UTI

Question 1

Cystitis is often referred to as…

Answer 1

a lower UTI

Question 2

Pyelonephritis is…

Answer 2

a upper UTI

Question 3

The kidneys, ureters, bladder and urethra are normally sterile - TRUE/FALSE

Answer 3

FALSE - the lower urethra is normally colonised by coliforms and enterococci

Question 4

What is meant by a complicated UTI?

Answer 4

a UTI complicated by systemic symptoms or urinary tract structural abnormalities

Question 5

Bacturia does not always mean a UTI - TRUE/FALSE

Answer 5

TRUE - bacteria in the urine may not mean infection in the elderly or catheterised patients; ask about symptoms

Question 6

All cystitis is infection - TRUE/FALSE

Answer 6

FALSE - cystitis simply refers to inflammation in the bladder

Question 7

Risk factors for a UTI (7)

Answer 7

Female sex, sexual contact, pregnancy, immunosuppression/compromise, obstruction, malformation, familial

Question 8

You should treat a positive urine dipstick without symptoms in pregnancy - TRUE/FALSE

Answer 8

TRUE - many women who are positive may be asymptomatic until they develop pyelonephritis or fetal death occurs

Question 9

You should treat a positive urine dipstick without symptoms in the elderly - TRUE/FALSE

Answer 9

FALSE - only treat if symptomatic

Question 10

You should treat a positive urine dipstick without symptoms in patients with a catheter - TRUE/FALSE

Answer 10

FALSE - the longer a catheter is in place, the more likely it is to be colonised

Question 11

Symptoms of a UTI

Answer 11

Dysuria, frequency of urination, nocturia, haematuria, fever, loin pain, rigors

Question 12

Which symptoms of a UTI suggest pyelonephritis?

Answer 12

fever, loin pain, rigors

Question 13

What are some risk factors for developing pyelonephritis?

Answer 13

diabetes, HIV/AIDs, immunosuppression, UT abnormalities

Question 14

Whhat form of specimen should be collected for urinary culture and why?

Answer 14

Mid-stream urine - the initial urine passed will be contaminated with colonisers of the urethra

Question 15

What features of a urine dipstick suggest infection?

Answer 15

Leukocytes (WBCs), Nitrites - coliforms convert nitrates to nitrites

Question 16

Why are protein and blood not necessarily suggestive of infection?

Answer 16

protein should not be positive, blood may suggest infection or may be a sign of other things

Question 17

What are the ideal features of an antibiotic used to treat an uncomplicated lower UTI?

Answer 17

excreted in the urine, oral, inexpensive and few side effects

Question 18

What is abacterial cystitis/urethral syndrome?

Answer 18

when a patient has symptoms of a UTI but no growth in culture

Question 19

What may cause abacterial cystitis/urethral syndrome?

Answer 19

early phase UTI, urethral trauma (honeymoon cystitis), urethritis (chlamydia/gonorrhoea)

Question 20

Do you treat asymptomtomatic bacturia?

Answer 20

Only in pregnant women, not in the elderly

Question 21

When should a catheterised patient with significant bacteruria be given antibiotics?

Answer 21

Only when there is supporting evidence of UTI - unneccessary antibiotics may only result in resistance

Question 22

Treatment for lower UTI - women

Answer 22

trimethoprim or nitrofurantoin - 3 days/PO

Question 23

What organisms does trimethoprim treat?

Answer 23

coliforms

Question 24

Treatment for lower UTI - men

Answer 24

trimethoprim or nitrofurantoin - 7 days/PO + get cultures

Question 25

Treatment for complicated UTI/pyelonephritis - GP

Answer 25

Co-amoxiclav or co-trimoxazole - 14 days

Question 26

What organism does co-trimoxazole treat?

Answer 26

enterococci

Question 27

Treatment for complicated UTI/Pyelonephritis - Hosp

Answer 27

Amoxicillin and gentamicin - 3 days/IV; co-trimoxazole if penicillin allergic

Question 28

What organisms does amoxicillin treat?

Answer 28

enterococci

Question 29

What organisms does gentamicin treat?

Answer 29

coliforms

Question 30

4 Cs of C.difficile

Answer 30

Cephalosporins, co-amoxiclav, clindamycin, ciprofloxacin

Question 31

Extended spectrum beta lactamases are resistant to...

Answer 31

all cephalosporins and almost all penicillins

Question 32

Extended spectrum beta lactamases in UTIs may respond to...

Answer 32

Nitrofurantoin

Question 33

Which antibiotic should be avoided in first trimester of pregnancy?

Answer 33

trimethoprim

Question 34

Which organisms does trimethoprim not treat?

Answer 34

pseudomonas

Question 35

Trimethoprim may also be found in which antibiotic?

Answer 35

co-trimoxazole - trimethoprim + sulphamethoxazole

Question 36

What condition is associated with co-trimoxazole?

Answer 36

Steven Johnson Syndrome

Question 37

Which antibiotic should be avoided in late pregnancy, breast feeding and babies under 3 months?

Answer 37

nitrofurantoin

Question 38

Which organisms does nirtofurantoin not treat?

Answer 38

pseudomonas

Question 39

Common causative organisms of UTIs?

Answer 39

e.coli, proteus, pseudomonas, enterococcus faecalis, staph saphrophyticus

Question 40

E.coli is a...

Answer 40

gram neg. coliform; endotoxin causes fever

Question 41

Proteus produces...

Answer 41

urease --> ammonia and a foul smelling urine (burnt chocolate); produces swarming cultures

Question 42

Pseudomonas is a...

Answer 42

gram neg. bacillus

Question 43

What is pseudomonas associated with?

Answer 43

catheters and equipment

Question 44

Which antibiotic best treats pseudomonas?

Answer 44

cipfrofloxacin - not to be used in pregnant women/young kids

Question 45

Which organism is most commonly associated with hospital acquired infections?

Answer 45

enterococcus faecalis