UTI

Question 1

Describe host factors that increase the likelihood of getting a UTI. (6)

Answer 1

Age - peaks for men in old age, peaks for women in old age, but also in pregnancy, sex and preschools.
Women - shorter urethra.
Obstruction - enlarged prostate, uterus, stones, tumours.
Neurological problems - incomplete emptying.
Ureteric reflux - ascending infection from the bladder especially in children.

Question 2

Describe the types of bacteria that commonly cause UTIs. (3)

Answer 2

Mostly Gram Negative rods called enterobacteriae (like E Coli), but can also be coagulate-negative staph or gram negative bacteria (eg pseudomonas aeruginosa).

Question 3

Describe the clinical syndromes associated with the lower urinary tract. (3)

Answer 3

Bacterial cystitis - frequency, dysuria, haematuria, pyuria.
Abacterial cystitis - as above but without bacteruria because the bacteria are covert - only visible on culture.
Prostatitis - fever, dysuria, perineal and lower back pain.

Question 4

Describe the clinical syndromes associated with the upper urinary tract. (2)

Answer 4

Acute pyelonephritis - cystitis with fever and loin pain.

Chronic interstitial nephritis - Renal impairment following chronic inflammation often secondary to infection.

Question 5

Describe the differences between complicated and uncomplicated UTIs. (6)

Answer 5

Complicated - all UTIs in men, pregnancy, or children precipitated by immunosuppresion, impaired renal function, abnormal urinary tract (inc catheters), virulent organisms (eg staph aureus).
Uncomplicated - normal everything - classically only in women.

Question 6

Describe the microbiological studies that are performed on urine when you suspect a UTI. (5)

Answer 6

Mid-stream sample. 
Visual inspection for opacity. 
Dipsticks (useful to exclude)
Microscopy
Culture

Question 7

Describe the causes of sterile pyuria, and how it relates to abacterial cystitis. (5)

Answer 7

WBC cells in the urine with low bacteria.
Previous antibiotics, vaginal infection, non-infectious inflammation (tumours or chemicals), urinary TB (rare). This relates to abacterial cystitis because abacterial cystitis might be from things other than bacteria that still cause inflammation like chemicals or STIs.

Question 8

Describe the treatments for different types of UTI. (4)

Answer 8

Increase fluid intake.
Uncomplicated - 3 days of trimethoprim or nitrofurantoin.
Complicated - 5-7 days of trimethoprim or nitrofurantoin.
Pyelonephritis or sepsis - 14 day course of co-amoxiclav or 7 days ciprofloxacin. .