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Questions and Answers
What is considered an uncomplicated case for a young healthy woman regarding UTI treatment?
What is considered an uncomplicated case for a young healthy woman regarding UTI treatment?
Which factor is NOT associated with a predisposition to urinary tract infections?
Which factor is NOT associated with a predisposition to urinary tract infections?
What should be done routinely in all men with UTI?
What should be done routinely in all men with UTI?
Which of the following is NOT an indication for routine screening of urologic abnormalities?
Which of the following is NOT an indication for routine screening of urologic abnormalities?
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What is the minimum white blood cell count in urine that indicates pyuria?
What is the minimum white blood cell count in urine that indicates pyuria?
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What is the most common organism responsible for urinary tract infections?
What is the most common organism responsible for urinary tract infections?
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Which predisposing factor involves an anatomical issue in the urinary tract?
Which predisposing factor involves an anatomical issue in the urinary tract?
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Which of the following bacterial virulence factors is associated with epithelial cell receptors?
Which of the following bacterial virulence factors is associated with epithelial cell receptors?
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What is the recommended approach to urine analysis in cases of acute uncomplicated pyelonephritis?
What is the recommended approach to urine analysis in cases of acute uncomplicated pyelonephritis?
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What should be done if symptoms improve but do not completely resolve after initial treatment for a urinary tract infection?
What should be done if symptoms improve but do not completely resolve after initial treatment for a urinary tract infection?
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Which factor is related to urinary tract instrumentation?
Which factor is related to urinary tract instrumentation?
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What happens during a rectal examination in cases of acute bacterial prostatitis?
What happens during a rectal examination in cases of acute bacterial prostatitis?
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What is the typical first-line antibiotic class used for uncomplicated cystitis treatment?
What is the typical first-line antibiotic class used for uncomplicated cystitis treatment?
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The presence of what in urine is typically indicative of an infection?
The presence of what in urine is typically indicative of an infection?
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What group of individuals is most commonly affected by acute uncomplicated pyelonephritis?
What group of individuals is most commonly affected by acute uncomplicated pyelonephritis?
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What is the recommended method for prophylaxis of recurrent acute uncomplicated cystitis?
What is the recommended method for prophylaxis of recurrent acute uncomplicated cystitis?
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What distinguishes gram-negative bacteria like E. coli in the context of infection?
What distinguishes gram-negative bacteria like E. coli in the context of infection?
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In which scenario should symptoms be managed as if they are complicated urinary tract infections?
In which scenario should symptoms be managed as if they are complicated urinary tract infections?
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What is a characteristic of category I prostatitis according to the NIH Consensus Classification?
What is a characteristic of category I prostatitis according to the NIH Consensus Classification?
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What is a common laboratory finding in acute uncomplicated pyelonephritis?
What is a common laboratory finding in acute uncomplicated pyelonephritis?
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Which clinical feature is NOT typically suggestive of acute uncomplicated pyelonephritis?
Which clinical feature is NOT typically suggestive of acute uncomplicated pyelonephritis?
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Which of the following is true about the urine culture thresholds for indicating a UTI?
Which of the following is true about the urine culture thresholds for indicating a UTI?
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Which symptom combination indicates the need for diagnostic tests in cases of acute uncomplicated pyelonephritis?
Which symptom combination indicates the need for diagnostic tests in cases of acute uncomplicated pyelonephritis?
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What is the likely cause of chronic prostatitis/chronic pelvic pain syndrome (CPP)?
What is the likely cause of chronic prostatitis/chronic pelvic pain syndrome (CPP)?
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Which medication is indicated for the treatment of acute bacterial prostatitis?
Which medication is indicated for the treatment of acute bacterial prostatitis?
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What factor is NOT indicated for extending treatment to a 7-day course in acute uncomplicated pyelonephritis?
What factor is NOT indicated for extending treatment to a 7-day course in acute uncomplicated pyelonephritis?
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What characterizes chronic bacterial prostatitis?
What characterizes chronic bacterial prostatitis?
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Which statement is true regarding chronic prostatitis/chronic pelvic pain syndrome (CPP)?
Which statement is true regarding chronic prostatitis/chronic pelvic pain syndrome (CPP)?
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In post-coital prophylaxis for urinary tract infections, which medication is commonly used?
In post-coital prophylaxis for urinary tract infections, which medication is commonly used?
