UTI

Question 1

How would a UTI present? [6]

Answer 1

• Dysuria (pain on micturation)
• Frequency/urgency
• Smelly cloudy urine
• Flank Pain
• Strangury (Wanting to void but can’t)
• Signs of systemic infection: confusion, chills

Question 2

What microorganisms cause UTI? [5]

Answer 2

Mostly bowel organisms

• E. Coli
• Proteus Spp.
• Klebsiella Spp.
• Pseudomonas Aeruginosa
• Enterococci

Question 3

State medical terms for inflammation of the urethra, bladder, ureter or kidney? [4]

Answer 3

Urethritis
Cystitis
Ureteritis
Acute Pyeonephritis (chronic if recurrent or prolonged)

Question 4

What are the main tests for UTI?[3]

Answer 4

Dipstick Urinalysis

Mid Stream specimen of Urine - MSSU for urine culture & Microscopy

Suprapubic aspiration (mainly for people who cant give an MSSU e.g. young kids or elderly)

Question 5

How do you tell if bacteria in a urine culture are pathogenic or contaminating commensals? [1]

Answer 5

They grow in log scales in the culture. 10^5 is almost certainly infectious even if asymptomatic.

Question 6

What are the complications of a UTI? [3]

Answer 6

• Sepsis, septic shock
• Chronic pyelonephritis
• Calculi –> Obstruction –> Hydronephrosis –> Hypertension & chronic renal failure

Question 7

What are the categories of UTI aetiology? [3]

Answer 7

1) Stasis of Urine (either obstruction or loss of full bladder feeling)
2) Pushing bacteria up urethra (sex in women or urological procedures)
3) Generalised predisposition to infections (e.g. diabetes)

Question 8

What can cause you to lose the feeling of a full bladder? [1]

Answer 8

A spinal cord or brain injury

Question 9

Whats the main cause of urinary obstruction in children? [1]

Answer 9

Vesicouretic reflux

Its a loss of the angle of entry of ureter to bladder

Question 10

What are the main causes of obstruction in adults? [3]

Answer 10

• Benign Prostatic Hyperplasia (men)
• Uterine Prolapse (Women)
• Tumours & Calculi (both)

Question 11

What are the consequences of an obstruction? [2]

Answer 11

Back up of urine causing hydroureter and hydronephrosis and eventually chronic renal failure.

Slowed flow –> Infection & sediment formation (calculi)

Question 12

Why are women more at risk of UTIs? [5]

Answer 12

• Short urethra
• No prostatic bacteriostatic secretion
• Close urethral orifice to rectum
• Sexual activity (vagina just behind urethra so pushes bacteria up)
• Pregnancy places pressure on the ureter & bladder

Question 13

Why does diabetes predispose you to UTIs? [2]

Answer 13

1) Glc in urine

2) Poorly functioning WBCs

Question 14

How would a UTI present in a small child? [4]

How does initial management differ in treatment of a small child with UTI? [1]

Answer 14

Dysuria unlikely as they cannot complain of it

• Diarrhoea
• Crying & not eating
• N&V
• Fever

In contrast to adults, the development of a urinary tract infection (UTI) in childhood should prompt an investigation for possible underlying causes and damage to the kidneys

Question 15

How would pyelonephritis appear? [5]

Answer 15

~dehydration
Fever
Loin/flank pain
~systemic unwellness/bacteraemia
Cloudy Urine

Question 16

Risk factors for a UTI? [9]

Name 5 female specific risk factors

Answer 16

• Sex
• Renal Stones
• Immunosuppression (Long term CCS, DM or transplant meds)
• Anatomical Abnormalities e.g. horseshoe kidney or duplex collecting system
• Foreign Body e.g. catheter or stent
• Static urine due to poor bladder emptying e.g. retention
• Malnutrition
• Pre-existing parenchymal disease
• Fistula between bladder/bowel

Female specific:

• Female
• Oestrogen Deficiency
• Pregnancy
• Childbirth
• Poor hygiene e.g. not wiping from front to back in girls

Question 17

What other tests would we do in kids with UTIs? [1]

Answer 17

A micturating Cystogram to check for vesico-ureteric reflux

Question 18

How do we treat most UTIs? [4]

State 2nd line and 3rd line

Answer 18

3d of trimethoprim
send a urine culture if:
aged > 65 years
visible or non-visible haematuria

Question 19

How would we advise women with recurrent UTIs? [2]

Answer 19

Drink plenty of fluids

Urinate frequently, particularly bbed and before/after sex.

Question 20

How do we handle UTIs due to indwelling catheters [2]

How to treat UTI in men?

Answer 20

Only treat if the patients symptomatic.
If you do treat you have to change the catheter before starting treatment
a 7-day, rather than a 3-day course should be given

Men: an immediate antibiotic prescription should be offered

Question 21

What radiological signs (CT) may indicate pyelonephritis? [4]

Answer 21

• Scarring
• Clubbing of calyces
• Abscess
• Emphysematous (gaseous) pyelonephritis. Lots of gas pockets within the kidney due to gas-forming bacteria.

Question 22

Causative organisms UTI [3]

Answer 22

Causative organisms
E. coli
Proteus
Pseudomonas

Question 23

In a recurrent UTI, differentiate between reinfection vs relapse

Answer 23

Relapse is recurrence of bacteriuria with same organism within 7 days of completion of antibiotics - implies failure to eradicate organism.

Reinfection is when bacteriuria is absent after antibiotics for 14 days followed by recurrence of infection by same/different organism. Implies poor bladder defense mechanisms or increased susceptibility