UTIs

Question 1

Classification

Answer 1

Lower: cystitis, urethritis, prostatitis, epididymo-orchitis
Upper: acute pyelonephritis
Both uncomplicated (not anatomical or neurological abnormalities

Question 2

Risk factors for Lower UTI

Answer 2

Obstruction, poor bladder emptying, catheterisation
Vesico-enteric fistula
Sex, genetics
Diabetes

Question 3

Risk factors for upper UTI

Answer 3

Vesico-ureteric reflux

Obstruction

Question 4

Pathogenesis

Answer 4

Contamination, migration and colonisation
Colonisation mediated by pili and adhesins
Infiltration, multiplication
Biofilm formation
Host tissue damage
Bacteremia

Question 5

Adherence of pathogen

Answer 5

Uropathogenic E. coli expression of type 1 pili
UPEC are highly adhesive (ureteral ascent)
P-pili confer tropism to the kidney

Question 6

Invasion of pathogen

Answer 6

Bind to host cell
Induce active rearrangement within host cell and uptake of bacteria (now safe from antibiotics & host defences)
Toll like receptor recognition - pushes bacteria out

Question 7

Evasion of pathogen

Answer 7

UPEC escapes into cytoplasm & multiplies
New bacteria communities invade more host cells or invade transitional cells
Establish a quiescent intracellular reservoir
UPEC secretes factors to enable nutrient acquisition (haemolysin A) to survive

Question 8

Symptoms of cystitis

Answer 8

Bladder and urethral symptoms
Dysuria, frequency, urgency, suprapubic pain, nocturia
Cloudy urine, visible blood

Question 9

Symptoms of pyelonephritis

Answer 9

Fever, rigours, loin pain

Renal angle tenderness

Question 10

Diagnosis - dipstick

Answer 10

Lood for nitrites, leucocytes and red blood cells

Question 11

Contamination of sample

Answer 11

Contamination by bacteria colonising distal urethra, or hands/genital contamination
Rapid transport
Boric acid preservation
Refrigerate

Question 12

Urine specimens

Answer 12

Midstream urine
Suprapubic aspirate
Catheter urine
- be clear which one it is

Question 13

Microscopy - when not to culture

Answer 13

Don’t culture if scan is negative for red cells, white cells and organisms

Question 14

Antimicrobial resistance rates - where to find

Answer 14

PHE national lab surveillance system

English surveillance programme for antimicrobial utilisation and resistance

Question 15

Prevention of UTI

Answer 15

Correct underlying host causes
Antibiotic prophylaxis
Behavioural change

Question 16

Catheter Associated UTI

Answer 16

3-5% of people per day with catheter will have bacterial colonisation
Removal of catheter will help most
Insertion/removal/manipulation all cause CAUTIs
70% of CAUTIs are preventable

Question 17

Asymptomatic bacteriuria

Answer 17

Best left untreated unless pregnant

Common in elderly

Question 18

Relapse vs Recurrence

Answer 18

Relapse: same uropathgoen causes UTI within 2 weeks of completing antibiotic treatment
Recurrence: 2 culture proven episodes in 6 months or 3 in 1 year - may be different uropathogen