UTI

Question 1

Anatomical Feature Affected During a Lower UTI?

Answer 1

Urethra

Bladder

Question 2

Anatomical Features Affected During an Upper UTI

Answer 2

Ureters

Kidneys

Question 3

Bacterial infections may occur anywhere within the urinary tract, these can include:?

Answer 3

Urethritis - infection of the urethra.
Cystitis - infection of the bladder.
Ureteritis - infection of the ureters.
Pyelonephritis - infection of the kidney.

Question 4

The most common organisms associated with UTI’s are:

Answer 4

E.coli, which are responsible for up to 80% of UTI’s.

Proteus mirabilis, also associated with the formation of kidney stones.

Klebsiella spp, not seen as frequently as E.coli but still a problem.

Staphylococcus epidermidis, which are the second leading cause particularly in sexually active young women.

Question 5

Risk Factors associated with UTI include:

Answer 5

Gender – women.

Sexual Intercourse.

Immunocompromised patients (inc diabetes).

Old age.

Question 6

Kidney and Ureter Defects?

Answer 6

Ectopia – Kidneys are in the wrong place
Malrotation – Kidneys in the wrong position
Kidney agenesis – A missing kidney
Polycystic Kidney Disease – Kidney contains cysts.
Formation of extra ureters
Narrowing or widening of the ureters or reflux.

Question 7

Bladder and Urethra Defects

Answer 7

Exstrophy – Bladder does not close completely, opens out onto the surface of the abdomen. Surgically repaired but not “normal”
Diverticula – Outpouches developing in the bladder wall.
Bladder outlet may be narrowed or urethra compromised – bladder does not empty completely.
Abnormal urethra or the urethra could be missing.
Urethral valves – block or partially block the flow of urine.

Question 8

There are a number of risk factors associated with kidney stones. These include:

Answer 8

Medication - many medications including some antibiotics and diuretics can predispose patients to kidney stones.
Not drink sufficient fluids - insufficient intake of fluids can predispose a patient to kidney stones.
Medical conditions that affect the urine - infections particularly with proteus mirabilis cause the urine to become more alkaline, if left untreated crystals can form and these will lead to kidney stone formation.

Question 9

So how do we get rid of kidney stones?

Answer 9

These will pass through the whole urinary system, until they are passed out of the patient.
This is a very painful process and can result in renal colic.
If kidney stones become lodged in the urinary system, ultra sound can be used to break the stone into smaller pieces, so it can pass through the urinary tract easier.

Question 10

symptoms of lower uti

Answer 10

Dysuria - pain during urination.
Frequency - needing to urinate more often.
Suprapubic tenderness - pain in the suprapubic area.
Urgency - when you need to go, you need to go.
Polyuria - more urine produced and needing to urinate more often.
Haematuria - blood in the urine.

Question 11

symptoms of upper UTI

Answer 11

All the symptoms of a lower UTI plus.
Loin pain - pain either side of the backbone between the hip bone and the ribs.
Possible fever - an increased temperature.

Question 12

Portsmouth guidelines for UTI treatment?

Answer 12

Women (without fever or flank pain)
Severe or >= 3 symptoms - treat.
Mild, <3 symptoms or non-turbid urine - perform a dipstick, don’t treat unless other risk factors.

Men, Children and Pregnant Women
More complex - further investigations required (laboratory analysis).

Question 13

what additional advise for UTI?

for alleviating symptoms

Answer 13

increasing fluid levels to flush the microbes

analgesia for the pain

when they see blood or symptoms does not improve- she needs to see her GP.

check for interactions before prescribing urine alkalizer like cranberry juice

Question 14

The urine dipstick results indicated:

Answer 14

+++ nitrites
++ leucocyte esterase
Scanty blood

Question 15

Nitrites
Detects nitrites within the urine
Indicates urinary tract infection caused by _________organisms. The Bacteria will convert endogenous nitrates to ________. However false negative results can be obtained if the bacteria are unable to reduce nitrates to nitrites. Example of bacteria that are unable to do this are, _________, _________ and _____________.

Answer 15

Nitrites
Detects nitrites within the urine
Indicates urinary tract infection caused by Gram negative organisms. The Bacteria will convert endogenous nitrates to nitrites. However false negative results can be obtained if the bacteria are unable to reduce nitrates to nitrites. Example of bacteria that are unable to do this are, Enterococci spp, Staphylococci spp and Acinetobacter.

Question 16

Nitrite positive, and leucocyte esterase positive or negative means __________

Answer 16

80-90% will have a UTI.

Question 17

Nitrite negative and leucocyte positive means ________

Answer 17

50% will have a UTI

Question 18

Nitrite negative and leucocyte negative__________

Answer 18

<20% will have a UTI.

Question 19

which formulation is appropriate?

Answer 19

oral

Question 20

which drug is used?

Answer 20

Trimethoprim

Nitrofurantoin

Question 21

how long for the treatment?

Answer 21

3 days for lower UTI

Question 22

advise to stop getting infected?

Answer 22

wipe from front to back to avoid contamination

wear more dresses and skirts also cotton materials to allow the area to breath

use unperfumed soap, no body bath

urinate after sex

Question 23

for upper UTI So when should we consider admitting a patient to hospital?

Answer 23

If they are significantly dehydrated - in the hospital environment we are able to replace the fluid, helping the patient to recover .
If significant systemic signs are present - this could indicate that the UTI has advanced to sepsis. Systemic signs can include high or low temperature, marked signs of illness and tachycardia, hypotension or breathlessness.
If the patient is pregnant and they are showing any of the symptoms above.
If the patient is frail - becoming dehydrated in these cases can be very problematic.
If the patient has pyelonephritis and is not responding to oral antibiotics within 24 hours. We do not expect the patients symptoms to have completely resolved, however no improvement could suggest that this infection has advanced and parenteral therapy may be required.
If the patient is immunocompromised, as they may require parenteral therapy due to their impaired immune response.
If the patient has a foreign body or an abnormality of the urinary tract, as this will complicate their infection significantly.
If the patient has renal impairment.

Question 24

what is the sensitivity for L proteus mirabilis

amoxicillin-

cafalexin -

nitrofurantoin -

trimethoprim -

ceftazidime -

ciprofloxacin -

Answer 24

amoxicillin-resistant

cafalexin - sensitive

nitrofurantoin - sensitive

trimethoprim - resistant.

ceftazidime - sensitive

ciprofloxacin - sensitive

Question 25

how long for treatment of upper UTI?

Answer 25

7-10 days

Question 26

what does recurrent pyelonephritis cause?

Answer 26

chronic renal damage.

Question 27

what happens when patient have very severe infection?

Answer 27

sepsis

symptoms are

low blood pressure, tachycardia, hypotension, high respiratory rate, high temperature