UTIs W3

Question 1

name for infection of the upper urinary tract?

Answer 1

pyelonephritis

Question 2

name for infection of the lower urinary tract?

Answer 2

cystitis

Question 3

risk factors for uncomplicated UTIs?

Answer 3

females
previous UTIs
sexual activity
vaginal infection
diabetes
obesity
genetic
older age (oestrogen deficiency, cog impairment)

Question 4

who gets complicated UTIs?

Answer 4

patients with factors that compromise the urinary tract or host defence:
-urinary obstruction (prolapse, enlargement)
-urinary retention caused by neuro disease
-immunosuppression
-renal failure
-renal transplantation
-pregnancy
-presence of foreign bodies (catheters etc)

Question 5

post menopause and UTIs?

Answer 5

more susceptible due to vaginal dryness

Question 6

why does urinary obstruction/retention cause UTIs

Answer 6

causes stagnant urine

Question 7

features of gram positive organisms

Answer 7

thick cell walls
live in dry places (skin, muscular and soft tissue infections)
eg staph and strep

Question 8

features of gram negative organisms

Answer 8

soft cell membrane
live in wetter places (gallbladder, urinary tract, gut)
eg e-coli

Question 9

what type of organism causes UTIs? what is the most common cause?

Answer 9

UTIs are normally caused by gram negative organisms.
UPEC - uropathogenic E coli

Question 10

UTI pathophysiology?

Answer 10

uropathogen from the gut contaminates periurethral area. urethra colonised, migrates and colonises bladder. neutrophil infiltration, bacterial multiplication and immune system subversion. biofilm formation, epithelial damage. ascension to and colonisation of the kidneys. bacteraemia (bacteria in blood)

Question 11

how is the bladder cell wall invaded? what does this lead to?

Answer 11

type 1 pili. multiplication to form intracellular bacterial communities. these exfoliate or form quiescent bacterial reservoirs.

Question 12

what may quiescent bacterial reservoirs cause and why

Answer 12

recurrent UTI as difficult to kill with antibiotics due to hibernating state.

Question 13

bacteria virulence factors?

Answer 13

adherence - pili, adhesins
toxin production - eg haemolysins
immune evasion - eg capsule
iron acquisition
other - flagella

Question 14

haemolysins?

Answer 14

break down haem to provide food for bacteria

Question 15

antibacterial defences?

Answer 15

urine (low pH and high urea make it toxic for bacteria)
urine flow
urinary tract mucosa (bactericidal activity, cytokines)
urinary inhibitors of bacterial adherence (tamm-horsfall protein)
inflammatory response

Question 16

types of UTI in males?

Answer 16

urethritis - urethra
prostatitis - prostate
epididymis-orchitis - epididymis
cystitis - bladder
pyelonephritis - kidneys

Question 17

why is prostatitis difficult to treat?

Answer 17

only certain antibiotics can penetrate the prostate. usually needs a longer course of treatment.

Question 18

clinical presentation of pyelonephritis?

Answer 18

loin pain/flank tenderness
fever/rigors
sepsis

Question 19

clinical presentation of cystitis?

Answer 19

dysuria
frequency
urgency
suprapubic tenderness

Question 20

clinical presentation of UTIs in infants?

Answer 20

vomiting, fever

Question 21

clinical presentation of UTIs in elderly?

Answer 21

less localised symptoms. confusion/falls

Question 22

dysuria?

Answer 22

painful urination

Question 23

who should the dipstick be used for and why?

Answer 23

patients <65 only in presence of clinical UTI symptoms.

asymptomatic bacteria commonly present in elderly cause no harm and can play a role in preventing UTIs, but cause positive results on the dipstick.

Question 24

types of bacteriuria definitions? - from urine culture results

Answer 24

significant bacteriuria: indicates number of bacteria in voided urine exceeds the number expected from contamination from the anterior urethra

asymptomatic bacteriuria: significant bacteriuria in a patient without symptoms (only ever treated in pregnant women)

symptomatic bacteriuria: UTI

Question 25

antibiotics for cystitis?

Answer 25

trimethoprim: 200mg every 12 hours. 3 days for women, 7 days for men.

nitrofurantoin - 100mg every 12 hours. ONLY FOR CYSTITIS!!!

Question 26

who is nitrofurantoin unsafe for?

Answer 26

patients with fever and loin pain.

Question 27

antibiotics for cystitis negatives?

Answer 27

increases risk of recurrent UTI
increases antimicrobial resistance

Question 28

antibiotics for pyelonephritis?

Answer 28

gentamicin. consider adding amoxicillin (vancomycin for penicillin allergy)

Question 29

when is amoxicillin or vancomycin added to pyelonephritis treatment?

Answer 29

enterococcus isolated in urine in last 12 months or
source of infection is unclear or
patient has signs of severe sepsis

Question 30

antibiotics for catheter associated UTI?

Answer 30

gentamicin
may only need single shot of gentamicin and a catheter change.

Question 31

how are catheter associated UTIs diagnosed?

Answer 31

clinically!!!
don’t use dipstick or urine culture - will prob be positive regardless.

Question 32

UTI management for men?

Answer 32

is prostate involved? - requires longer treatment and specific antibiotics

Question 33

UTI management for pregnant women?

Answer 33

treat asymptomatic bacteria - reduces risk of pyelonephritis which can lead to pre-term labour

Question 34

UTI management for children?

Answer 34

need investigation and consideration of vesico-ureteric reflux (reflux from bladder to ureter, common cause for dialysis)

Question 35

advice for recurrent UTIs?

Answer 35

fluid intake 2-2.5L per day
avoid fizzy drinks, caffeine, alcohol
intercourse advice - lubrication, pre and post coital voiding, personal hygiene, positioning to reduce friction
STI screening
hygiene - wipe front to back
avoid perfumed products
treat constipation
consider weight reduction
stop smoking