uti

Question 1

What is a UTI?

Answer 1

Urinary tract infection (UTI) is a common type of infection in
the human urinary system. It can involve any part of the urinary
system, including the urethra, ureters, bladder and kidneys
Most UTIs can be treated with an antibiotic.
Introduction

Question 2

What is the urinary tract?

Answer 2

The urinary tract includes two kidneys, two
ureters, a bladder, and a urethra.

The urinary tract is the body’s drainage
system for removing wastes and extra fluid.

Question 3

How do we classify UTI’s?

Answer 3

A UTI is classified as “ simple/uncomplicated”
or “complicated”.

Uncomplicated UTIs will usually affect the
bladder.

Complicated UTIs describe resistant infections
that require stronger medications, or those
that affect the kidneys.

Question 4

Types of Bacteria

Answer 4

UTIs are caused by Gram negative and Gram positive bacteria, as well
as fungi.

Uncomplicated UTIs typically affect women, children and elderly
patients.

Complicated UTIs are usually associated with indwelling catheters,
urinary tract abnormalities, immunosuppression or exposure to
antibiotics.

Question 5

What causes UTI’s?

Specific viruses/bacterium

Answer 5

The most common causative agent is Escherichia coli

Other causative agents are Klebsiella pneumoniae , Staphylococcus
saprophyticus , Enterococcus faecalis , group B Streptococcus (GBS),
Proteus mirabilis , Pseudomonas aeruginosa , Staphylococcus aureus
and Candida spp .

Question 6

What does dysuria mean?

Answer 6

Uncomfortable pee

Question 7

What does polyuria mean?

Answer 7

Frequent urge to urinate

Question 8

What does cystitis mean?

Answer 8

Inflammation of bladder

Question 9

What is pyelonephritis

Answer 9

Inflammation of kidneys and ureters

Question 10

Symptoms of UTI

Answer 10

Frequent need to urinate
Burning/painful urine
Cloudy looking urine
Pelvic pain
Blood in urine
Strong smelling

Question 11

What is the bodies defence mechanisms?

Answer 11

The first lines of host defence to urinary pathogens are the
unidirectional flow of urine and the presence of antimicrobial
factors in the urine.

Human urine is frequently inhibitory and sometimes bactericidal.

The epithelial cells lining the urinary tract secrete pro
inflammatory cytokines and antibacterial agents that are
important for the phagocytosis.

The secretion of glycosaminoglycans by bladder transitional cells
forms a surface layer of mucin that acts as an anti adherence
factor.

Another mechanism used by the bladder to reduce bacterial load
is shedding of the superficial epithelial cell layer.

Exogenous regulation of hormones.

Question 12

Facts about UTI’s

Answer 12

150 mil people affected each year

50% of all women in UK had one

20-30% reoccur

Question 13

Pathogenesis of UTI

Answer 13

1. Contamination of the periurethral area with a uropathogen from the gut
2. Colonisation of the urethra and migration to the bladder
3. Colonisation and invasion of bladder, mediated by pili and adhesions and/or inflammatory response in bladder and fibrinogen accumulation in the catheter
4. Neutrophil infiltration
5. Bacterial multiplication and immune system subversion
6. Biofilm formations
7. Epithelial damage by bacteria toxins and proteases
8. Ascension to the kidneys
9. Colonisation of the kidneys
10. Host tissue damage by bacterial toxins
11. Bactercaemia

Question 14

Risk factors with UTI

Answer 14

Aging

A previous UTI

D iabetes mellitus

Impaired immune response

Females: short urethra, use of contraceptives that alter
normal bacteria flora of vagina and perineal tissues


Sexual activity

Pregnancy

Males: prostatic hypertrophy, bacterial prostatitis

Urinary tract obstruction: tumour or calculi

Question 15

What is pyelonephritis

Answer 15

Kidney infection

Question 16

What is cystitis

Answer 16

Bladder infection

Question 17

What is prostatitis

Answer 17

Prostate infection

Question 18

Summary of cystitis

Answer 18

Most common UTI

The common etiologic agents of cystitis are: Escherichia coli , Proteus ,
Klebsiella , and Enterobacter

Women are more likely to develop cystitis as a result of their shorter
urethra.

Question 19

Symptoms of cystitis

Answer 19

Symptoms:

Dysuria

Polyuria

Nocturia

Lower abdominal pain

Urine has foul odour, cloudy (pyuria), bloody (haematuria)

Question 20

How does cystitis progress?

Answer 20

Cystitis may precede pyelonephritis.

Cystitis is sometimes a secondary complication of some underlying
disorder such as prostatic enlargement, calculi, or tumours.

Question 21

What types of cystitis are there?

Answer 21

1. Haemorrhagic cystitis
2. Eosinophilic cystitis
3. Chronic cystitis
4. Interstitial cystits

Question 22

What is haemorrhage cystitis?

Answer 22

: When there is a haemorrhagic component,
This form of cystitis sometimes follows radiation injury or
chemotherapy such as Cyclophosphamide and Ifosfamide , which break
down into substances that irritate the bladder when they are excreted
from the body. Adenovirus infection also causes a haemorrhagic
cystitis.

Question 23

What is the grading of haemorrhage cystitis?

Answer 23

Grade I: This involves microscopic bleeding.

