UTI Flashcards
What is the most common pathogen causing urinary tract infections worldwide?
E. coli
Why is UTI more common in females than males?
The female urethra is shorter (1.5 inches) compared to the male urethra (8 inches), allowing easier pathogen access.
What is the most common route of UTI infection?
Ascending route (>95%) where pathogens travel from urethra to bladder, ureter, and kidneys.
Name two pathogens associated with hematogenous UTI infections.
Salmonella typhi and Staphylococcus aureus.
What genetic factor can predispose individuals to recurrent UTIs?
Mutations in innate immune response genes (e.g., Toll-like receptors, IL-8 receptors).
What are two common virulence factors of uropathogenic E. coli?
P fimbriae and Type 1 fimbriae (pili).
How does spermicides contribute to UTI risk?
Spermicides are toxic to normal vaginal flora, allowing pathogenic bacteria to colonize.
What host urinary characteristic helps prevent UTIs?
Urine pH, osmolality, and proteins like Tamm-Horsfall protein.
What is the most common risk factor for recurrent UTIs in premenopausal women?
Frequent sexual intercourse.
Why should pregnant women be screened and treated for asymptomatic bacteriuria (ASB)?
ASB in pregnancy is associated with maternal pyelonephritis, preterm delivery, and low birth weight.
What is the recurrence rate of UTIs in females who have had one episode?
20-30% of females experience recurrent episodes, averaging 2.6 infections per year.
What is the main risk factor for UTI in males with diabetes?
Incomplete voiding due to poor bladder function or obstruction.
What are the three routes of UTI infection?
Ascending routes, hematogenous routes, and lymphatic routes.
What host defenses maintain urinary sterility?
Urinary pH, immunoglobulins, lactoferrin, Tamm-Horsfall protein, and inflammatory cells.
Which age group and gender are most affected by UTIs during the neonatal period?
Male infants due to congenital urinary tract abnormalities.
What factor increases the risk of UTIs in postmenopausal women?
Estrogen depletion leading to a more alkaline vaginal pH.
What are independent risk factors for acute cystitis in females?
Recent use of a diaphragm + spermicide, frequent sexual intercourse, and history of UTIs.
What is the main concern with the use of SGLT2 inhibitors in diabetic patients?
Increased risk of genital and urinary tract infections due to glycosuria.
Why do uncircumcised males have a higher risk of UTI?
E. coli is more likely to colonize the glans and prepuce.
What is the primary microbial factor of E. coli that leads to pyelonephritis?
P fimbriae binding to renal epithelial cells.
How does neurogenic bladder contribute to UTI risk?
Urinary stasis and incomplete bladder emptying provide a focus for bacterial colonization.
What is the recommended frequency of replacing an indwelling foley catheter?
Usually every 2 weeks unless it is obviously dirty.
How does vesicoureteral reflux (VUR) contribute to UTI?
It allows urine backflow from the bladder to the ureter and kidneys, leading to bacterial colonization.
Why are asymptomatic bacteriuria rates higher in diabetic females?
Poor bladder function, obstruction, and impaired cytokine secretion.
What is a major risk factor for UTIs in sexually active females?
Use of spermicide, which increases bacterial binding.
What factors promote UTI colonization in postmenopausal women?
Estrogen depletion and altered vaginal flora with a more alkaline pH.
What is the most common cause of recurrent UTIs within two weeks of treatment?
Relapse due to a sequestered infection focus.
What is the spectrum of clinical syndromes associated with UTIs?
Asymptomatic bacteriuria, cystitis, pyelonephritis, prostatitis, complicated UTI.
What is the key feature of asymptomatic bacteriuria?
No local or systemic symptoms referable to the urinary tract.
What symptoms are typical for cystitis?
Dysuria, urinary frequency, nocturia, hesitancy, suprapubic discomfort, and gross hematuria.
What symptoms differentiate pyelonephritis from cystitis?
Fever, flank pain, costovertebral angle tenderness, nausea, and vomiting.
What complication of pyelonephritis is commonly associated with diabetes mellitus?
Acute papillary necrosis.
What imaging finding characterizes emphysematous pyelonephritis?
Gas in the renal parenchyma on CT scan.
What causes xanthogranulomatous pyelonephritis?
Chronic obstruction (e.g., staghorn calculi) and chronic infection causing suppurative destruction of renal tissue.
