UTI's

Question 1

Definition

Answer 1

Presence of micro-organisms in the urinary tract that cause clinical infection

Question 2

Complicated UTI - definition

Answer 2

Presence of systemic symptoms OR
Due to urinary structural abnormality OR
Due to presence of stones

Question 3

Urine in the kidneys, ureters and bladder is normally sterile. True or false?

Answer 3

True

Question 4

The lower end of the urethra is normally sterile. True or false?

Answer 4

False

- it is normally colonised by bacteria (mainly coliforms and enterococci from the large bowel)

Question 5

Common routes of UTI infection

Answer 5

Ascending infection (most common)
Blood stream (less common)

Question 6

What word is used to describe upper UTIs ?

Answer 6

Pyelonephritis

Question 7

Pyelonephritis - definition

Answer 7

Infection involving the ureters +/- kidneys

Systemic involvement present

Question 8

Pyelonephritis - who gets it

Answer 8

Commonly patients are in hospital

Question 9

Pyelonephritis - causative organisms (gram -ve)

Answer 9

Coliforms

• e.coli
• klebsiella
• proteus

Pseudomonas aeruginosa

Question 10

Pyelonephritis - causative organisms (gram +ve)

Answer 10

Enterococcus faecalis

Staph aureus

Question 11

Pyelonephritis - clinical features

Answer 11

Fever 
Rigors 
Loin pain
Malaise 
Nausea/vomiting 
Dysuria 
Frequency

Question 12

Pyelonephritis - investigations

Answer 12

MSU 
- collect mid stream of urine in a foil bowl 
Urine culture 
Urine microscopy (rare) 
- do this only in transplant pts

Question 13

What blood culture container is MSU put in in hospital setting?

Answer 13

White top

- must reach the lab within 2 hours

Question 14

Do you do urinalysis in patients with upper UTI?

Answer 14

NO

Question 15

When do you NOT do urinalysis?

Answer 15

In patients who have upper UTI
Catheterised patients
Elderly patients (above 65)

Question 16

Urine culture - how many organisms need to be present to be deemed as ‘significant’ and suggestive of UTI?

Answer 16

Over 10^5 organism /ml urine
(this is KASS criteria)

However if there is mixed growth (2 or more organisms) and there is over 10^5 organisms then it is probe not a UTI

Question 17

Pyelonephritis - management (community)

Answer 17

Co-amoxiclav
OR
Co-trimoxazole

Question 18

Pyelonephritis - management (hospital)

Answer 18

Amoxicillin IV + Gentamicin IV

• gentamicin only given for 3 days
• use co-trimoxazole if pt penicillin allergic

Question 19

Pseudomonas aerginosa - management

Answer 19

Ciprofloxacin (4C)

- not used young children or pregnant women

Question 20

Catheterised patients with blood culture results revealing >10^5 organisms/ml urine should always be given antibiotics. True or false?

Answer 20

False

- they should only be given antibiotics if there is supporting evidence of UTI (i.e. symptoms)

Question 21

What word is used to describe lower UTI’s?

Answer 21

Cystitis

Question 22

Cystitis - definition

Answer 22

Infection confined to the bladder

There is NO systemic involvement

Question 23

Cystitis is more common in the hospital setting / community setting ?

Answer 23

Community setting (GP)

Question 24

Which gender are more likely to get UTI’s and why?

Answer 24

Females

• short, wide urethra
• proximity of urethra to anus

Question 25

Risk factors for developing lower UTI

Answer 25

Female Sexual activity Pregnancy

Question 26

Cystitis - causative organisms (gram -ves)

Answer 26

Coliforms - E coli - Klebsiella

Question 27

Cystitis - causative organisms (gram +ves)

Answer 27

Staphylococcus saphrophyticus | Enterococcus faecalis

Question 28

Cystitis - clinical features

Answer 28

``` Dysuria Suprapubic pain Frquency of urination Nocturia Haematuria ```

Question 29

Cystitis - investigations

Answer 29

MSU - collect mid stream of urine in foil bowl Urinalysis

Question 30

What blood culture container is MSU put in in community (GP) setting?

Answer 30

Red top - boric acid container (this inhibits the overgrowth of organisms) - works for 24 hours

Question 31

Urinalysis for lower UTI

Answer 31

Good for ruling out infection in some patients Leukocyte esterase - presence of WBC in the urine Nitrites - bacteruria

Question 32

"Young previously healthy woman presents to GP with cystitis. What is the best investigation?"

Answer 32

Urinalysis (dipstick)

Question 33

Cystitis - management (uncomplicated female, community) | *include duration

Answer 33

Trimethoprim (3 days) OR Nitrofurantoin (3 days)

Question 34

Nitrofurantoin is effective in the upper and lower urinary tract. True or false?

Answer 34

FALSE | - nitrofurantoin is NOT effective in the upper UT as it needs to be activated in the bladder

Question 35

Cystitis - management (male, community) | *include duration

Answer 35

Trimethoprium (7 days) OR Nitrofurantoin (7 days)

Question 36

Both males and females with uncomplicated lower UTI require urine cultures? True or false

Answer 36

False | - only males need cultures

Question 37

Cystitis - management (male/female, complicated, community) | *include duration

Answer 37

Co-amoxiclav (14 days) OR Co-trimoxazole (14 days)

Question 38

Abacterial cystitis - definition

Answer 38

Patient with symptoms of UTI but no organism growth on investigation

Question 39

Abacterial cystitis - causes

Answer 39

Urethral trauma | Urethritis (caused by STI)

Question 40

Abacterial cystitis - management

Answer 40

Citrate salts (alkalinise urine) - useful in relieving dysuria Empty bladder after sex - if sexually related

Question 41

Asymptomatic bacteruria - definition

Answer 41

Patient who is asymptomatic but has significant bacteruria | - since the patient has no symptoms they do not have an infection

Question 42

Asymptomatic bacteruria - management

Answer 42

Do not need antibiotics

Question 43

Asymptomatic bacteruria - management (pregnancy)

Answer 43

Must treat with antibiotics (cephalexin or nitrofurantoin) - if not treated, patient could get pyelonephritis

Question 44

What is proteus

Answer 44

Gram -ve coliform | Causative organism of upper UTI

Question 45

Which organism is likely to cause renal stone formation?

Answer 45

Proteus | - it produces urease

Question 46

Which organism causes "stag horn calculi?"

Answer 46

Proteus