UTIs

Question 1

What defines a recurrent UTI?

Answer 1

3 symptomatic UTIs within a year (following therapy)

Question 2

What defines a relapse UTI?

Answer 2

Same bacterial organism within 7 days

*after completing the antibacterial treatment

Question 3

What defines a reinfection?

Answer 3

Bacterium absent for 14 days post treatment, infection comes back same or diff organism

Question 4

What are 4 risk factors for developing a UTI?

Answer 4

Female, age, comorbidities change pH, institutional care

Question 5

What’s the difference between a complicated and uncomplicated UTI?

Answer 5

Uncomplicated: Infection via usual pathogen, person has normal UT/kidney function

Complicated: everything else

Question 6

Name 5 things that can present as inflamed in a patient with a UTI

Answer 6

1. Pyelonephritis
2. cystitis; bladder
3. urethritis
4. epididymitis
5. prostatitis

Question 7

List 6 typical symptoms of a UTI

Answer 7

Frequency, dysuria, bad smell, lower abdo pain, urge incontinence, unspecific discomfort; aching, nausea

Question 8

How would you diagnose a severe UTI?

Answer 8

3 or more of following symptoms:

1. polyuria: >3L a day of urine 2. frequency
2. hematuria
3. suprapubic tenderness
4. urgency
5. dysuria

Question 9

How would you treat women under 65 presenting with 3 severe UTI symptoms without discharge

Answer 9

Immediate treatment

*high chance culture is +ve

Question 10

How would you treat a women over 65 with symptoms and discharge

Answer 10

Culture

*less chance of UTI

Question 11

Two UTI differentials

Answer 11

Sexually transmitted diseases, sepsis

Question 12

How does a mild UTI present and what investigations would you do?

Answer 12

2 or less symptoms:

dipstick test: check nitrates IF cloudy

Question 13

Which urine dipstick results indicate a definite UTI, probably UTI and the likelihood of a different disease?

Answer 13

Definite: positive nitrites (with/without leukocytes and blood)

Possible: negative nitrites but positive leukocytes

Sm else: -ve all 3 OR just +ve blood and protein

Question 14

Why are nitrites indicative of infection? What time of day is best to test for them?

Answer 14

Bacteria in urine releases nitrate reductase enzyme: reduces nitrates-> nitrites

Morning (built up over night)

Question 15

How should you treat an asymptomatic woman over 65?

Answer 15

Only send for urine culture if 2+ signs of infection (especially temperature),

*those with no symptoms usually don’t need treatment

Question 16

List 6-7 scenarios where you would perform an automatic urine culture

Answer 16

1. Pregnancy
2. suspected pyelonephritis
3. suspected UTI in men:
4. Failed antibiotic treatment or recurrent symptoms
5. Recurrent UTI
6. Abnormalities in the GU system
7. Renal impairment: (undiagnosed UTI would make the renal impairment worse)

Question 17

What could happen to the fetus if the mother has a UTI?

Answer 17

death, developmental delay, cerebral palsy

Question 18

How do UTIs often present in children?

Answer 18

Unexplainable fever.

Question 19

What is the difference between a white top and a red top container?

Answer 19

Red top has boric acid (culture can be left room temp for longer)

Question 20

What is the main organism causing uncomplicated UTIs?

Answer 20

E-coli

Question 21

Name 3 organisms that can cause an uncomplicated and complicated UTI

Answer 21

Klebsiella, Staphlococci, Proteus

Question 22

List 3 ways that bacteria can spread through the urinary tract

Answer 22

Catheters, infection from urethra (esp females), blood/lymphatics

Question 23

Name 3 things our UT does to protect itself

Answer 23

Transitional cells secrete glucosamine: forms mucin layer - prevents bacterial spread

Low pH and urea

Bladder sheds inflamed layers (eradicates bacteria attached to epithelia)

Question 24

List 2 antibiotics you could prescribe for a UTI and how long antibiotic treatment is in males and females

Answer 24

Nitrofurantoin: good for genital infection if renal function is working

Trimethoprim 3 days women, 7 days men

Question 25

At what age do men most commonly acquire UTI?

Answer 25

> 65