What is the treatment for xanthogranulomatous pyelonephritis?
Nephrectomy and antibiotics.
What are the hallmark symptoms of prostatitis?
Dysuria, pelvic or perianal pain, fever, and bladder outlet obstruction.
What differentiates complicated UTI from uncomplicated UTI?
Complicated UTI involves systemic illness, anatomic predisposition, foreign bodies, or factors delaying response to therapy.
What are typical symptoms of lower urinary tract infections?
Dysuria, frequency, urgency, gross hematuria, and hypogastric pain.
What are typical symptoms of upper urinary tract infections?
Fever, chills, flank pain, costovertebral angle tenderness, and nausea.
What is the diagnostic gold standard for confirming a UTI?
Urine culture.
What urine culture threshold is diagnostic of UTI in males?
≥ 10³ CFU/mL.
What are the key findings of a urine dipstick test in uncomplicated cystitis?
Nitrite or leukocyte esterase positivity.
What symptom combination increases the probability of UTI to 96% in women?
Dysuria and urinary frequency without vaginal discharge.
What are the most sensitive and specific diagnostic tests for UTIs?
Suprapubic aspiration (>95% sensitivity and specificity).
What are the causes of false negatives in a nitrite dipstick test?
Dilute urine, frequent voiding, or infection with enzyme-deficient bacteria.
What does a leukocyte esterase test detect?
Enzymes in intact or lysed polymorphonuclear leukocytes.
What are the most common contaminants of urine specimens?
Normal microbial flora of the distal urethra, vagina, and skin.
What UTI-related condition can be misdiagnosed as interstitial cystitis?
Chronic pelvic pain syndrome.
What is the recommended treatment duration for UTI with prostatitis?
At least 14 days, extended to 4-6 weeks if recurrent.
What should be suspected in recurrent UTI in men?
Sequestered focus within the prostate or prostatic calculi.
What factors predispose postmenopausal women to UTIs?
Estrogen depletion, altered vaginal flora, and a more alkaline pH.
What does the presence of bacteriuria without symptoms indicate?
Asymptomatic bacteriuria.
Which group has a higher risk of emphysematous pyelonephritis?
Diabetic patients with urinary obstruction.
What are risk factors for UTIs in men under 50?
Anal intercourse, lack of circumcision, and coitus with colonized partners.
What antibiotics are effective for cyst infections in polycystic kidney disease?
Lipid-soluble drugs like ciprofloxacin and TMP-SMX.
What imaging should be performed in men with first febrile UTI?
CT scan or ultrasound.
What differentiates cystitis from pyelonephritis in clinical presentation?
The presence of fever and flank pain in pyelonephritis.
What are the sensitivity and specificity of urine culture using a clean catch sample?
Sensitivity 90-95%, specificity 80-90%.
Why should pregnant women be screened for asymptomatic bacteriuria?
To reduce the risk of pyelonephritis, preterm delivery, and low birth weight.
What is the role of nitrite in diagnosing UTI?
Nitrite indicates Enterobacteriaceae that convert nitrate to nitrite.
What test is most sensitive for diagnosing bacteriuria in pregnant women?
Urine culture.
What is the typical treatment for complicated UTI?
Broad-spectrum antibiotics addressing systemic illness and underlying causes.
Which conditions can mimic UTI symptoms in females under 25?
Cervicitis (C. trachomatis, N. gonorrhoeae), vaginitis, and herpetic urethritis.
What is the sensitivity of pyuria for UTI?
30-80%, but it has poor correlation with bacteriuria.
What is the clinical significance of hematuria in UTI?
Hematuria is present in 30% of cystitis cases and suggests UTI if symptomatic.
What are indications for imaging in recurrent UTI?
Suspected obstruction or anatomic abnormalities.
What is the threshold for diagnosing UTI in women using culture growth?
≥ 10² CFU/mL in symptomatic cases.
What is the most common pathogen causing UTIs in the outpatient setting?
Escherichia coli (90%)
Which pathogen commonly causes UTIs in sexually active, reproductive-aged women?
Staphylococcus saprophyticus
What percentage of UTIs are monomicrobial?
0.95
What causes polymicrobial UTIs?
Catheter-associated infections or infections involving foreign bodies like stones.
Name two pathogens that cause uncomplicated UTIs.
