Urinary tract infections (R1)

Question 1

Clinical physiology
- Is the urine generally sterile?
- What are the 3 categories of normal defences against UTI’s?

Answer 1

Yes
Mechanical, chemical, commensals

Question 2

Clinica physiology
- 2 examples of mechanical defences against UTIs

Answer 2

Flow of urine –> flushes out bacteria and prevents adherence
Vesicoureteral junction –> one way valve

Question 3

Clinical physiology
- 3 examples of chemical defences?
- 2 types of commensal bacteria?

Answer 3

Chemical: low pH, high urea, low osmolarity (few nutrients for growth)
Commensals: streptococci, lactobacilli

Question 4

Aetiology
- Acronym for bacteria causing UTI’s?

Answer 4

SEEEK PP

Question 5

Aetiology
- SEEEK PP bacteria?
- Which ones are gram positive/negative?

Answer 5

Staphylococcus saphrophyticus +
E coli -
Enterococcus +
Enterobacter -
Klebsiella -
Proteus -
Pseudomonas -

Question 6

Aetiology
- Which bacteria is most common; second most common?
- Which bacteria affects young, sexually active women?
- Which bacteria can cause stones?
- Are all of these bacteria normal residents of the bowel?

Answer 6

• E coli > staphylococcus saphrophyticus
• S. saphrophyticus
• Proteus
• Yes: can make it into urinary tract by forwards wiping

Question 7

Aetiology
- Examples of viral UTIs?
- Risk factors?

Answer 7

Adenovirus, CMV, BK polyomavirus
More common in children and immunocompromised individuals

Question 8

Aetiology
- Examples of fungal UTI’s
- Risk factors?

Answer 8

Candida > cryptococcus

Hospitalisation + cathethers
Prolonged antibiotics
Diabetics

Question 9

Applied biomedical sciences
- Upper versus lower UTI’s?

Answer 9

Upper UTI’s affect the kidneys
- Pyelonephritis

Lower UTI’s affect below the kidneys
- Ureter: ureteritis
- Prostate: prostatitis
- Bladder: cystitis
- Urethra: urethritis

Question 10

Applied biomedical sciences
- Do UTI’s tend to be caused by ascending or descending infections?

Answer 10

Much more common ascending

Question 11

Complications
- Of lower UTI?
- Of upper UTI?
- Of proteus infections?
- Of antibiotic use?
- Of infection in pregnancy?

Answer 11

Lower UTI: may ascend to become upper UTI
Upper UTI: sepsis, abscess, scarring of kidney –> CKD
Proteus: stones
Antibiotics: resistance
Pregnancy: prematurity, low birth weight

Question 12

Prevention
- Behavioural?

Answer 12

Prevent stasis: drink fluids often, empty bladder often
Wipe from front to back
Pee after sex

Question 13

Risk factors?

Answer 13

Question 14

History?

Answer 14

• Pain (suprapubic, flank; itis positive)
• Haematuria
• Irritative symptoms: dysuria, FUN (frequency, urgency, nocturia)
• Pyelonephritis: N&V, fevers/chills/rigors
• Prostatitis: obstructive symptoms
• Urethritis: smelly urine

Question 15

Exam
- Vital signs
- Abdomen

Answer 15

• Pyelonephritis: fever, possibly sepsis
• Urinary retention: distended abdomen
• Cystitis: suprapubic tenderness
• Renal tenderness: pyelonephritis

Question 16

Investigation
- What test confirms the diagnosis

Answer 16

Urine: FWT and MCS

Question 17

Investigation: FWT results
- SG
- pH
- Leukocytes
- Blood
- Nitrites
- Proteins
- Glucose

Answer 17

SG: may be increased, due to high levels of bacterial proteins
pH: may be increased
Leukocytes: present
Blood: present
Nitrites: present if gram negative bacteria
Proteins: may be present
Glucose: may be present (risk factor)

Question 18

Investigation: MCS
- Is it the gold standard?
- What indicates UTI?
- Additional findings?

Answer 18

> =10^5 CFU/mL indicates UTI
Bacteria, RBC, WBC may be present

Question 19

Investigations
- Additional investigations for those who are sick?

Answer 19

Labs
- FBC: leukocytosis
- CRP: elevated
- Blood cultures: if fever

Imaging
- Ultrasound, CT abdo/pelvis or KUB

Question 20

Principles of management?

Answer 20

• Fluids: IV if septic, drink plenty (flush out bacteria)
• Symptom management: pain (NSAID or phenazopyridine), vomiting
• Antibiotics (empirical –> specific)
• Additional considerations

Question 21

Management: antibiotics
- Considerations before using gentamycin?
- Are antibiotics needed in non pregnant females with asymptomatic bacteriuria?

Answer 21

• Gentamycin is nephrotoxic: check renal function first
• No

Question 22

Acute cystitis: antibiotics

Answer 22

• Oral trimethoprim or nitrofurantoin
• If contraindicated, oral cefalexin

Question 23

Non severe pyelonephritis (none of >=38 degrees, N&V, sepsis): antibiotics

Answer 23

• Oral Augmentin (amoxicillin + clavulanic acid)
• If allergic: oral ciprofloxacin

Question 24

Severe pyelonephritis (atelast one of >=38 degrees, N&V, sepsis): antibiotics

Answer 24

• IV gentamycin + amoxicllin/ampicillin
• If contraindicated: IV cefrtiaxone/cefotaxime

Question 25

Acute prostatitis: antibiotics
- Non severe?
- Severe?

Answer 25

Non severe: oral trimethoprim or cefalexin
Severe: as per severe pyelo (- IV gentamycin + amoxicllin/ampicillin, or IV cefrtiaxone/cefotaxime if contraindicated)

Question 26

Pregnancy: antibiotics
- Acute cystitis
- Pyelonephritis

Answer 26

Cystitis: oral nitrofurantoin or cefalexin
Pyelo: as per severe pyelo (- IV gentamycin + amoxicllin/ampicillin, or IV cefrtiaxone/cefotaxime if contraindicated)

Question 27

Candida infection: antifungal?

Answer 27

Oral fluconazole

Question 28

Additional step for any men with a UTI?

Answer 28

Refer to urology

Question 29

Treating recurrent infections in non pregnant women?

Answer 29

• Treat acute infections with antibiotics
• Educate on prevention strategies
• If post menopausal: offer topical estrogen
• As a last resort: antibiotic prophylaxis - trimethoprim, nitrofurantoin, cefalexin.

Question 30

How would you explain a UTI to a patient?
How would you explain the symptoms?

Answer 30

Draw out urinary tract.
UTI: when bugs grow in your kidneys.

The bacteria irritate the lining of your urinary tract, causing
- Pain at the site (cystitis, pyelonephritis)
- Dysuria, frequency/nocturia and urgency.
- Haematuria: blood to be passed in urine.

Kidney infections can make you generally unwell
- Nausea and vomiting
- Fever + sepsis