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Which of these treatments is typically NOT prescribed for chronic bacterial prostatitis?
Which of these treatments is typically NOT prescribed for chronic bacterial prostatitis?
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When are blood cultures recommended in the management of urinary tract infections?
When are blood cultures recommended in the management of urinary tract infections?
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What is a characteristic symptom of acute bacterial prostatitis?
What is a characteristic symptom of acute bacterial prostatitis?
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Which pathogen is commonly associated with catheter-associated urinary tract infections (UTIs)?
Which pathogen is commonly associated with catheter-associated urinary tract infections (UTIs)?
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What is one of the symptoms relief methods mentioned for chronic bacterial prostatitis?
What is one of the symptoms relief methods mentioned for chronic bacterial prostatitis?
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Which of the following is recommended for long-term therapy in patients who do not respond to full-dose treatment?
Which of the following is recommended for long-term therapy in patients who do not respond to full-dose treatment?
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What is the recommended duration of treatment for a patient using Ciprofloxacin for complicated UTI?
What is the recommended duration of treatment for a patient using Ciprofloxacin for complicated UTI?
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What treatment is recommended for men with recalcitrant chronic bacterial prostatitis?
What treatment is recommended for men with recalcitrant chronic bacterial prostatitis?
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What type of treatment is described as having a duration of only 1 week for symptomatic relief?
What type of treatment is described as having a duration of only 1 week for symptomatic relief?
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Which of these antibiotics is prescribed at a dose of TMP-SMX 80/400 mg for chronic therapy?
Which of these antibiotics is prescribed at a dose of TMP-SMX 80/400 mg for chronic therapy?
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What is the percentage of Klebsiella pneumonia identified in UTI associated with anatomical abnormalities?
What is the percentage of Klebsiella pneumonia identified in UTI associated with anatomical abnormalities?
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Study Notes
Factors Predisposing to UTI
- Presence of Microorganisms in the kidney and urinary tract
-
Host Biological and Behavioral Factors:
- Gender and Sexual Activity
- Pregnancy
- Obstruction
- Neurogenic Bladder Dysfunction
- Vesicourethral Reflux
- Urinary Tract Instrumentation
- Diabetes Mellitus
- Immunosuppression
- Urinary Tract Abnormalities
Bacterial Virulence Factors
-
Adhesins/Epithelial Cell Receptors:
- P fimbriae (MR): glycospingolipid globoseries, gal-a 1-4 (P blood group antigens)
- Type I fimbriae (MS): glucoproteins, uroplakin I and II
- S/F/C fimbriae (MR): Sialyl a 2-3 galactoside
- Type I C (MR):
- G fimbriae (MR): terminal N acetyl D
Bacterial Etiology of Urinary Tract Infection
-
Gram-negative bacteria:
- E.Coli: 70-95% of UTIs in women, 21-54% of UTIs in men
- Proteus Mirabilis: 1-2% of UTIs in women, 1-10% of UTIs in men
- Klebsiella Spp: 1-2% of UTIs in women, 2-17% of UTIs in men
- Citrobacter Spp./= 10 CFU bacteria/ ml:
Acute Uncomplicated Pyelonephritis
-
Criteria for Young Women:
-
/= 10 CFU bacteria/ml on 2 consecutive urine specimens
- Symptoms improved but not completely resolved after 7 days of antimicrobial treatment
- Symptoms fail to resolve after 7 days of antimicrobial treatment
-
Acute Uncomplicated Pyelonephritis in Women
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Symptoms:
- Fever (> 38C)
- Chills, nausea, flank pain
- CVA tenderness
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Laboratory Findings:
- Significant pyuria
- Bacteriuria of > 10,000 cfu/ml
- Leukocyte casts
- Leukocytosis
Diagnosis of UTI
- Urine cultures are not necessary in cases with significant pyuria:
-
8 pus cells/mm3 uncentrifuged urine
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5 pus cells/mm3 centrifuged urine
- (+) LE and nitrite test
-
- Diagnostic test needed in those with unusual combination of symptoms
-
Diagnostic Tests:
- Urinalysis
- Urine gram stain & culture
- Blood cultures (not routinely recommended)
Uncomplicated UTI in Young Women
- A single dose of antibiotics after sexual intercourse is considered an uncomplicated treatment for a single episode of symptomatic lower UTI in young (15 to 40 y/o) healthy, sexually active women without history of structural or functional urologic abnormalities.
