Urinary Tract Infections

Question 1

What are different types of urinary tract infections?

Answer 1

• Kidney
  
  • Acute pyelonephritis
  • Chronic pyelonephritis
• Bladder
  
  • Cystitis
• Urethra
  
  • Urethritis
• Prostate
  
  • Prostatitis
• Epididymis/testis
  
  • Epididymo-orchitis

Question 2

What is a kidney infection called?

Answer 2

• Acute pyelonephritis
• Chronic pyelonephritis

Question 3

What is a bladder infection called?

Answer 3

• Cystitis

Question 4

What is a urethral infection called?

Answer 4

• Urethritis

Question 5

What is a prostate infection called?

Answer 5

• Prostatitis

Question 6

What is a epididymis/testis infection called?

Answer 6

• Epididymo-orchitis

Question 7

What is the M:F ratio of urinary tract infections?

Answer 7

1:3

Question 8

What is the most common hospital acquired infection?

Answer 8

Urinary tract infection

Question 9

What are some predisposing factors for a urinary tract infection?

Answer 9

• Immunosuppression
• Steroids
• Malnutrition
• Diabetes

Specific to urinary tract:

• Female sex (short urethra)
• Sexual intercourse and poor voiding habits
• Congenital abnormalities
  
  • Such as duplex kidney
• Stasis of urine
  
  • Such as due to poor bladder emptying
• Foreign bodies
  
  • Such as catheters, stones
• Oestrogen deficiency in postmenopausal woman
• Fistula between bladder and bowel

Question 10

What bacteria commonly causes urinary tract infections?

Answer 10

• E coli
• Proteus
• Klebsiella
• Enterococcus

Question 11

What form of transfer occurs for urinary tract infections?

Answer 11

• Transurethral route
  
  • Periurethral area contaminated
  • Urethra to bladder
  • Bladder (and up ureter)
• Bloodstream
• Lymphatics

Question 12

Describe the natural history of urinary tract infections?

Answer 12

• Single episode 90% of time
• Complicated vs uncomplicated

Question 13

What is the clinical presentation of urinary tract infections in children?

Answer 13

• Diarrhoea
• Excessive crying
• Fever
• Nausea and vomiting
• Not eating

Question 14

What is the clinical presentation of urinary tract infections in adults?

Answer 14

• Flank pain
• Dysuria (like passing broken glass)
• Cloudy offensive urine
• Urgency
• Chills
• Strangury
• Confusion (very old people)

Question 15

What are the clinical features of acute pyelonephritis?

Answer 15

• Pyrexia
• Poor localisation
• Loin tenderness (renal angle)
• Signs of dehydration
• Turbid urine

Question 16

What investigations are done for acute pyelonephritis?

Answer 16

• Mid-stream sample of urine
• Urinalysis in ward
  
  • Blood
  • Leucocytes
  • Protein
  • Nitrates
• Microbiology in laboratory
  
  • Microscopy and gram staining
  • Bacteriuria > 10⁵ CFU/ml
  • Culture and sensitivity

Question 17

What additional investigations are done for acute pyelonephritis in children, men or when UTIs are frequent?

Answer 17

• USS or IVU may be helpful
• Isotope studies to rule out reflux and scarring

Question 18

What are the principles for management of urinary tract infections?

Answer 18

• Identify the infecting organism and institute appropriate treatment
• Identify predisposing factors and treat if possible

Question 19

What is the treatment of urinary tract infections?

Answer 19

• Fluids
• Antibiotics
  
  • Amoxicillin
  • Cephalosporin
  • Trimethoprim
  • IV antibiotics for severe infections

Question 20

What are examples of abnormal urinary tracts?

Answer 20

Includes:

• Anatomical/neurological abnormalities
• Stones
• Diabetes

All may cause infections and sometimes lead to renal impairment

Question 21

Do repeated UTIs result in renal damage?

Answer 21

Even repeated/persistent UTIs rarely result in renal damage

Question 22

How do UTIs in children lead to renal damage?

Answer 22

UTIs in children, damage is caused by reflux and infection

Question 23

What investigations are done for UTIs in children?

Answer 23

• Micturating cystogram
• Assess progression by USS and biochemistry

Question 24

What is the treatment for UTIs in children?

Answer 24

Surgery

Question 25

What advice is given to avoid recurrent UTIs?

Answer 25

* Fluid intake 2L/day * Void every 2-3 hours by day * Void before bedtime and before and after intercourse

Question 26

What is indwelling urinary catheter?

Answer 26

Is a catheter that is left in your bladder

Question 27

What is inevitable with an indwelling urinary catheter?

Answer 27

Aseptic technique but colonisation is inevitable Antibiotics only if patient is symptomatic: * Replace catheter

Question 28

When does bacteriuria occur?

Answer 28

When \>= 10⁵ But depends on clinical symptoms

Question 29

How is chronic pyelonephritis diagnosed?

Answer 29

Radiological diagnosis

Question 30

What is the clinical presentation of chronic pyelonephritis?

Answer 30

* Scarring and clubbing * Hypertension/CRF * Reflex

Question 31

What percentage of chronic pyelonephritis leads to renal failure?

Answer 31

15%