UTI

Question 1

Bacteriuria

Answer 1

Presence of bacteria in urine

Question 2

Pyuria

Answer 2

Presence of WBCs in urine

Question 3

Cystitis

Answer 3

UTI associated with bladder mucosa

Question 4

Pylenephritis

Answer 4

UTI of renal parenchyma -kidneys

Question 5

Urethritis

Answer 5

Urethra infection

Question 6

Normal flora of Urinary Tract

Answer 6

Coagulase-negative staphylococci
Diphtheroids
Lactobacilli
Bacillus species
Enterococci Saprophytic yeast

Question 7

Significant Bacteriuria Concept

Answer 7

Up to 10^4/ml considered normal i.e. Insignificant
Organisms
10^5/ml and above considered to be Significant

Question 8

Female - Predisposing Factors

Answer 8

• Shortness of female urethra
• Sexual intercourse (honeymoon cystitis)
• Pregnancy & Contraceptive devices

Question 9

Male - predisposing factors

Answer 9

• Prostatic hypertrophy (prostate enlargement)

Question 10

Common factors - both genders

Answer 10

Presence of foreign body: stone, catheter, surgical instrumentation.
 - Obstruction: Urethral stricture .
 - Neurogenic bladder dysfunction
Spinal cord injury
Diabetes

Question 11

Hemolytic uremic syndrome (HUS)

Answer 11

• when BVs in kidneys become damaged and inflamed. This damage can cause clots to form in the vessels. The clots clog the filtering system in the kidneys.
• Linked to O157 EHEC

Question 12

E coli causing UTI

Answer 12

E coli contributes to 90% of UTI strains

01,02,04,07,18,75

Question 13

Virulence factors - E coli

Answer 13

• Pili/Fimbriae
• Hemolysins
• Aerobactin
• Biofilm

Question 14

Pathogenicity

Answer 14

Ascending route - Colonization of perinium and urethral area by enteric (intestinal) m.o.s

Rarely haematogenous (via blood) - Descending route

Entero-Vesical- Fistula - enterovesical fistula is an abnormal connection between the bowel and bladder - Fistulas form when inflammation causes sores, or ulcers, to form on the inside wall of the intestine or nearby organs

Question 15

Lower UTI

Answer 15

Urethritis & Cystitis

Question 16

Urethritis

Answer 16

Dysuria - burning sensation / pain during micturition & frequent urination.

Question 17

Cystitis

Answer 17

Dysuria - characteristic supra pubic pain & tenderness, occasional hematuria. Diminished bladder capacity leads to frequent micturition.

Question 18

Causes of lower UTI

Answer 18

Staph.saprophyticus
Appropriate Specimen : Cystitis = Urine (Clean Catch)
{Most Appropriate Abx = Cotrimoxazole }

Question 19

Upper UTI

Answer 19

Acute pyelonephritis

Question 20

Acute pyelonephritis

Answer 20

Flank / loin pain & fever, renal tenderness on palpation.
Hematuria with fever & chills.
(Sp:Pyelonephritis-Urine)

Question 21

Helminths - UTI

Answer 21

Schistosoma haematobium.

Trichomonas vaginalis

Question 22

Fungi - UTI

Answer 22

Candida albicans

Question 23

Specimen - UTI

Answer 23

Urine- MSU (“clean catch”)
Catheter specimen (CSU)
Suprapubic aspirate

Question 24

Lab ID - UTI

Answer 24

Gram Stain –GNB/GPC  (1 Bacterium / field is significant)
Urinalysis- e.g. Pyuria (>5 WBC/HPF) 
Culture  on  -- CLED  / ( MAC ) , B A.
Biochemical
Antimicrobial Susceptibility Testing

Question 25

Significant results

Answer 25

Significant bacteriuria: ≥ 100,000 CFU/ml

Question 26

ID of anaerobic bacteria- UTI

Answer 26

Extremely foul smelling urine No response to aerobic antibiotics No growth on gram stain

Question 27

E coli - ID

Answer 27

Gram: Gram-negative rods/bacilli (pink) BA (Blood Agar): Large, white, colonies. MAC (MacConkey): Lactose fermenting, Pink colonies CLED (Cystine-Lactose-Electrolyte Deficient) : Lactose fermenting, Yellow colonies. Motile

Question 28

Klebsiella pneumoniae

Answer 28

Gram negative bacilli-Non motile Citrate, Urease positive Colony-on MC-Lactosfermenting (L.F,), Mucoid ,Large

Question 29

Pseudomonas aeruginosa

Answer 29

GNR, motile

Question 30

Proteus spp

Answer 30

Gram: Gram-negative rods / bacilli ( pink ) BA: Single colony showing Swarming MAC: Non-Lactose fermenting ( NLF ) non-pink colonies CLED: Non-Lactose fermenting-colonies (translucent blue ) MR +ve , Urease +ve Motile

Question 31

Antimicrobial agents - UTI

Answer 31

Co-trimoxazole = ( Most Appropriate Antibiotic ). | Amoxicillin , Tetracycline , Amoxicillin-Clavulanic acid, Cefuroxime , Ciprofloxacin

Question 32

Prevention - UTI

Answer 32

Plenty water and frequent voiding - Voiding after sexual intercourse - Cranberry Juice → → ↑ - Fluid intake → urine output - Acidifies urine - Interferes with bacterial attachment to urothelium -Phenazopyridine ( urogesic ) relieves symptoms.