UTIs

Question 1

Bladder tenesmus

Answer 1

Incomplete voiding

Question 2

Dysuria

Answer 2

Pain or discomfort when urinating

Question 3

Bacteriruia

Answer 3

The presence of bacteria in urine

Does not necessarily imply infection

Question 4

Asymptomatic bacteruria

and when is it clinically significant

Answer 4

Presence pf bacteria in the urinary tract in the absence of symptoms
Problems in pregnant women, or patients undergoing invasive procedures of the urinary tract)

Question 5

Normal mechanisms that maintain sterility of urine

Answer 5

Adequate urine volume
Free-flow from kidneys through urinary meatus
Complete bladder emptying
Normal acidity of urine
Peristaltic activity of ureters
Increased intra-vesicular pressure preventing reflux
In males, antibacterial effect of zinc in prostatic fluid

Question 6

What are upper or lower UTIs called?

Answer 6

Upper: Pyelonephritis
Lower: Cystitis and urethritis

Question 7

Cystitis (and 3 most common symptoms)

Answer 7

UTI presumed to be confined to the bladder
Most common symptoms: dysuria, urinary frequency, urinary urgency
Can have NO signs that suggest a systemic infection
Very rarely have a fever

Question 8

What two bacteria mimic symptoms of a lower UTI

Answer 8

Chlamydia trachomatis

Neisseria gonorrhoeae

Question 9

Pyelonephritis

Answer 9

Clinical diagnosis which implies a more invasive infection
Inflammation of the kidney and renal pelvis is assumed to be present when patients have pain or tenderness involving the flank, together with other clinical or lab evidence of UTI
Systemic findings: fever, flank pain, nausea, chills, malasie, headache, etc

Question 10

Prostatitis

Answer 10

Inflammation/infection of the prostate gland
May be present as acute or chronic
Can be hard to treat because you dont get great levels of antibiotics here

Question 11

Intrarenal abscess/perinephric abscess

Answer 11

Collection of pus in the kidney or in the soft tissue surrounding the kidney

Question 12

Uncomplicated UTIs

Answer 12

Occurs in patients with normal genitourinary tracts

Usually non-pregnant premenopausal women of childbearing age

Question 13

Complicated UTIs

Answer 13

Structural or functional abnormality of the genitourinary tract
Pregnant women, elderly, men, and children
Chronic symptoms
Comorbid illness (ex: diabetes) or immuno-compromised
Upper tract disease (pyelonephritis)
Any underlying abnormality that predisposes patient to UTI or makes UTI more difficult to treat effectively

Question 14

Relapse

Answer 14

Recurrence of infection by same organism after discontinuation of treatment
May be due to resistance

Question 15

Re-infection

Answer 15

Recurrence of an infection by a different organism after discontinuation of treatment
Might be some factor that disposes the patient to UTIs

Question 16

Risk factors

Answer 16

Aging (diabetes, urinary stasis, impaired immune response, incontinence)
Female (short urethra, sex, birth control, pregnancy)
Male (prostatic hypertrophy, anal intercourse)
Urinary tract obstruction (tumor or calculi, strictures)
Impaired bladder innervation
Hematogenous spread

Question 17

What family and species is most common for UTI

Answer 17

The Enterobacteriaceae is responsible for 90% of all UTIs (gram negative, facultatively anaerobic, common intestinal flora)
Escherichia coli is most commonly isolated pathogen (70%)

Question 18

What are some virulence factors

Answer 18

Adherence (major)
Motility
P fimbria (bind to P blood group antigen on uro-epithelial cells)
Hemolysins, colicin V (aid in resistance to complement dependent bactericidal effect of serum)
K antigen (associated with upper tract infections)
Type 1 fimbria (interbacterial binding and biofilm formation)

Question 19

3 classical uro-pathogens

Answer 19

Proteus, Morganella Providencia
Urease producing organisms
Increases urinary pH (leads to crystal formation/struvite stone formation that provides substrate for biofilm)
Highly motile, produce fimbria for attachment

Question 20

Staphylococcus saphrophyticus

Answer 20

Coagulase negative
Typically associated with younger, sexually active females
1-5% of cystitis
Identified in the lab using resistance to novobiocin

Question 21

Dipstick testing

Answer 21

Primarily interested in the detection of nitrites and leukocytes produced by infection
Detecting nitrites is not sensitive but is specific
Detecting leukocytes is sensitive but not specific
Combined is great!
RBC detection is not sensitive or specific

Question 22

Sensitivity versus specificity

Answer 22

Sensitivity is the ability of a test to correctly identify those WITH the disease
Specificity is the ability of the test to correctly identify those WITHOUT the disease

Question 23

Chromogenic media

Answer 23

Has certain substances that certain bacteria will use and then change colour
Can tell what bacteria it is just by looking at the colour

Question 24

2 things you MUST have labelled on specimen

Answer 24

Method of collection

Time/date of collection

Question 25

Boric acid tube

Answer 25

Maintains availability of the urine for about 48 hours

Good for those in remote communities

Question 26

3 drugs to treat uncomplicated cystitis

Answer 26

Nitrofurantoin
Fosfomycin
Septra (but a lot of resistance, so not anymore)

Question 27

2 drugs to treat pyelonephritis

Answer 27

Ciprofloxacin

Beta lactam and an aminoglycoside

Question 28

Urine culture

Answer 28

Use SBA and MacConkey plate

Question 29

What is the most common pathogen you’re going to culture from a young women?

Answer 29

E. coli!