Urinary Tract Infections

Question 1

What risks increase your chance of getting a UTI?

Answer 1

• women over men have an increased risk
• pregnancy increases the risk
• sexual activity
• the elderly have an increased risk
• patients with comorbid conditions (diabetes, spinal cord injuries, catheters, GU tract abnormalities)

Question 2

How is the urinary tract infection usually spread in the body?

Answer 2

• the bacteria is usually acquired from the urethra to the bladder, where the infection could then have the potential to spread to the kidney (occasionally can also penetrate into the bloodstream and cause septicaemia)

Question 3

What is hematogenous spread of a UTI referring to?

Answer 3

• the kidney is the first organ that is affected by the infection

Question 4

In which population of people is treatment recommend for certain individuals?

Answer 4

• during pregnancy and prostate resection

Question 5

_______ are readily treated with antibiotics

Answer 5

Uncomplicated UTIs

Question 6

_________ are more difficult to treat and the key risk factors include: underlying diseases, kidney stones, urinary tract abnormalities, indwelling urinary catheters

Answer 6

Complicated UTIs

Question 7

What are the contributing factors that leads to an increased pathogenesis of the UTI infections?

Answer 7

• shorter length of urethra
• sexual activity in females
• uncircumcised male infants
• blockage of the urethra
• catheterization (3-10% increased risk/day of catheterization)

Question 8

What is urethritis?

Answer 8

• infection of the urethra

- symptoms of dysuria (pain when urinating) and frequency

Question 9

What is cystitis?

Answer 9

• bladder infection
• dysuria, frequency, urgency, pain over the bladder area
• signs: bloody urine, cloudy urine and a bad odour

Question 10

What is acute urethral syndrome?

Answer 10

• same symptoms as cystitis but lower CFU/mL than cystitis

- pyuria: 8 leukocytes/mm of uncentrifuged urine

Question 11

What is pyelonephritis?

Answer 11

• infection of the kidney and the renal pelvis

Question 12

What is prostatitis?

Answer 12

• an infection involving the prostate

Question 13

What is cervicitis?

Answer 13

• inflammation of the cervix

Question 14

What is the epidemiology of UTIs in paediatrics?

Answer 14

• high morbidity
• impaired renal function
• hypertension
• end stage renal disease
• complications during pregnancy as an adult

Question 15

What is the epidemiology of UTIs in geriatrics?

Answer 15

• incidence in both men and women increases but the ratio changes
• prostate enlargement, leads to poorer bladder emptying and an increased UTI incidence

Question 16

What are the microbial virulence factors that allow the bacteria to attach to the urinary tract?

Answer 16

• adherence (via bacterial adhesins)
• calculi formation
• toxin and enzyme production (hemolysins and LPS)
• capsular polysaccharide
• biofilms

Question 17

What are the host defences in protecting the body from bacterial infection?

Answer 17

• flushing action of urine
• growth inhibitory properties of urine (low pH, osmolarity, high urea, organic acid concentrations)
• mucopolysaccharides
• preventing reflux

Question 18

When a baby is newborn, it will have a ______ urethra

Answer 18

sterile

Question 19

Within 1-3 years of life, what bacteria start colonizing the urinary tract?

Answer 19

• Staphylococcus, enterococci, and diptheroids

Question 20

From the time of 3 days to a few weeks old, what bacteria starts to colonize the urinary tract?

Answer 20

• lactobacillus acidophilus

Question 21

In the prepubertal stages, what bacteria start to colonize the urinary tract?

Answer 21

• micrococci
• streptococci
• coliforms
• diptheroids

Question 22

In the adult stages of life, what bacteria start to colonize the urinary tract?

Answer 22

• L acidophilus, Staph epidermidis, Streptococci (alpha and non-hemolytic) as well as E coli, diphtheroids and yeasts

Question 23

In pregnancy, what bacteria begin to colonize the urinary tract?

Answer 23

• L acidophilus, yeasts and S epidermidis

Question 24

In the postmenopausal stages of life, the urinary tract in similar to having the ____ flora

Answer 24

prepubertal

Question 25

What are the two main agents of UTIs?

Answer 25

- gram negative bacilli, as well as gram positive cocci

Question 26

What are the most common gram negative bacilli to infect the urinary tract?

Answer 26

- enterobacteriaceae - -- fecal E. coli, uncomplicated UTIs - -- MDR enterbacteriaceae, hospital acquired

Question 27

What are the bacteria that are LEAST likely to have a hospital stay?

Answer 27

E coli

Question 28

What bacteria causing a urinary tract infection are more likely to cause a stay in the hospital?

Answer 28

- pseudomonas, prteus, klebsiella, acinetobacter and enterobacter

Question 29

What bacteria is a gram positive cocci and is most likely to cause a symptomatic UTI in sexually active women under the age of 40?

Answer 29

- staphylococcus saprophyticus

Question 30

What gram positive bacilli are agents of causing UTIs?

Answer 30

- diphtheroids, mycobacteria, and Listeria monocytogenes

Question 31

What fungi that can colonize the urinary tract can also lead to hospitalizations

Answer 31

- candiduria

Question 32

What constitutes a lower urinary tract infection?

Answer 32

- bladder and urethra - cystitis (infection of the bladder) - can cause dysuria (pain during urination) and is more common than upper UTIs - increased urgency to urinate as well as increased frequency of urination

Question 33

What bacteria is likely to cause a lower UTI?

Answer 33

E coli, Klebsiella spp, other enterobacteriaceae and enterococci, CoNS

Question 34

What are two upper UTI infections?

Answer 34

- acute pyelonephritis | - subclinical pyelonephritis

Question 35

What are the symptoms of acute pyelonephritis?

Answer 35

- fever, lower UTI symptoms (typically caused by enterobacteriaceae and staph aureus)

Question 36

What are the most common bacteria that cause subclinical pyelonephritis

Answer 36

candida spp, mycobacterium spp, mycoplasma hominis

Question 37

What are the most vulnerable groups of people experiencing an upper UTI?

Answer 37

- pregnancy women and young children - patients undergoing instrumentation in UT - elderly and diabetics

Question 38

When doing a laboratory diagnosis of a UTI, how is there a differentiation between a UTI and contamination of the urine by microflora at the distal end of the urethra

Answer 38

- there should be a collection of midstream urine - this should not have over 10^5 organisms within - typically will see only one bacterial species - collection and transportation methods are critical in ensuring a good sample

Question 39

A urine sample should be cultured within ___ of collection and stored at 4 degrees for not over 18h

Answer 39

1 h

Question 40

Uncomplicated UTIs usually resolve _____ within 4 weeks in up to 40% of patients

Answer 40

spontaneously (tx with an Ab though ensures eradication) - follow up recommended at the end of the treatment

Question 41

With a UTI, the patient should also be advised to _______ to flush the bacteria?

Answer 41

- to drink large amounts of water

Question 42

What is the treatment typically of a completed UTI - pyelonephritis?

Answer 42

- systemic IV treatment until the symptoms subside - oral therapy can occur afterwards - over 10 days to sterilize the kidney