UTI

Question 1

Differentials for burning discomfort.

Answer 1

Pyelonephritis - SYSTEMIC symptoms

Urethritis

Gonorrhoea

Chlamydia

Cystitis

Question 2

Where does chlamydia and gonorrhoea commonly occur in males

Answer 2

Urethra - urethritis (therefore if woman presented with burning, unlikely to be urethritis)

Question 3

Where does chlamydia and gonorrhoea commonly occur in females

Answer 3

Cervix - cervicitis and further up

Question 4

Where do UTI’s occur?

Answer 4

Kidney, ureter, bladder, urethra.

Question 5

What further questions do you ask when presented with burning discomfort with urine passing?

Answer 5

Frequency - Indicates cystitis

Urgency - Indicates cystitis

Supra pubic pain/Cramping - Indicates cystitis (inflamed bladder)

Question 6

How common is cystitis in males to females? Why?

Answer 6

More common in females - anatomy, longer ureter in males.

Question 7

What is a mid stream urine?

Answer 7

Collecting specimen half way through urination to clear any bacteria colonising urethra - use for cystitis

Question 8

What is a first void urine?

Answer 8

Collecting urine from beginning of stream to collect sample from urethra - For urethritis (gonorrhoea and chlamydia)

Question 9

What is the most useful first step in management for dysuria? Why?

Answer 9

HISTORY! We can figure out if it is urethritis or cystitis which will affect subsequent investigations and treatment.

Question 10

What are hallmark symptoms of gonorrhoea?

Answer 10

Dysuria and discharge!

Question 11

Is obtaining a MSU for culture better or for a dipstick?

Answer 11

Dipstick - Cheaper, on the spot and can check for white blood cells!

Culture/microscopy takes a lot longer (2-3 days), would’ve treated by now, and more expensive.

Question 12

Should we treat all patients with AB’s?

Answer 12

Yes, all patients will get better with cystitis but not until a month. That’s a long time to have pain and discomfort.

Question 13

Main causative organisms of cystitis?

Answer 13

E.coli - colonised urethra and made its way up to bladder. Fimbriae have attached to urothelium wall and releases toxins that damage the urothelium, which is the point of infection. (Cytokines released from damaged urothelium - inflammation)

Question 14

Can E.coli in cystitis go on to cause pyelonephritis?

Answer 14

No, different E.Coli (uro-pathogenic E.coli) which have different types of fimbriae which allow it to attach to kidney tissue and would cause pyelonephritis at the same time as cystitis. So don’t worry about E.coli if present in urine.

Question 15

Risk factors contributing to cystitis in females and males.

Answer 15

…

Question 16

Why is cystitis more common in older women then younger?

Answer 16

Post-menopausal. Low oestrogen which is known to help in host defence against e.coli colonies around urethral opening.

Question 17

When should you prescribe AB’s for a patient with delirium and fevers and E.coli present in urine?

Answer 17

When there is no other known cause of the fever etc. Worth a go.

Question 18

What properties should and antibioitc used to treat cystitis have?

Answer 18

Cleared by kidneys
Narrow range 
Safe
Cheap
Works!

Question 19

What are the options for anti-microbial treatment for cystitis?

Answer 19

Trimethprim - Folate antagonist (inhibits DNA synthesis) therefore contraindicated in pregnancy

Nitrofuratoin

Question 20

Benefits and disadvantages between Nitrofuratoin and Trimethprim

Answer 20

Nitrofuratoin is 99% effective but has to be taken 3 times a day (USED IN HOSPITALS WHERE NURSES BRING YOU AB’S SO NO WORRY ABOUT COMPLIANCE)

Trimethprim is 80% effective but is taken at night as pee less so stays in bladder longer. (GP’s usually prescribe this for better compliance)

Question 21

What type of AB’s are the ones used for cystitis?

Answer 21

Bacteriostatic

Broad spectrum