UTIs

Question 1

What is a UTI

Answer 1

• Inflammatory response of the urothelium to bacterial invasion
• Usually associated with bacteriuria & pyuria
• Bacterial infection of the urine with>10^5 colony forming units/ml of urine. (allow lower counts in symptomatic pts)

Question 2

Define bacteriuria

Answer 2

The presence of bacteria in the urine, which may be symptomatic or asymptomatic

Question 3

Define pyuria

Answer 3

The presence of WBCs (>/=10per HPF x400) in the urine

Question 4

Define pyelonephritis

Answer 4

Inflammation of the kidney due to a bacterial infection

Question 5

What falls under simple/uncomplicated UTIs

Answer 5

• Female
• First presentation
• Not pregnant
• No signs of pyelonephritis

Question 6

What falls under complicated UTIs

Answer 6

• Male
• Recurrent UTIs
• Pregnancy
• Elderly
• Catheter related
• Children

Question 7

Why are UTIs more common in women

Answer 7

cos they have a shorter urethra so bacteria don’t have to travel much distance to reach the bladder

Question 8

Outline the difference between ‘recurrent UTIs’ and ‘Persistent UTIs’

Answer 8

1. ) Recurrent UTIs= >2 in 6/12 (or >3 in 1 year)

2. ) Persistent UTIs= hasn’t been managed or organism is resistant to the abx you have given

Question 9

State and give egs of the different types of UTIs

Answer 9

1. ) Lower UTIs:
   - urethritis
   - cystisis
   - prostatitis
2. ) Upper UTIs:
   - Pyelonephritis
   - Intrarenal/perinephric abscess (this may be a reason for no improvement on treatment cos the abscess would need to be drained)

Question 10

What are the risk factors for a UTI

Answer 10

• previous UTI
• surgery
• catheterisation
• upper tract obstruction (stones)
• Neurogenic bladder

adults:

• sex,spermicides;diaphragm
• pregnancy
• diabetes mellitus
• BPE

older age:

• prolapse
• oestrogen deficiency

Question 11

Outline the different uropathogens

Answer 11

• streptococci
• proteus
• Klebsiella
• E coli
• Staphylococci

Question 12

How can we classify bacteria?

Answer 12

1. )COCCI(round)
   - Gram positive: staphylococcus;streptococcus;enterococcus
   - Gram negative: Aerobes=neisseria
2. ) BACILLI(RODS)
   - Gram positive: a.) Aerobes=corynebacteria(c.urealyticum)
   b. )anaerobes= lactobacillus

• Gram negative
  a. ) Aerobes= enterobacteria(escherichia, Klebsiella, proteus), peudomonas
  b. ) Anaerobes: bacteroides

3. )Others:
   - Filamentous bacteria(M.tuberculosis), chlamydiae, fungi, mycoplasma

Question 13

Outline the characteristics of STD: what it may be; symptoms; investigations & examinations

Answer 13

• Chlamydia trachomatis or Neisseria gonorrhea
• Chlamydia= frequently asymptomatic in females, but can present with dysuria, discharge or pelvic inflammatory disease
• Send urinalysis, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
• Pelvic exam-send discharge from cervix or urethra for chlamydia PCR
• Low estrogen in post menopausal women

Question 14

Define post void residual

Answer 14

The amount of urine left in your bladder after using the toilet

Question 15

How can a MSU be used as a useful assessment for STD

Answer 15

• urine dipstick +/- microscopy
• Ensure accurate collection of mid stream sample
• Process specimen promptly, or refrigerate to prevent overgrowth of contaminants

Question 16

What further investigations may be carried out following complications to an STD?

Answer 16

• Imaging: USS&PVR(post void residual bladder), KUB(kidney,ureter&bladder) X-ray
• Cytoscopy

Question 17

In which cases should asymptomatic bacteriuria be treated?

Answer 17

• Pregnancy
• Patients prior to undergoing a surgical procedure
• Post renal transplant-early postop (cos you would’ve immunosuppressed them so something which is aysmptomatic could turn into a full blown UTI)

Question 18

Outline the mechanism of penicillin/cephaloporin

Answer 18

• bactericidal

- Inhibits bacterial wall synthesis

Question 19

Outline the mechanism of aminoglycosides

Answer 19

• bactericidal

- Inhibits ribosomal protein synthesis

Question 20

outline the mechanism of tetracyclines

Answer 20

bacteriostatic

-translocation interference

Question 21

Outline the mechanism of trimethoprim

Answer 21

bacteriostatic

• nucleic acid interference
• dihydrofolate reductase inhibition

Question 22

Outline the mechanism of Fluroquinolones

Answer 22

bacteriostatic

-inhibit DNA gyrase

Question 23

Why is routine use of prophylactic abx in catheterized pts not recommended

Answer 23

• Because the actual bugs are sitting on the catheter
• There’s no way you can penetrate the catheter with the abx so there’s no point in treating them
• If the urine looks ‘mucky’ or they have a UTI you’ll have to change the catether and give abx if really needed

Question 24

What strategies are available to reduce risk of UTI

Answer 24

1. ) ABX
2. ) Behaviour
3. )Cranberry
4. ) Developing vaccines D-mannose
5. )Estrogens

Question 25

How can lifestyle measures reduce the risk of a UTI

Answer 25

- increased fluid intake - post-coital voiding - perineal hygiene

Question 26

Which fruit may present risk of UTI

Answer 26

cranberry | -better concentration when taken as tablets

Question 27

Which vaccines may reduce risk of UTI

Answer 27

- Urovac:vaginal mucosal vaccine - Intranasal vaccine for proteus mirabilis - PapDG vaccine for E coli - Fim CH vaccine for E coli - Vaccine for chlamydia Trachomatis

Question 28

How can administration of estrogens reduce risk of UTI

Answer 28

- giving women topic estrogens to rebalance pH levels; meaning the Ecoli are less able to attach, reduces risk of UTI - Post menopausal they sometimes get atrophic vaginitis i.e the area in/around the vagina becomes beneficial/correct for the e coli to attach due to the change in environment - Ensure no contraindications: eg DVTs/ Ca breast

Question 29

What are the symptoms of UTI

Answer 29

- burning, frequency, urgency of peeing - Pyuria= pus m(WBC) in the urine - Urine culture- growth of bacteria in the urine