UTIs

Question 1

What flora is contained in each part of the urinary tract?

Answer 1

• Kidneys/ureters/bladder=sterile

- Urethra=skin/lower GI & perineal flora

Question 2

What does perineal flora consist of?

Answer 2

• Mainly coagulase -ve staph
• Gram +ve staph
• Aerobic bacteria

Question 3

What is cystitis and how does it present?

Answer 3

• Lower UTI
• Dysuria
• Urgency & urinary frequency
• Poly/haem/nocturia
• Supra-pubic pain/tenderness
• Treated with antibiotics

Question 4

What is pyelonephritis and how does it present?

Answer 4

• Upper UTI (kidney/renal pelvis)
• Symptoms of lower UTI
• Abdo/loin pain/tenderness
• Fever
• Systemic infection (rigors, nausea, vomiting)
• Treated with ciprofloxacin, cefuroxime, tazobactam

Question 5

What is urethral syndrome?

Answer 5

• Also abacteria cystitis/frequent dysuria syndrome

- lower UTI symptoms without any infection

Question 6

What criteria is used for significant bacteriuria? Does it have any limitations?

Answer 6

• Kass criteria
• L=many symptomatic females have low bacterial counts, lower bacterial counts than cut off point in males, not relevant to catheter urine or sterile aspirated urine

Question 7

What is sterile pyuria?

Answer 7

• Pus cells in urine

- No organism growth

Question 8

What are predisposing factors for a UTI?

Answer 8

• Female
• Urinary stasis (pregnancy, stones, strictures, tumours)
• Instrumentation
• Sexual intercourse
• Fistulae
• Congenital

Question 9

What are the main sources of UTIs?

Answer 9

• Perineum=movement of bacteria along lumen
• Fistulae= movement of bacteria from genital/GI to urinary tract
• Haematogenous=seeding of infection from blood

Question 10

What are the main organisms responsible for UTIs?

Answer 10

• E.Coli
• Staph Saprophyticus
• Proteus mirabilis
• Enterococcus spp
• Klebsiella
• Pseudomonas aeruginosa

Question 11

What are the causes of sterile pyuria?

Answer 11

• Inhibition of bacterial growth (antibiotics)
• Fastidious organisms (anaerobes, gonorrhoea)
• UT inflammation (stones, renal disease)

Question 12

what are catheter UTIs

Answer 12

• Long-term indwelling catheterization leads to bacteriuria

- Manipulation/removal of catheter may lead to bacteraemia

Question 13

What antibiotics can be given for a UTI?

Answer 13

• Nitrofurantoin

- Trimethoprim