Week 4 - A(3) - Microbiology of UTI tutorial in labs

Question 1

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Answer 1

a) - It is a gut commensal - most numerous aerobe in the gut flora b) - There is loin pain and the patient has shivers (rigors) c) - Sensitivity of the antibiotic, lower or upper UTI, is the antibiotic secreted in the urine

Question 2

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Answer 2

e) - Nitrofurantoin only has effects as far as the bladder and activates here d) - IV amoxicillin + gentamicin e) patients weight and creatinine

Question 3

Instead of giving amoxicillin and gentamicin IV, what would be given if the patient was penicillin hypersensitive?

Answer 3

Would give IV co-trimoxazole + gentamicin

Question 4

g- Give two reasons why erythromycin is NOT a suitable antibiotic for the treatment of UTI in a penicillin-hypersensitive patient.

Answer 4

Erythromycin is not active against coliforms - active against the atypical gram negative organsisms

Question 5

3a and c urine is cloudy 3b is clear

Answer 5

3a) - Yes send - symptomatic and urine is cloudy 3b - do not send - asymptomatic and urine is clear 3c) - yes, it is symptomatic and urine is cloudy

Question 6

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Answer 6

a) - patients symptoms are suggestive of UTI b) could be to antibiotics or abacterial cystitis

Question 7

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Answer 7

c) - Patient has abacterial cystitis d) - plenty of fluid and pain medication e) - Consider STI

Question 8

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Answer 8

a) The sample is two days old and therefore any bacteria would have colonised it b) Should get rid of the specimen c) Use a boricon container (red cap) as it lasts 24 hours and make sure gets to the lab in time

Question 9

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Answer 9

a) NO b) Yes c) No d) No e) - resitance - can lead to catheter colonisation, C.difficile could arise,

Question 10

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Answer 10

f - Patinet has non severe CDiff g - prescribe oral metronidazole h - All of the abovea (The patient should be in a single room, Gloves and plastic aprons should be worn when emptying faeces containers, the patient should have his own commode) i - No do not test for cure

Question 11

Patinet had >10^5 organisms/ml even though she is asymptomatic

Answer 11

a) - asymptomatic bacteruria b) - yes c) - choose nitrofurantoin if 1st or 2nd trimester, choose trimethoprim if 3rd semester d) - could develop pyelonephritis (common in 30% of women) and can cause intrauterine growth retardation in child

Question 12

Case 7 You are working as a GP trainee in a busy surgery. The Practice Nurse, who is seeing a 76 year old lady for review of her Type 2 diabetes, asks you to complete a request to send the patient’s urine to the Microbiology lab. The nurse has “dipstick” tested the urine and it is positive for nitrites (only). It is negative for protein, glucose, blood, ketones and leukocyte esterase (a) What other critical information do you need to know about the patient?

Answer 12

Does she have any symptoms

Question 13

The patient tells you she has NO dysuria, frequency, urgency or nocturia. She does not feel unwell. Should you send her urine to lab?

Answer 13

NO - she is not symptomatic

Question 14

The nurse says that she would normally send the urine for culture in this situation and the urine is sent to the Microbiology lab. The urine culture result comes back 2 days later (see report) (c) Are you going to prescribe antibiotics for this patient, and if so, what would you prescribe?

Answer 14

Do not prescribe antibiotics

Question 15

A negative dip stick test for leukocyte esterase (white cells) is a useful test to rule out UTI when combined with a negative nitrite test (negative predictive value of 95%). If both blood and protein are present in the urine, what should you consider checking?

Answer 15

CRP, ANCA, ANA and plasma electrophoresiss for myeloma