Escherichia coli and Staphylococcus saprophyticus
Name two pathogens that cause complicated UTIs.
Pseudomonas aeruginosa and Enterococcus faecalis
What is the gold standard for diagnosing UTI?
≥ 10^5 CFU/mL in urine culture
What bacterial count is diagnostic of UTI in symptomatic patients?
≥ 10^2 CFU/mL
What bacterial count is diagnostic of UTI in men?
≥ 10^3 CFU/mL
What is the most common clinical presentation of UTI?
Acute uncomplicated cystitis
What is the first step in managing infectious disease?
Identify the site(s) of infection
What diagnostic tests are NOT recommended for acute uncomplicated cystitis (AUC) according to the Philippine guidelines?
Pretreatment urine culture, standard urinalysis, and dipstick leukocyte esterase/nitrite tests
What is the recommended approach for AUC management?
Empiric antibiotic treatment based on history and physical exam
Name two oral antibiotics suggested for AUC according to the 2023 Philippine CPG.
Fosfomycin and nitrofurantoin
What antibiotic class is suggested for acute uncomplicated pyelonephritis (AUP)?
Fluoroquinolones
Name one preventive measure for women with recurrent UTI.
Cranberry products
Why are catheter-associated UTIs (CAUTI) common?
Biofilm formation on the catheter surface
What is the most effective way to prevent CAUTI?
Avoid catheterization, ensure sterile insertion, and promptly remove catheters.
What is the most common cause of complicated UTI?
Catheter-associated urinary tract infection (CAUTI)
What are three prophylactic strategies for preventing recurrent UTI?
Continuous prophylaxis (>6 months), post-coital prophylaxis, and patient-initiated therapy
What is the most common pathogen in urinary candidiasis?
Candida non-albicans
Which patients are at higher risk of urinary candidiasis?
Patients with diabetes, indwelling catheters, or prolonged corticosteroid/broad-spectrum antibiotic use
What is the first-line treatment for Candida albicans in urinary candidiasis?
Fluconazole 200-400 mg/day for 1-2 weeks
What treatment is recommended for persistent candiduria caused by Candida glabrata or Candida krusei?
Low-dose amphotericin B + flucytosine for 14 days
What are the most common complications of genitourinary TB (GUTB)?
Ureteral strictures, hydronephrosis, and renal damage
What diagnostic test can confirm GUTB in 90% of cases?
Urine culture with 3 morning specimens
What are the key symptoms of genitourinary TB?
Urinary frequency, dysuria, nocturia, hematuria, and flank/abdominal pain
What is the most sensitive test for diagnosing bacteriuria in pregnant women?
Urine culture
What are the diagnostic thresholds for UTI based on bacterial count in catheterized patients?
> 10^3 CFU/mL
What are non-antimicrobial preventive measures for UTI?
Lactobacillus probiotics and cranberry products
What structural abnormalities can cause complicated UTI?
Vesicoureteral reflux, bladder diverticuli, and prostate hypertrophy
What imaging finding is characteristic of GUTB on IV pyelogram?
Rosary bead appearance
What is the recommended treatment regimen for GUTB?
2 months of HRZE followed by 4 months of HR
What is the most common complication of indwelling urinary devices?
Biofilm formation leading to infection
What is the key feature of small renal abscesses (<5 cm) management?
Prolonged antimicrobial therapy without drainage
How should a large renal or perinephric abscess be managed?
Drainage combined with antimicrobial therapy
Why is antimicrobial resistance monitoring important for UTI management?
Empiric treatment must be adjusted based on resistance patterns.
Why is asymptomatic bacteriuria (ASB) usually not treated?
Treatment does not decrease recurrence frequency, except in pregnancy or urologic procedures.
What is the threshold for significant pyuria in microscopic analysis?
≥ 10 WBCs per high-power field
What causes recurrent UTI in patients with spinal cord injuries?
Pyuria, significant bacteriuria, and incomplete bladder emptying
Why are nitrite tests less sensitive in frequent voiding?
Insufficient time for nitrate-to-nitrite conversion in the bladder
Which pathogen is most commonly associated with biofilm infections in CAUTI?
Pseudomonas aeruginosa
What are the primary symptoms of acute uncomplicated cystitis?
Dysuria, frequency, urgency, and gross hematuria without vaginal discharge