Grade II: The bleeding is visible.

Grade III: The bleeding contains small clots.

Grade IV: There is bleeding with large clots that may obstruct the flow
of urine

Question 24

What is Eosinophilic cystitis?

Answer 24

: This type of cystitis is rare but thought to be
more common in people with allergies. It’s caused by a build up of a
type of white blood cell = eosinophils in the bladder.


Manifested by infiltration of the submucosa by eosinophils together
with fibrosis and occasionally giant cells. Most cases of eosinophilic
cystitis represent nonspecific subacute inflammation, although,
rarely, these lesions are manifestations of a systemic allergic disorder.

Question 25

What is chronic cystitis?

Answer 25

: Due to persistent infection. The mucosa appears red, friable, granular, sometimes with ulcerated surface. Chronicity of the infection gives rise to fibrous thickening in the muscularis propria and consequent thickening and inelasticity of the bladder wall.  Follicular cystitis is a chronic cystitis where lymphoid follicles form in the bladder. If you have follicular cystitis, you may have to take antibiotics as well as steroid treatments to reduce inflammation.

Question 26

what is interstitial cystitis?

Answer 26

Persistent, painful form of chronic cystitis occurring most frequently in women and associated with inflammation of all layers of the bladder wall.  Also diagnosed as painful bladder syndrome.  I t isn’t caused by a bacterial infection. The condition is of unknown aetiology but is thought to be of autoimmune origin, particularly because it is sometimes associated autoimmune disorders.

Question 27

Prognosis of interstitial cystitis

Answer 27

Scientists have not yet found a cure for IC nor can they predict who will respond best to which treatment.  Medications are prescribed for inflammation and pain.  Only half of IC patients are full recovery from this disease.  Much more research needs to be done in order to find a cure.

Question 28

Pathophysiology of interstitial cystitis - theories

Answer 28

Mast cell activiation neurogenic inflammation uti decreased tight junction protein Signalling disturbance

Question 29

Summary of pyelonephritis

Answer 29

Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys and parenchyma (functional kidney tissue).  Occurs as a complication of an ascending urinary tract infection that spreads from the bladder to the kidneys.  The main cause is gram negative bacteria, Escherichia coli . Proteus , Klebsiella , and Enterobacter.  Bacteria can reach the kidneys in 2 ways: hematogenous spread and through ascending infection from the lower urinary tract

Question 30

Pathogenesis of pyelonephritis

Answer 30

E. coli is the most common bacteria causing acute pyelonephritis due to its unique ability to adhere and colonise the urinary tract and kidneys. * E.coli has adhesive molecules called P fimbriae. * The adhesion of bacteria to the renal cells disrupts the protective barriers, which leads to localised infection. * E. coli can lead to an acute inflammatory response which can cause scarring of the renal parenchyma.

Question 31

What are the risk factors of pyelonephritis?

Answer 31

Risk factors 1. Pregnancy 2. Urinary tract obstruction and congenital malformation 3. Urinary tract trauma, scarring 4. Renal calculi 5. Polycystic or hypertensive renal disease 6. Chronic diseases, i.e. diabetes mellitus 7. Vesicourethral reflux

Question 32

What are the symptoms of pyelonephritis?

Answer 32

Rapid onset with chills and fever * Malaise * Vomiting * Flank pain * Costovertebral tenderness * Urinary frequency, dysuria Treatment: Levofloxacin, ciprofloxacin, co trimoxazole, ampicillin

Question 33

How do we diagnose UTIs?

Answer 33

If UTI symptoms: obtain a urinalysis (UA) and culture  UTI affected urine can be visibly cloudy due to an increase of suspended particles that scatter light.  The urine is examined under a microscope for bacteria or white blood cells.  A positive UA shows evidence of inflammation (e.g., elevated white blood cells). A positive urine culture is defined as ≥100,000 cfu /mL of a urinary pathogen.  Blood cultures when suspecting pyelonephritis or urosepsis.

Question 34

Other clinical ways to diagnose UTIs

Answer 34

If infection does not respond to treatment. T he following tests can be made :  Ultrasound : In this test, sound waves create an image of the internal organs. This test is done on top of your skin, is painless and doesn’t typically need any preparation.  Cystoscopy : This test uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra.  CT scan : Another imaging test, a CT scan is a type of X ray that takes cross sections of the body (like slices). This test is much more precise than typical X rays.

Question 35

Treatment for Uncomplicated acute cystitis

Answer 35

Nitrofurantoin or cephalosporin: 5 days7 Trimethoprim/sulfamethoxazole (TMP/SMX): 3 days14

Question 36

Treatment for Uncomplicated pyelonephritis

Answer 36

Fluoroquinolone: Levofloxacin: 5 days; Ciprofloxacin 7 days14 TMP/SMX or IV/oral cephalosporin: 10–14 days (10 days if early response)15,16

Question 37

Treatment for complex UTI

Answer 37

3 days if lower tract CAUTI in women ≤65 years if catheter is removed/not replaced Other residents: 7 days if prompt resolution of symptoms or 10–14 days if delayed response, obstruction, or other urologic abnormality3

Question 38

How to prevent UTI's?

Answer 38

Birth control (increases risk) Good hygiene Probiotics Hydration