Hormonal Treatment in Postmenopausal Women
- Intravaginal estriol cream at night for 2 weeks - 2x a week for 8 months
Indications for Screening Urologic Abnormalities
- Routine screening is not recommended unless:
- Gross hematuria during episodes of UTI
- Obstructive symptoms
- Clinical impression of persistent infection
- Infection of urea-splitting bacteria
- History of pyelonephritis
- History or symptoms suggestive of urolithiasis
- History of childhood UTI
- Elevated serum creatinine
Prophylaxis for Recurrent Acute Uncomplicated Cystitis
-
Continuous Prophylaxis:
- TMP-SMX: 40/200 mg daily or thrice weekly
- Trimethoprim: 100 mg daily
- Nitrofurantoin: 50/100 mg daily
- Cefaclor: 250 mg daily
- Cefalexin: 125/250 mg daily
- Norfloxacin (or other likely effective drug): 200 mg daily
-
Post-Coital Prophylaxis:
- TMP-SMX: 40/200 mg or 80/400 mg
- Nitrofurantoin: 250 mg
- Ciprofloxacin: 125 mg
- Norfloxacin: 200 mg
NIH Consensus Classification of Prostatitis
-
Category I (Acute Bacterial Prostatitis):
- Acute infection of the prostate gland characterized by fever, chills, low back pain, and perineal pain.
- Irritative voiding symptoms are characteristic (dysuria, frequency, urgency, nocturia).
- Rectal examination reveals a markedly tender, swollen prostate.
- Treatment with fluoroquinolones is recommended.
-
Category II (Chronic Bacterial Prostatitis):
- Recurrent infection of the prostate caused by persistence of the same organism despite treatment.
- Symptoms are irritative voiding and pain of varying degrees.
- Rectal examination reveals no characteristic finding.
- Treatment with Trimethoprim 50/ 100 is recommended.
-
Category III (Chronic Prostatitis/CPP):
- Chronic Pelvic Pain Syndrome (CPPS)
- No demonstrable infection; primarily pain complaints, plus voiding complaints and sexual dysfunction affecting men of all ages.
- Usually cause is unknown.
- Treatment: Oloxacin 100 mg
Chronic Prostatitis/ CPPS Treatment
-
IIIA. Modification according to results of 1st line treatment:
- Quinolone for 28 days:
- Ciprofloxacin 500mg BID
- Ofloxacin 200mg BID
- Norfloxacin 400mg BID
- Doxycycline 100mg BID
- Minocycline 100mg BID
- Trimethoprim 200mg BID
- TMP-SMX 160/800 mg BID
- Quinolone for 28 days:
-
Men with recalcitrant chronic bacterial prostatitis:
- TURP or total prostatectomy
- Symptomatic relief: anti-inflammatory agents and prostatic massage
- Long term, low dose suppressive therapy may be recommended
- TMP-SMX 80/400mg OD is recommended for 4 to 6 weeks.
Complicated Urinary Tract Infections
-
Pathogens Identified in Complicated UTIs:
- Catheter-associated UTI: E coli, P aeruginosa, Proteus mirabilis, enterbacter, Providencia stuartii, Morganella morgagni, Citrobacter, Enterococcus, Candida sp
- Short term (1 week) UTI: E coli, P aeruginosa, Proteus mirabilis, enterbacter, Providencia stuartii, Morganella morgagni, Citrobacter, Enterococcus, Candida sp.
- Anatomic Abnormalities UTI: E.Coli, Klebsiella pneumonia(37%), P.aeruginosa, Proteus mirabilis
- UTI in Diabetes: E.Coli, Klebsiella pneumonia(37%), P.aeruginosa, Proteus mirabilis, Enterobacter, Enterococcus, Candida
- Renal Transplant UTI: E.Coli, Klebsiella pneumonia, Candida albicans, Pseudomonas aeruginosa
- Duration of Treatment is 7 days
- Post-treatment urine culture: 1-2 weeks after completion of medication
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Description
This quiz covers the various factors predisposing individuals to urinary tract infections (UTIs), including biological, behavioral, and bacterial virulence factors. Additionally, it explores the bacterial etiology and the role of gram-negative bacteria in UTI occurrences. Test your knowledge on this important topic in microbiology and urology.