UTI

Question 1

what is a complicated uni?

Answer 1

Complicated urinary tract infection refers to infection in a urinary tract

with functional or structural abnormalities (including indwelling catheters and calculi).

Question 2

what % of the female population will experience a symptomatic urinary tract infection at some time during their life?

Answer 2

40% to 50%

Question 3

most common cause of UTI?

Answer 3

E. coli

Question 4

Name other organisms with potential to cause UTI?

mmemonic?

Answer 4

KESS P:

Klebsiella aerogenes
Enterococcus faecalis
Staphylococcus saprophyticus
Staphylococcus epidermis

Proteus mirabilis

Question 5

Name 3 Antibacterial Host Defences in the Urinary Tract

Answer 5

Urine (osmolality, pH, organic acids)

Urine flow and micturition

Urinary tract mucosa (bactericidal activity, cytokines)

Question 6

why are ascending UTIs more common in women?

Answer 6

The female urethra is short and is in proximity to the warm moist vulvar and perianal areas, making contamination likely

Question 7

risk factors for cystitis.

in healthy women?

Answer 7

hx UTIs

recent sex

Question 8

For Ascending UTIs, which symptoms does one get first?

Answer 8

LUTs rather than UUTs

Question 9

name some extra renal causes of obstruction?

Answer 9

Extrarenal:
valves,
stenosis, or bands;
calculi;

extrinsic ureteral compression from a variety of causes; and benign prostatic hypertrophy

Question 10

name some intra renal causes of obstruction?

Answer 10

nephrocalcinosis,

uric acid nephropathy, analgesic nephropathy,

polycystic kidney disease, hypokalemic nephropathy,

and the renal lesions of sickle cell trait or disease

Question 11

name some Neurogenic causing obstruction in the urinary tract

Answer 11

poliomyelitis,

	- tabes dorsalis - syphilis
	- diabetic neuropathy, 
	- spinal cord injuries

Question 12

which bacteria affect the kidneys via the Haematogenous Route?

Answer 12

Staphylococcus aureus bacteremia or

endocarditis - strep and staph

Question 13

which bacteria DO NOT infect the kidneys via the Haematogenous Route?

Answer 13

gram negatives

Question 14

In LUTz what symptom is absent?

Answer 14

Fever

Question 15

name the LUTs symptoms

Answer 15

Frequency
Urgency
Dysuria ; small amount of turbid urine
suprapubic heaviness

don’t forget: nocturia and grossly cloudy urine

Question 16

List the UUTs symptoms

Answer 16

Fever (sometimes with rigors)
Flank pain

and frequently LUTs (e.g., frequency, urgency, and dysuria)

at times, the lower tract symptoms antedate the appearance of fever and upper tract symptoms by 1 or 2 days

Question 17

how would an older patient present with uti?

Answer 17

ATYPICAL PRESENTATION

Majority - asymptomatic

Symptoms, not diagnostic as many experience:
frequency, dysuria, hesitancy, and incontinence

Symptoms of UUTs often atypical e.g., abdominal pain, change in mental status

Question 18

ivx for incomp uti?

Answer 18

Urine dipstick

MSU for urine MCS

Bloods

Question 19

How to investigate complicated UTI?

Answer 19

Renal USS

Intravenous urography

Question 20

which substances present on urine dipstick are suggestive of UTI?

Answer 20

Positive Nitrites or leucocytes

RBC positive

Question 21

what ivx NOT to do for uni in adults over 65?

why?

Answer 21

Dont do DIPSTICK - unreliable:

asymptomatic bacteriuria because half have bacteria in urine anyways, especially with catheter

Question 22

Name 3 protocols for management of sepsis?

Answer 22

NICE

NEWS2

RCGP

Question 23

perform dipstick, get negative nitrites and positive leucocyte. meaning?

Answer 23

UTI equally likely to other diagnoses.

if init was pos nitrites, neg leucocytes, uti is still likely

Question 24

what organisms are responsible for sterile pyuria?

Answer 24

Chlamydia

other vaginal infections

non-culturale organisms: TB

Question 25

meaning of epithelial cells in urine culture?

Answer 25

possible perineal contamination

re-test if symptomatic

Question 26

define sterile pyuria

Answer 26

the presence of leucocytes in the urine in the absence of demonstrable urinary tract infection.

Question 27

Nitrites in urine are indicative of which organisms?

Answer 27

Nitrites are indicative of coliforms e.g E.coli becaue they contain nitrate reductase so convert nitratres to nitrites.

Question 28

3 methods of sampling urine?

Answer 28

Midstream clean catch (MSU)
preferred for the routine collection of urine for culture.

Catheterisation

Suprapubic aspiration

Question 29

list causes of sterile pyuria?

Answer 29

Prior treatment with antibiotics
Calculi
Catheterisation
Bladder neoplasm
TB
Sexually Transmitted Disease

Question 30

Patients with infection usually have at least ____ cfu/mL in urine?

Answer 30

10^5

Question 31

what to prescribe for uncomplicated uti?

Answer 31

Male/Female - Cefalexin 500 mg BD 3days

if woman with hx of uti - 7 days of therapy better

or Female - Nitrofurantoin 50mg PO QDS for 7 days

Question 32

what to prescribe for uti in pregnancy lady?

Answer 32

Cefalexin 500 mg PO BD for 7 days

Question 33

treatment for pyelonephritis - no sepsis?

Answer 33

Co-amoxiclav +/- gentamicin

500mg PO TDS 2 weeks
if systemically unwell - IV

Question 34

prescription for catheter associated uti?

Answer 34

gentamicin STAT iv/im

80mg

Question 35

which part of the kidney is most susceptible to infection

Answer 35

medulla

Question 36

complications of pyelonephritis?

Answer 36

abscess

scarring
chronic renal impairment
Septic shock

Acute papillary necrosis