UTI

Question 1

complicated UTI

Answer 1

pregnant, abnormal urological anatomy, diabetes, immunocompromised, indwelling bladder catheter, male.

any one of these

Question 2

epidemiology of UTI

Answer 2

most common bacterial infection in outpatient setting.

by 32 half of women had at least one UTI (cystitis)

Question 3

pathogenesis

Answer 3

UT is sterile 95% of the time.

e. Coli (most common)

proteus mirabilis

klebsiella pneumoniae

Question 4

well defined risk factors

Answer 4

sexual intercourse, new partner, spermicides, recent UTI

Question 5

less defined risk factors

Answer 5

voiding patterns, voiding frequency, 24hr fluid intake, wiping patterns, BMI

Question 6

pathogenesis

Answer 6

GI pathogens colonize peri-urethral mucosa,

ascend through urethra to bladder

continue on to ureters/kidney. (UUTI)

Question 7

uropathogenic e. Coli

Answer 7

pili, flagella, adhesins, siderophores, toxins, polysaccharide coating.

Question 8

suggestive cystitis

Answer 8

pain or burning urination
increased frequency
increased urgency
suprapubic pain

Question 9

pyelonephritis

Answer 9

fever >38.3
flank or costo-vertebral angle pain
nausea/vomiting
+/- symptoms of cystitis

Question 10

lab diagnosis

Answer 10

gold standard: symptoms + culture demonstrating >10^5 colony-forming units

AND evidence of inflammation.

Question 11

asymptomatic bacteriuria

Answer 11

positive urine culture without inflammation

Question 12

specific gravity

Answer 12

urine density/density of water

Question 13

nitrite

Answer 13

metabolic byproduct of some uropathogenic bacteria

Question 14

WBC screen

Answer 14

should be less than 5 per high power field.

Question 15

urinalysis in isolation

Answer 15

not diagnostic

Question 16

most common treatment

Answer 16

notrofurantoin, TMP/SMX, fosfomycin

even though it usually resolves without antibiotics. these are used to provide symptom relief.

Question 17

drug resistance

Answer 17

amoxicilin is >20%

Question 18

recurrent UTI

Answer 18

failure of antibiotic- reculture, change AB
incorrect diagnosis- re-eval symptoms
behavioral/ biological cause- change behavior

Question 19

asymptomatic bacteriuria

Answer 19

positiv urine culture without symptmos of UTI or inflammation.

no need for ab unless:

pregnant, pre-urology procedure, renal transplant, neutropenic

Question 20

catheter associated UTI symptoms

Answer 20

usually lack typical UTI symptoms
new fever with no other source
CVA tenderness, flank pain, pelvic discomfort.

Question 21

catheter associated UTI diagnosis

Answer 21

inflammation doesnt necessarily correlate

absence of pyuria rules it out!!!

Question 22

catheter associated UTI treatment

Answer 22

remove catheter, replace if indicated.

ABs last longer. 7 days if prompt, 10-14 if delayed.

3 days if catheter removed in female without evidence of associate pyelo