UTI

Question 1

What is a UTI?

Answer 1

Bacteria in the urinary tract that causes clinical infection.

Question 2

What is cystitis?

Answer 2

LUTI/infection of bladder

Question 3

What is another term for a LUTI?

Answer 3

Cystitis

Question 4

What is pyelonephritis?

Answer 4

UUTI/Kidney infection

Question 5

What is another term for a UUTI?

Answer 5

Pyelonephritis

Question 6

Which parts of the urinary tract are normally sterile?

Answer 6

Kidneys, ureters and bladder

Question 7

What kind of bacteria normally colonize the lower urethra?

Answer 7

Coliforms and enterococci

Question 8

What makes a UTI complicated?

Answer 8

Systemic upset or urinary tract structural abnormalities.

Question 9

What is bacteriuria?

Answer 9

Bacteria in the urine

Question 10

Does bacteriuria always mean a UTI?

Answer 10

No, elderly or catheterised patients may have it too.

Question 11

Is cystitis just caused by infection?

Answer 11

No, just means inflammation of bladder so can be many causes.

Question 12

What three factors regulate the presence of infection?

Answer 12

Host- Immunological status, behaviour etc
Organism- Type of organism, virulence etc
Environment- Medical devices, anatomy/urinary retention

Question 13

What are some risk factors for contracting a UTI?

Answer 13

Women
Catheter
Structural abnormalities

Question 14

What are the two routes bacteria can take to infect the urinary tract?

Answer 14

Ascending

Blood

Question 15

How common is blood stream infection of the kidneys?

Answer 15

Quite uncommon

Question 16

What is an important factor of bloodstream infections of the kidney?

Answer 16

Multiple small abscesses

Question 17

Name five important bacteria that can cause UTI

Answer 17

E. Coli
Klebsiella
Enterobacter
Proteus
Pseudomonas

Question 18

What is the most common form of bacteria to infect the urinary tract?

Answer 18

Lactose fermenting coliforms such as E. Coli, Klebsiella and Enterobacter

Question 19

What makes E. Coli exceptionally good at causing UTI?

Answer 19

Long flagellum that allow it to adhese and climb up.

Question 20

What part of E. Coli is responsible for a lot of its effects such as fever?

Answer 20

Endotoxin

Question 21

Where is endotoxin found in E. Coli?

Answer 21

LPS layer

Question 22

What does proteus do in urine?

Answer 22

Breaks down urea to ammonia to increase pH and precipitate out struvite stones.

Question 23

What does proteus infection smell like?

Answer 23

Burnt chocolate

Question 24

What is pseudomonas infection associated with?

Answer 24

Catheters and medical devices

Question 25

What is the best antibiotic for a pseudomonas infection?

Answer 25

Ciprofloxacin

Question 26

How should ciprofloxacin be administered?

Answer 26

Oral or IV

Question 27

Which groups should not receive ciprofloxacin?

Answer 27

Children and pregnant women

Question 28

What are the three major gram negative causes of UTI?

Answer 28

E. Coli Proteus Pseudomonas

Question 29

What are the two main gram positive causes of UTI?

Answer 29

Enterococci | Staph

Question 30

Which enterococci is important to know?

Answer 30

Enterococci faecalis

Question 31

Where is enterococci usually acquired?

Answer 31

Hospital

Question 32

Which two forms of staph commonly cause UTI?

Answer 32

S. Aureus | S. Saprophyticus

Question 33

What kind of UTI does S. Aureus normally cause?

Answer 33

Blood born

Question 34

Where is S. Saprophyticus normally found?

Answer 34

Female reproductive tract

Question 35

What group is most affected by S. Saprophyticus?

Answer 35

Women of childbearing age

Question 36

How do you diagnose a UTI?

Answer 36

Dysuria Increased urination frequency Nocturia (change from baseline) Haematuria

Question 37

What three factors suggest UUT involvement?

Answer 37

Fever Rigors Loin pain

Question 38

What are some risk factors for a LUTI?

Answer 38

Female Sexually active Diabetes Obesity

Question 39

What three organisms tend to cause LUTI?

Answer 39

Klebsiella Enterobacter S. Saprophyticus

Question 40

What are some risk factors for UUTI?

Answer 40

HIV/Immunosuppression Diabetes Congenital abnormalaties

Question 41

What four organisms tend to cause UUTI?

Answer 41

Klebsiella Enterobacter S. Aureus Proteus

Question 42

How should you collect a urine sample?

