UTI - E. Spivak 2017

Question 1

Bacterial infection of the bladder confined to lower urinary tract is called what?

Answer 1

Acute cystitis

Question 2

Bacterial infection of upper urinary tract is called what?

Answer 2

Acute pyelonephritis

Question 3

What are the 3 criteria for uncomplicated UTIs?

Answer 3

1-Not pregnant
2-Normal urinary anatomy
3-No co-morbidities

Question 4

What are the 6 criteria that would make a patient a complicated UTI case?

Answer 4

1-Pregnant
2-Abnormal urological anatomy
3-Diabetes mellitus
4-Immune compromise
5-Indwelling bladder catheter
6-Male Gender

Question 5

A healthy individual should have what kind of bacterial colonization?

Answer 5

None. Urine should be sterile in a healthy young person

Question 6

85% of bacteria that cause UTIs are what?

Answer 6

Gram negative colonizers of GI tract

*ie. E. Coli, proteus mirabilis, klebsiella pneumoniae

Question 7

Pili, flagella, adhesins, siderophores, toxins and polysaccharide coating on E. Coli are referred to as what?

Answer 7

Virulence factors

*allows it to be uropathogenic

Question 8

Pain or burning with urination (dysuria), increased frequency and urgency of urination and suprapubic pain are symptoms suggesting what?

Answer 8

Cystitis

Question 9

Fever/chills, flank pain, nausea/vomiting plus symptoms of cystitis could suggest what?

Answer 9

Pyelonephritis

Question 10

What 3 things are necessary for a UTI diagnosis?

Answer 10

1-Symptoms
2-Urine culture of 10^5 CFU/mL

*Positive culture without symptoms is asymptomatic bacteriuria

Question 11

What drugs do we use to treat Uncomplicated cystitis

Answer 11

Nitrofurantoin, Trimethoprim-sulfamethoxazole and fosftomycin

Question 12

What drug classes do we use to treat Uncomplicated pyelonephritis?

Answer 12

Fluoroquinolones, trimethoprim-sulfamethoxazole and B-lactams

Question 13

UTI develops in _____% of patients with indwelling urinary catheters

Answer 13

> 10%

Question 14

In healthy individuals in the absence of infection, which bacteria typically colonizes the lower urinary tract? 
A. Staph aureus
B. Proteus species
C. E. Coli
D. None of the above

Answer 14

D none of the aove

Question 15

What is the predominant pathogen in UTI’s? What are some other ones that are not predominant

Answer 15

E. Coli

Proteus mirabilis
Klebsiella pneumonia
Staph saprophyticus

Question 16

T/F either pyuria or “Nitrite positive” alone is an indication to prescribe antibiotics because it is specific to UTIs

Answer 16

False. Neither is sufficient for diagnosis of UTI and prescription of antibiotics

Question 17

T/F pyuria is common in patients with asymptomatic bacteruria

Answer 17

True. Especially in Dialysis or elderly patients and even pregnant women and people with short-term catheters

Question 18

We are trending toward prescribing narrower spectrum antibiotics for UTI’s T/F

Answer 18

true

Question 19

for asymptomatic bacteruria we do not give antibiotics unless 1 of 4 things is part of this patient? What are those 4 things

Answer 19

pregnant
pre-urology procedure
renal transplant
neutropenic

Question 20

T/F antibiotics do not decrease ASB or prevent subsequent development of UTI

Answer 20

True

Question 21

who has the highest prevalence of Asymptomatic bacteruria?

Answer 21

female long term care residents

Question 22

What is the 2 consequences that Spivak stressed when talking about giving Abx unnecessarily?

Answer 22

developing Abx resistant organisms

Missing the real diagnosis

Question 23

What are the symptoms of catheter-associated UTIs?

Answer 23

usually lack typical UTI symptoms
new fever with no other source
CVA tenderness, flank pain, pelvic discomfort

Question 24

if you have a patient who you think has a CA-UTI but they have no pyuria, what is your diagnosis?

Answer 24

you rule out CA-UTI

Question 25

what is the treatment for CA-UTI?

Answer 25

remove catheter and replace it if it has been in over 2 weeks if they still need a catheter

7 days of Abx if prompt response
or 3 days of Abx if in female patient with no evidence of pyelonephritis