34 - UTI

Question 1

What flora would be present in urethra

Answer 1

Perineal flora

Question 2

What is in perineal flora

Answer 2

Skin flora + similar to the orifice

Anaerobic bacteria
Aerobic - enterobacteria
Gram-+ve cocci - enterococcus

Question 3

Cystitis

Answer 3

Low urinary tract infection

Syndrome: dysuria
Urinary freq.
Urgency
Supra-pubic pain/tenderness
Polyuria, nocturia, haematuria

Question 4

Pyelonephritis

Answer 4

Upper UTI - kidney and/or renal pelvis

Symptoms of lower UTI
Loin/ab pain/tenderness
Fever

Systemic infection evidence - rigors, nausea, vomiting, diarrhoea w/ elevated CRP + WBC

Question 5

Urethral syndrome

Answer 5

aka Abacterial cystitis
aka frequency-dysuria syndrome

30-50 yo women
UTI symptoms w/o demonstrable infection

Aetiology - hormones, inflammation of skene / paraurethral glands, foods, environmental chemicals, hypersensitivity, traumatic intercourse

Question 6

“the female prostate” inc.

Answer 6

Skene glands / paraurethral glands

Question 7

Number of bacteria/ml urine - normal

Answer 7

10^2

Question 8

Number of bacteria/ml urine - abnormal

Answer 8

10^5 - lower in men

Question 9

Sterile pyuria - definition

Answer 9

Pus cells in urine which doesn’t grow in culture

Question 10

Predisposing factors for UTI

Answer 10

Sex 10f:1m
Urinary stasis - pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
Sex
Fistulae
Congenital - vesico-ureteric reflux

Question 11

Sources of infection for UTI

Answer 11

Perineum - bacteria along lumen

Fistulae - bacteria from genital/GI to urinary

Haematogenous - seeding of infection

Question 12

Most common cause of UTI

Answer 12

E.coli

Question 13

Which organism is noticeably more responsible for UTIs in hospitals

Answer 13

Enterococcus

Question 14

Causes of sterile pyuria

Answer 14

Inhibition of bacterial growth via antibiotics or contaminated specimen

Fastidous (hard to grow) organisms

Urinary tract inflammation via renal/bladder stones or other renal disease

Question 15

Fastidous organisms e.g.

Answer 15

Mycobacterium TB
Haemophilus spp.
Neisseria gonorrheaae
Anaerobes

Question 16

Catheter UTI

Answer 16

Need to distinguish between colonisation and infection via clinical features

History of infections w/ catheter
Purulent urethral/suprapubic catheter exit site discharge

Catheter or meatal/suprapubic catheter exit site colonisation with Staph. aureus (inc. MRSA)

Question 17

Tests for UTI

Answer 17

Dipstick
Bloods
Microbiological
Imaging

Question 18

Dipstick tests what parameters usefully

Answer 18

Blood
Protein
Nitrite
WBCs

Question 19

Microbiological tests

Answer 19

Urine - mid-stream, catheter urine, ‘clean-catch,’ supra-pubic aspirate

Blood: suspected pyelonephritis

Tests inc. microscopy, culture and sensitivity testing

Question 20

Mid-stream urine testing

Answer 20

Sample procurement needs specific instructions

Transport via boric acid preservative

Sample processed in semi-quantative culture

Question 21

Special test - early morning urine (EMU) x 3

Answer 21

Whole content of bladder

Suspected urinary tuberculosis

Question 22

Further investigations indicated when:

Answer 22

recurrent UTI
any UTI in male patient
any UTI in childhood
Pyelonephritis

Question 23

What further investigations would you do?

Answer 23

Renal tract USS

Specialised tests inc. isotope scans, micturating cystourethrogram

Question 24

UTI antiobiotics

Answer 24

Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin

Question 25

Treatment for cystitis

Answer 25

Treatment pre-empts microbiology report

Short antibiotic course of 3 days for females

7 days course for males

Question 26

Treatment for pyelonephritis

Answer 26

Empiric therapy w/ cefuroxime, ciprofloxacin

Piperacillin-tazobactam if >65 yo

Targeted therapy based on sensitivity results

7-14 day course of antibiotics

Question 27

Asymptomatic bacteriuria treatment

Answer 27

Treat only specific groups:

Pregnant - association w/ upper UTI, pre-term delivery, + low birth weight babies

Infant - prevention of pyelonephritis and renal damage

Prior to urological procedures

Elderly are catheterised