MICRO UTIs - Week 8

Question 1

Pyelonephritis

Answer 1

UTI @ kidneys.

Question 2

Cystitis

Answer 2

UTI @ bladder.

Question 3

Urethritis

Answer 3

UTI @ urethra.

Question 4

Pyuria.

Answer 4

Pus cells present in the urine.

Question 5

2 x pathways of pyelonephritis contraction.

Answer 5

Ascending & haematogenous.

Question 6

Most common organisms causing UTIs

Answer 6

E. Coli, proteus.

Question 7

Virulence factors of E. Coli.

Answer 7

• Fimbriae – allow for bladder wall adherence.
• Capsule – inhibits phagocytosis -> pyelonephritis
• Haemolysin – toxin produced by bacteria -> renal injury -> cell membrane damage.

Question 8

Virulence factors of proteus.

Answer 8

• Urease production – increases alkalinity of urine (optimal pH for proteus) -> kidney stone formation.

Question 9

Predisposing factors of UTIs.

Answer 9

• Female – due to shorter length of urethra & closer proximity to anus (potential bacterial source).
• Obstructions (e.g., renal calculi, strictures, tumours, prostatic hypertrophy, pregnancy).
• Catheterisation.
• Neurological voiding issues.
• Diabetes mellitus – when uncontrolled, high glucose can increase bacterial growth and/or for controlled/uncontrolled, neuropathy can also increase risk.
• Vesicoureteral reflux – involving backflow of urine into ureters.
• Primary VUR – usually due to congenital abnormalities.
• Secondary VUR – usually due to blockage/narrowing of bladder neck/urethra.

Question 10

Lower UTI symptoms & upper UTI symptoms.

Answer 10

Lower UTI symptoms:
* Dysuria
* Urgency
* Frequency
* Suprapubic pain
* Fever – generally absent/low grade
* Cloudy/smelly urine.

Upper UTI symptoms:
* Fever
* Chills
* Back pain/flank pain
* Nausea
* Vomiting
* Dysuria
* Frequency.

Question 11

‘Symptoms’ of asymptomatic UTIs in elderly patients or infants.

Answer 11

Elderly pts - restlessness, hallucinations, social withdrawal, agitation, confusion, nausea.
Infants - fever, crying during urination, cloudy/foul-smelling, bloody urine, irritability, vomiting, refusing to eat.

Question 12

Diagnosis of UTI

Answer 12

• Mid-stream urine sample (MSU).
• Microscopy.
• Urine dipstick – particularly nitrites , leukocytes, blood.
• Blood tests WBCs, CRP – particularly if pts present w fever.
• Renal and/or bladder USS
• Voiding cystourethrogram (VCUG).

Question 13

How many cfu/ml must be counted for a properly collected MSU for an UTI diagnosis? What is the number for urine specimens collected from suprapubic aspiration/nephrostomy tube?

Answer 13

> 10^5. ? - does not apply.

Question 14

Management of UTIs

Answer 14

Oral or IV antibiotics w follow-up culture encouraged post treatment.

Question 15

Prevention measures for UTIs

Answer 15

• Drink water
• Cranberry juice
• Wipe from front to back
• Empty bladder soon after intercourse
• Change birth control method – avoid diaphragms and spermicide-treated condoms.

Question 16

For recurrent UTIs in adult men, what should be considered?

Answer 16

Chronic prostatitis.