UTI

Question 2

Host Factors contribuiting to UTI

Answer 2

+++ Anatomical factors

Question 3

Host Factors contribuiting to UTI

• Age

Answer 3

Higer in boys < 1 year & in girls < 4 years

Question 4

Host Factors contribuiting to UTI

• Sex

Answer 4

• Females (2-4 folds higher)
• This may be the result of the shorter female urethra.
  Because the incidence of UTI in male neonates is as high, if not higher, than female neonates

Question 5

Host Factors contribuiting to UTI

• Race

Answer 5

White children have 2-4 folds higher than black (for not completely understood reasons )

Question 6

Host Factors contribuiting to UTI

• Genetic

Answer 6

• Higher in first degree relatives
• Adherence of bacteria may be genetically determined.

Question 7

Host Factors contribuiting to UTI

• dysfunctuinal elimination

Answer 7

• An abnormal elimination pattern (frequent or infrequent voids, urgency, constipation)
• Bladder and/or bowel incontinence
• Withholding maneuvers

Question 8

Host Factors contribuiting to UTI

• Circumcision

Answer 8

(Uncircumcised male infants with fever have 4-8 fold higher prevalence)

Question 9

Host Factors contribuiting to UTI

• Catheterization

Answer 9

(Increased Risk with Increased duration of bladder catheterization)

Question 10

Host Factors contribuiting to UTI

• Anatomical abnormalities

Answer 10

• Urinary obstruction
• Vesicoureteral reflux

Question 11

Anatomical abnormalities contributing to UTI

• Urinary Obstruction

Answer 11

Question 12

Anatomical abnormalities contributing to UTI

• VUR

Answer 12

Question 13

RF for Renal Scarring

Answer 13

Question 14

Use of Leucocyte Esterase

Answer 14

• Suggestive of UTI
• However, +ve result doesn’t always signal UTI

Question 15

Test Principle of Leucocyte Esterase

Answer 15

-Leukocyte esterase is present in neutrophils and can be assayed in urine by dipstick strips

Question 16

Sensitivity & Specifity of Leucocyte Esterase

Answer 16

Sensitivity: 84%

Specifity: 78%

Question 17

False Positive in Leucocyte Esterase

Answer 17

• Imipenem
• Clavulanic acid

Question 18

False negative in Leucocyte Esterase

Answer 18

• Ascorbic acid
• Boric acid
• Gentamicin
• Nitrofurantoin
• Cephalexin
• Proteinuria
• Glycosuria
• Urobilinogen

Question 19

Use of Nitrite

Answer 19

• Suggestive of UTI
• Not identify gram +ve infection (Lack nitrate reductase enzyme)

Question 20

Test Principle in Nitrite

Answer 20

• bacterial enzyme nitrate reductase can convert urinary nitrate to nitrite.

Question 21

Sensitivity & Specificity in Nitrite

Answer 21

• 50%
• 98% (Highly specific & low false +ve rate)

Question 22

Microscopic Examination in UTI

Answer 22

Question 23

Def of Pyuria

Answer 23

Question 24

Sensitivity of Pyuria

Answer 24

Sensitivity is 89 % which means it suggests infection, but infection can occur in absence of pyuria

Question 25

Specifity of **Pyuria**

Answer 25

Presence of WBCs in urine is not specific for UTI as pyuria can be present without UTI

Question 26

Causes of Sterile **Pyuria** (False Positive)

Answer 26

- Renal TB - Urethritis - Inflammation near the bladder (appendicitis, Chrons disease) - Intestinal nephritis

Question 27

True UTI without +ve leukocyte esterase on dipstick analysis and > 5 WBC/HPF with standardized microscopy is .......

Answer 27

unusual

Question 28

Absence of pyuria in presence of significant bacteriuria may occur in .....

Answer 28

- Early in the course of UTI (before the local inflammatory response develops - Bacterial contamination of the urine sample (e.g. from the urethra or periurethral) - Colonization of the urinary tract (e.g. asymptomatic bacteriuria)

Question 29

Pyuria & Bacteruria association

Answer 29

Question 30

..... is the gold standard for the diagnosis of UTI.

Answer 30

Urine culture

Question 31

Urine culture should be performed in the following groups, even if the dipstick and microscopic analysis are negative:

Answer 31

Question 32

Urine culture interpretation in UTI

Answer 32

Question 33

Imaging in Dx of UTI - value of US

Answer 33

Question 34

VCUG in UTI - Time

Answer 34

3-6 weeks after infection but can be done after completing of antibiotic therapy

Question 35

VCUG in UTI - Prophylactic Antibiotics

Answer 35

- Prophylactic oral antibiotics should be given for 3 days with VCUG taking place on the 2nd day

Question 36

VCUG in UTI - Uses

Answer 36

Question 37

Technique of **Tc-99m DMSA scintigraphy** in UTI

Answer 37

Question 38

What is the gold standard test for diagnosing acute pyelonephritis and renal scars?

Answer 38

Tc-99m DMSA scintigraphy

Question 39

DMSA in UTI - Disadvantages

Answer 39

However, it doesn't distinguish lesions that will spontaneously resolve from those which cause renal scarring

Question 40

DMSA in UTI - How to overcome the drawbacks?

Answer 40

Thus, a delay of 4 - 6 months is needed following acute pyelonephritis to allow acute reversible lesions to resolve in order to diagnose renal scarring

Question 41

TTT of UTI - Goals

Answer 41

Question 42

TTT of UTI - Hygeinic Measures

Answer 42

Question 43

TTT of UTI - Oral Antibiotics

Answer 43

Question 44

TTT of UTI - Duration of Antibiotics

Answer 44

Question 45

TTT of UTI - For pyelonephritis

Answer 45

Question 46

TTT of UTI - For Cystitis

Answer 46

Question 47

Suppressive Therapy in UTI - Indications

Answer 47

VUR → Till reflux resolves especially in children < 5 years of age.

Question 48

Suppressive Therapy in UTI - Duration

Answer 48

Antibiotic prophylaxis is continued for up to 6 months after surgical correction of VUR.

Question 49

Suppressive Therapy in UTI - Drugs

Answer 49

Question 50

DOC for suppressive therapy in UTI in first 3 months of life

Answer 50

Cephalexin

Question 51

Prognosis of UTI

Answer 51

- Recurrent UTI - HTN - Renal scarring