UTIs

Question 1

What is asymptomatic bacteriuria?

Answer 1

Presence of bacteria in the urine with no symptoms

In preg its associated with pre-term labour

High prevalence in older people especially females

Question 2

What host factors enable UTIs?

Answer 2

Shorter urethra = more infect in females

Obstruction = enlarged prostate, preg, stones, tumours

Neurological probs = incomplete emptying, residual urine

Ureteric reflex = ascending infec from bladder

Question 3

Outline the possible sites and causes of urinary tract infection

Answer 3

PUJ = calculi

Ureter = calculi, Ca, retroperitoneal fibrosis

Bladder = neuropathic bladder

VUJ = calculi

Bladder neck = hypertrophy

Prostate = BPH, Ca

Urethra = stricture

Question 4

What bacterial factors enable UTI?

Answer 4

Fimbriae = attachment to ep

Haemolysins = damage host mem, renal damage

K Ag = prod of polysaccharide capsule

Urease = breaks down urea creating environment favourable for bacterial growth

Question 5

What is cystitis?

Answer 5

Lower UTI

Question 6

What is pyelonephritis?

Answer 6

Upper UTI

Question 7

Describe the signs/symptoms of lower UTIs

Answer 7

Dysuria

Frequency

Urgency

Sometimes low grade fever

Question 8

Describe the signs/symptoms of an upper UTIs

Answer 8

Fever

Loin pain

May have dysuria, frequency

Question 9

Define an uncomplicated UTI

Answer 9

Infection by a usual organism in a pt with a normal urinary tract and normal urinary function

Question 10

Define a complicated UTI

Answer 10

When one or more factors are present that predispose the person to persistent infect, recurrent infect, or treatment failure

Abnormal urinary tract

Virulent organism

Impaired host defences

Impaired renal function

Question 11

How can we collect a urine sample?

Answer 11

MSU = first part may be contaminated

Clean catch in children

Collection bag

Catheter sample (never collect from bag, it will always be infected, always use ports)

Supra-pubic aspiration

Transport = 4 degrees, with boric acid (helps stem overgrowth)

Question 12

Outline near pt testing

Answer 12

Turbidity = clear then non infect

Dipstick = leucocyte esterase, nitrite, haematuria, proteinuria

Question 13

What factors are important on a urine dipstick regarding a UTI?

Answer 13

Leucocyte esterase = presence of WBCs

Nitrite = bacteria produce urease which breaks down to nitrites

Haematuria = inflam, cancer, infection

Proteinuria = DM, hypertension

Question 14

What is always seen on a urine dip in catheterised pts?

Answer 14

WBCs

Bacteria

Question 15

What is a significant bacterial count in urine analysis?

Answer 15

10^5 cfu/ml

Question 16

What is the role of culture in a urine infection?

Answer 16

Identifying the causative organism

E.coli = pink

Klebsiella = creamy/white

Sensitivity testing

Question 17

Why do we image the urinary tract?

Answer 17

Considered in all children with UTI

Valuable in septic pts to identify renal involvement

Question 18

What is sterile pyuria and its causes?

Answer 18

Presence of elevated WBCs in urine which appears sterile using standard culture techniques

UTI with fastidious organism

Renal TB

Vaginal infection/inflam

Question 19

Outline the treatment for UTI

Answer 19

Increase fluid intake

Uncomplicated = 3 day course Abx – trimethoprim

Complicated lower = 5-7 day course Abx – trimethoprim, nitrofurantoin, cephalexin

Question 20

Describe the treatment of pyelonephritis/septicaemia

Answer 20

14 day course

IV initially

Co-amoxiclav, ciprofloxacin, gentamicin

Question 21

When is prophylaxis for UTIs given?

Answer 21

Particularly useful for children with repeated episodes

3 or more episodes in 1 year

When no treatable underlying condition

Trimethoprim/nitrofurantoin