodes per year
Patient otherwise healthy
(NOT entire male dog)

Question 21

How would you treat sporadic bacterial cystitis?

Answer 21

NSAIDs to reduce inflammation
Empirical - Amoxy clavulante
Change post sensitivity
— if results available within 24h, wait until sens to treat

3-5d antibiotics based on sensitivity

Question 22

What is the difference between sporadic and recurrent bacterial cystitis?

Answer 22

Recurrent - more than three episodes per year or more than two in 6 months

Question 23

How would you approach work up for recurrent Bacterial cystitis?

Answer 23

Find underlying cause

Further diagnostics
- urine c+s
US, Rads, cystoscopy
Review previous Abs

Question 24

How should you treat recurrent bacterial cystitis?

Answer 24

As for sporadic
Address causal factors
FOLLOW UP CULTURE 5-7d post Abs

Question 25

What comorbidities are associated with recurrent bacterial cystitis?

Answer 25

``` Endocrinopathies Renal disease Obesity Abnormal vulvar conformation Congenital UT abnormalities Urinary retention Urinary incontinence Prostatic dz Polyploid cystitis Urolithiasis Immunosuppressive therapy Rectal fistula ```

Question 26

What would you consider in an entire male with a UTI?

Answer 26

Bacterial prostatitis

Question 27

What drug can penetrate the drug prostate barrier?

Answer 27

Fluoroquinolones

Question 28

Is antibiotic therapy indicated in subclinical bacteriuria

Answer 28

NO

Question 29

How do most diuretics act?

Answer 29

Inhibit sodium chloride reabsorption to increase salt and water excretion

Question 30

Name a loop diuretic

Answer 30

FUROSEMIDE

Question 31

Why might IV Furosemide be good for acute pulmonary oedema?

Answer 31

Has a pulmonary venodilator action when given IV

Question 32

How does Furosemide reach the loop of Henle?

Answer 32

PCT secretion

Question 33

Where do thiazides diuretics act?

Answer 33

Early DCT

Question 34

Name a potassium sparing diuretic

Answer 34

Spironolactone - competitive antagonist of aldosterone - prevents potassium excretion

Question 35

What is a potential adverse effect associated with spironolactone?

Answer 35

Hyperkalaemia Less of a risk because competitive with aldoserone Hyponatraemia

Question 36

What is and adverse effect associated with Furosemide ?

Answer 36

Hypokalaemia Hypochloraemic metabolic acidosis Hyponatraemia

Question 37

What adverse effect is associated with thiazides?

Answer 37

Hypomagnesaemia Hypochloraemic metabolic acidosis Hyponatraemia

Question 38

What drugs are diuretics synergistic with?

Answer 38

Vasodilators — need to reduce dose once congestion resolves

Question 39

What is the effect of NSAIDs on salts?

Answer 39

Exacerbate salt and water retention as PGs are natriuretic (salt losing)

Question 40

Describe the course of action of loop diuretics

Answer 40

Most effective but short acting