W20 - UTI

Question 1

Bacteriuria - definition

Answer 1

Bacteriuria: the presence of bacteria in the urine.

Question 2

Define Cystitis

Answer 2

Cystitis: inflammation of the bladder, often caused by infection.

Question 3

Uncomplicated UTI vs complication UTI

Answer 3

• Uncomplicated urinary tract infection refers to infection in a structurally and neurologically normal urinary tract.
• Complicated urinary tract infection refers to infection in a urinary tract with functional or structural abnormalities (including indwelling catheters and calculi).

Question 4

Complicated UTI generally means infection in:

4 groups of people - name them

Answer 4

men

• pregnant women
• children
• patients who are hospitalised or in health care–associated settings

Question 5

________ is by far the most frequent infecting organism in acute UTI

Answer 5

E. coli is by far the most frequent infecting organism in acute UTI

Question 6

Other than E coli, name 3 other causative organisms for UTIs

Answer 6

Klebsiella

Proteus

Enterococci

Question 7

Name 3 antibacterial host defences in the urinary tract

Answer 7

1. Urine (osmolality, pH, organic acids)
2. Urine flow and micturition
3. Urinary tract mucosa (bactericidal activity, cytokines)

Question 8

Obstruction can cause renal pooling, multiplication of bacteria, and subsequent UTI.

Name some intra-renal and post-renal causes of obstruction

Answer 8

Intra-renal:

1. nephrocalcinosis
2. uric acid nephropathy
3. analgesic nephropathy
4. PCKD

Post-renal:

1. Valves, stenosis, bands
2. calculi
3. extrinsic ureteral compression (BPH)

Neurogenic dysfunction:

1. Polymyelitis
2. Tabes dorsalis
3. diabetic neuropathy
4. spinal cord injury

Question 9

UTI symptoms (3) in neones and children <2 years of age

Answer 9

• Failure to thrive
• vomiting
• fever

Question 10

UTI symptoms (3) in children >2yr

Answer 10

• frequency
• dysuri
• abdo or flank pain

Question 11

3 inventigations for uncomplicated UTI/pyelonephritis

1 investigation if complicated UTI

Answer 11

1. Urine dipstick - nitrites, leukocytes
2. MSU for urine MC&S
3. Bloods: FBC, U&Es, CRP

+ Renal USS/ IV urography if complicated

Question 12

What do each of the following mean when seen in microscopy of a urine sample?

1. White cell pyuria?
2. Squmous epithelial cell?

Answer 12

• White cells Pyuria – indicative of infection
• Squamous epithelial cells – indicative of contamination

Question 13

What does this micrscopy slide of a urine sample show? what is the fried egg cell?

Answer 13

Fried egg cell = squamous epithelial cells

suggests contaminated sample

Question 15

Some causes (6) of sterile pyuria

Question 16

1st line UTI abx treatment for each of below:

1. UTI (uncomplicated, female)
2. UTI (pregnant, or breastfeeding)
3. UTI (male)
4. Pyelonephritis, or urosepsis

Question 17

Pyelonephritis is infection of

Answer 17

the kidney

Question 18

Pyelonephritis - common abx prescribed

Answer 18

co-amoxiclav +/- IV gentamicin