UTI

Question 1

Most common cause of UTI

Answer 1

E. Coli (Gram Negative)

Question 2

Treatment of uncomplicated vs complicated UTI’s?

Answer 2

Uncomplicated: Rarely progresses to severe disease even if untreated, you just ameliorate symptoms. TMP-SMX
Complicated: Can be severe my need IV antibiotics or hospitalization. Antimicrobial resistance in community impacts treatment choice. Ciprofloxacin

Question 3

What is Cystitis?

Answer 3

Inflammation of the bladder.
Simple: Treat with TMP-SMX.
Complicated: Ciprofloxacin.
Clinical Presentation: Acute dysuria, frequency, urgency, (pain when urinating), Suprapubic pain/tenderness, usually no fevered, NO vaginal discharge/itch, NO genital ulcers, NO backpain

Question 4

What is Pyelonephritis?

Answer 4

Kidney Infection! UTI spread to Kidney! Treat with Ceftriaxone, or Ciprofloxacin.
Clinical Presentation: Acute fever, chills, flank/backpain, nausea, vomitting, costovertebral angle tenderness,+- signs of cystitis

Question 5

Discuss the pathogenesis of UTI

Answer 5

• Contamination of periurethral area with uropathogen from the gut
  
  • Result of ascending infection of bacteria, initially colonizing the urethral mucosal surface then ascending up into the bladder and sometimes to the kidney!
  • Creates biofilms!

Question 6

Describe host defenses in the urinary tract?

Answer 6

• Urine… pH
  
  • Urinary tract mucosa
  • Inflammatory response
  • Adaptive immune system (humora, cell mediated)
  • Prostatic Secretions

Question 7

Recognize the significance of asymptomatic bacteriuria in different age groups – children, adult, elderly?

Answer 7

Prevalence of Asymptomatic Bacteriuria

- Young adults: 1-3%
- >65 years: 20% female, 10% men
- >80: 50% female, 30% men
- NO SYMPTOMS! Only pregnant women should be screened and treated... Don't treat the pee... treat the syndrome!

Question 8

List the most common organisms that cause UTIs and why?

Answer 8

• E. Coli (85%).. gram negative, this is most common cause! ON EXAM (found in GI Tract!)
  
  • Klebsiella and other Enterobacteriaceae (5%)
  • Staph. Saprophyticus (5%)

Question 9

UTI Risk Factors?

Answer 9

• Female gender… 10:1
  
  • PREGNANCY** (on exam)
  • Urethral catheterization (urethra shorter in women… easier for bacteria to go to!)
  • Urinary tract obstruction
  • Family History

Question 10

Recall criteria used to diagnose urinary tract infections?

Answer 10

• Send for urine sample for R&M and C&S. For UTI send midstream urine (clean catch).
  
  • R&M… finds pyuria.. if present does NOT mean it is a UTI, BUT… if no pyuria makes UTI very unlikely
  • C&S… many bacteriuria is normally in urine… thus use cut off! >10^8!

Question 11

Complicated vs Uncomplicated UTI’s?

Answer 11

• Complicated: More likely to fail short course therapy, involve drug resistant bugs, experience recurrence, progress to pyelonephritis, have atypical symptoms.
  
  • Uncomplicated: Most common type of UTI.

Question 12

What makes a UTI complicated?

Answer 12

• CRAPD
• Fall short course therapy
• Involve drug-resistant bugs
• Experience Recurrence
• Progress to pyelonephritis
• Have atypical symptoms

Question 13

Prostititis

Answer 13

Doesn’t respond to antibiotics… longer course!