UTI

Question 1

What is a lower UTI infection?

Answer 1

Infection confined to the bladder (cystitis)

Question 2

What is an upper UTI infection?

Answer 2

Infection involving the ureters +/- kidneys (pyelonephritis)

Question 3

What bacteria colonise the distal urethra?

Answer 3

Coliforms

Enterococci

Question 4

What is a complicated UTI?

Answer 4

UTI with
Systemic symptoms OR
Urinary structural abnormality/ stones

Question 5

What is bacteriuria?

Answer 5

Bacteria present in urine

Only UTI if symptoms present

Question 6

What is cystitis?

Answer 6

Inflammation of the bladder - not necessarily infection

Question 7

Why do women get more UTIs than me?

Answer 7

Short, wide urethra
Proximity of urethra to anus
Increased risk with sexual activity, pregnancy

Question 8

What are the routes of infection in an UTI?

Answer 8

Ascending infection: bacteria from bowel, perineal skin, lower end of urethra
Bloodstream: bacteraemia, seeding into kidneys

Question 9

What coliforms commonly cause UTI?

Answer 9

E.COLI
Klebsiella
Enterobacter
Proteus

Question 10

What bacteria, that is not a coliform, will cause UTIs?

Answer 10

Pseudomonas aeruginosa

Question 11

What will a proteus UTI cause?

Answer 11

Struvite stones (triple phosphate stones) - staghorn calculus

Question 12

How does proteus cause struvite stones?

Answer 12

Produces urease which breaks down urea to form ammonia, increasing urinary pH

Question 13

What is the only oral antibiotic active against pseudomonas aeruginosa?

Answer 13

Ciprofloxacin

Question 14

What is the mechanism of action of quinolones?

Answer 14

Inhibits bacterial DNA gyrase, preventing supercoiling of bacterial DNA

Question 15

What enterococcus commonly causes UTI?

Answer 15

Enterococcus faecalis

Question 16

What is the most common gram positive organism to cause UTI?

Answer 16

Staphylococcus saprophyticus - coag neg staph

Affects women of child bearing age

Question 17

What are the symptoms and signs of a UTI?

Answer 17

Dysuria
Frequency of urination
Nocturia
Haematuria

Question 18

What are the symptoms of pyelonephritis?

Answer 18

Fever
Loin pain
Rigors

Question 19

What is the ideal urine sample for culture?

Answer 19

MSU as first passed urine is most likely to be contaminated with commensals

Question 20

Should you dipstick urine in the elderly and those with catheters?

Answer 20

NO

Question 21

What do nitrites signify on dipstick?

Answer 21

Presence of bacteria in the urine
Coliforms can reduce nitrates to nitrites HOWEVER, enterococcus, staphylococcus and pseudomonas do NOT so will have a negative teet

Question 22

What level of bacteria in the urine is associated with infection?

Answer 22

> 10^5

Question 23

What is abacterial cystitis?

Answer 23

Symptoms of UTI but no significant growth on culture

Question 24

Should you treat an UTI if there are no symptoms?

Answer 24

NO

Question 25

Should asymptomatic pregnant women be treated for an UTI?

Answer 25

YES; 20-30% will progress to pyelonephrtiis

Question 26

What is the treatment for an uncomplicated lower UTI in females?

Answer 26

Trimethoprim or nitrofurantoin orally for 3 days

Question 27

What is the treatment for an uncatheterised UTI in a male?

Answer 27

Trimethoprim or nitrofurantoin orally for 7 days

Question 28

Should you get cultures in male UTIs?

Answer 28

YES

Question 29

What is the treatment for a complicated UTI or pyelonephritis in the community?

Answer 29

Co-amoxiclav or co-trimoxazole for 14 days

Question 30

What is the treatment for a complicated UTI or pyelonephritis in hospital?

Answer 30

Amoxicillin and gentamicin IV for 3 days

Question 31

How long can gentamicin be given for?

Answer 31

3 days

Question 32

What antibiotics can be used in ESBL producing UTIs?

Answer 32

Nitrofurantoin, pivmecillinam | Meropenem, ertapenem

Question 33

What is a carbapenamase-producting enterobacteriaceae?

Answer 33

``` Gram negative (coliform) bacilli that are resistant to meropenem Resistant to ALL current antibiotics ```

Question 34

What is second line for gram negs - after gent?

Answer 34

Aztreonam

Question 35

What is second line for gram positives, after amox?

Answer 35

Vancomycin

Question 36

What is the mechanism of action of trimethoprim?

Answer 36

Inhibits bacterial folic acid synthesis

Question 37

Can trimethoprim be given in pregnancy?

Answer 37

Avoid in 1st trimester (first 3 months)

Question 38

Can nitrofurantoin be used in pregnancy?

Answer 38

Avoid in late pregnancy, breast feeding and children under 3 months as can cause neonatal haemolysis