Answer 42

Midstream

Question 43

Why should you collect a midstream urine sample?

Answer 43

Because the first part tends to contain bacteria from the urethra

Question 44

What should you do before collecting a midstream urine sample?

Answer 44

Clean perineal/urethral meatus with sterile saline (not antiseptic!)

Question 45

What type of container should you ideally collect a urine sample in?

Answer 45

Sterile universal (white top)

Question 46

How soon should a sample in a sterile universal be tested?

Answer 46

<2h

Question 47

If it's going to take longer than 2h to test a urine sample what type of container should you use?

Answer 47

Boricon (red top)

Question 48

How long is a Boricon container good for?

Answer 48

Up to 24h

Question 49

If a midstream sample isn't possible what other collection techniques are there?

Answer 49

Clean catch Bag urine Catheter specimen Suprapubic aspiration

Question 50

What groups is a clean catch urine sample good for?

Answer 50

Children | Cog or physically impaired

Question 51

How does a clean catch sample work?

Answer 51

Clean, urinate but into toilet, stop, urinate into container until half full.

Question 52

Which group is a bad urine sample good for?

Answer 52

Babies

Question 53

What is a major problem with a bag urine sample?

Answer 53

Often contaminated with bowel flora

Question 54

What is a good result from a bag urine sample?

Answer 54

Negative (positive could be contaminated)

Question 55

Can a dipstick test be used to diagnose a UTI?

Answer 55

No but can indicate one in select patient groups

Question 56

Which groups should not have their urine dipstick tested?

Answer 56

Elderly or catheterised

Question 57

What two things on a urine dipstick indicate infection?

Answer 57

Leukocytes | Nitrites

Question 58

Infection with which organism does not give positive nitrites test?

Answer 58

Pseudomonas

Question 59

How is a UTI diagnosed in the lab?

Answer 59

Microscopy- rare and only in urgent cases | Urine culture

Question 60

What are the three categories in the Kass criteria?

Answer 60

Probable UTI- >10^5 organisms/ml Probably contamination- 10^4 organisms/ml No significant bacteriuria- <10^3

Question 61

What group is the Kass criteria applied to?

Answer 61

Women of childbearing age

Question 62

What are pure and mixed growths?

Answer 62

Pure- one organism | Mixed- 2+

Question 63

When is a >10^5 organisms/ml significant?

Answer 63

When it's caused by one organism (if 2+ then probably not significant)

Question 64

How should you treat an uncomplicated LUTI?

Answer 64

Antibiotics

Question 65

How long should antibiotics be given for in a LUTI?

Answer 65

3 days

Question 66

What is Abacterial cystitis/Urethral syndrome?

Answer 66

Symptoms of UTI and pus cells in urine but no growth.

Question 67

What can cause Abacterial cystitis/Urethral syndrome?

Answer 67

Early phase of UTI Urethral trauma (honeymoon cystitis) Chlamydia/gonorrhoea

Question 68

How can you treat Abacterial cystitis/Urethral syndrome?

Answer 68

Alkalise urine for symptomatic relief

Question 69

What is Asymptomatic bacteriuria?

Answer 69

Significant bacteriuria (>10^5 orgs/mL) but no pus cells and patient is asymptomatic.

Question 70

How do you treat Asymptomatic bacteriuria?

Answer 70

You don't unless pregnant

Question 71

When should a catheterised patient be treated for a UTI?

Answer 71

>10^5 orgs/mL and symptomatic

Question 72

What is the empirical treatment for a LURI in a female?

Answer 72

Nitrofurantoin or trimethoprim orally (3 days)

Question 73

What is the empirical treatment for uncatheterised male UTI?

Answer 73

Nitrofurantoin or trimethoprim orally (7 days)

Question 74

What is the empirical treatment for complicated UTI or pyelonephritis seen by a GP?

Answer 74

Co-amoxiclav or co-trimoxazole (14 days)

Question 75

What is the empirical treatment for complicated UTI or pyelonephritis seen in hospital?

Answer 75

Amoxicillin and gentamicin IV for 3 days

Question 76

What is the local treatment for coliforms?

Answer 76

IV Gent for UUTI | Oral trimethoprim for LUTI

Question 77

What is the local treatment for enterococci?

Answer 77

IV Amoxicillin

Question 78

Which group should gent not be given to?

Answer 78

Pregnant women

Question 79

What are some dangers of gent?

Answer 79

Renal damage | CNVIII damage

Question 80

How long should gnet be prescribed for?

Answer 80

3 days