Urinary Tract Infections Quiz

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Questions and Answers

Which type of urinary tract infection is characterized by inflammation of the bladder?

Urethritis

Prostatis

Pyelonephritis

Cystitis (correct)

Which of the following is a common symptom of lower urinary tract infections?

Dysuria (correct)

Fever

Vomiting

Diarrhea

What is the most common route of infection for urinary tract infections?

Tissue contiguous

Ascending (correct)

Hematogenous

Lymphatic

In which demographic are urinary tract infections most common among middle-aged individuals?

Women Signup and view all the answers

What percentage of community-acquired infections are attributed to urinary tract infections?

10-20% Signup and view all the answers

Which factor is NOT a predisposition for upper urinary tract infections?

Sedentary lifestyle Signup and view all the answers

What is a common complication of urinary tract infections in newborns?

Sepsis Signup and view all the answers

What defense mechanism helps to wash away bacteria from the urinary tract?

Flushing mechanism Signup and view all the answers

What is considered significant bacteriuria for complicated UTI in adults?

≥ 105 CFU/ml Signup and view all the answers

What is the minimum requirement for a midstream urine sample to indicate lower UTI with symptoms in men and women?

≥ 103 CFU/ml Signup and view all the answers

What is the condition characterized by the presence of 10 or more white cells/µl of urine in the absence of bacteria?

Sterile pyuria Signup and view all the answers

What type of urine specimen is not recommended for culture in children?

Bag urines Signup and view all the answers

What is the maximum duration for transporting urine at room temperature?

30 minutes Signup and view all the answers

What is the recommended treatment for asymptomatic bacteriuria in pregnant women?

Immediate antibiotic therapy Signup and view all the answers

In catheter-collected urine for a UTI without symptoms, what is considered significant bacteriuria?

≥ 103 CFU/ml Signup and view all the answers

What is the minimum bacterial count for recurrent UTI in women within 10-14 days after therapy?

Same species must be present Signup and view all the answers

What is the definition of asymptomatic bacteriuria in women?

Two consecutive samples ≥ 105 CFU/ml Signup and view all the answers

What is the consequence of using non-invasive methods for urine specimen collection?

Less than 103 CFU/ml Signup and view all the answers

Which of the following methods is NOT part of urine culture contamination assessment?

Bag urine collection Signup and view all the answers

Which microbiological examination technique may be requested by the physician for urine analysis?

Microscopic observation Signup and view all the answers

What is the definition of sterile pyuria?

Absence of bacteria with 10 or more white cells/µl Signup and view all the answers

Which bacteria is commonly associated with urinary tract infections and is also known for producing urease?

Klebsiella spp. Signup and view all the answers

What is detected during urinalysis that indicates the presence of white blood cells?

Leucocyte esterase Signup and view all the answers

What is the significance of finding nitrates in a urine test?

Indicates the presence of bacteria Signup and view all the answers

Which method is NOT typically used for diagnosing a urinary tract infection?

Microscopic examination of blood Signup and view all the answers

Which of the following symptoms is a sign of pyelonephritis that may require blood cultures?

Fever or chills Signup and view all the answers

What constitutes recurrent uncomplicated urinary tract infections (UTIs)?

3 or more uncomplicated UTIs in 12 months Signup and view all the answers

Which of the following prophylactic measures is effective in preventing recurrent uncomplicated UTIs?

Continuous antibiotic prophylaxis Signup and view all the answers

What is a recommended method for postmenopausal women to reduce the risk of urinary tract infections?

Vaginal estrogen creams or rings Signup and view all the answers

Which of the following is true regarding the efficacy of conservative measures against recurrent UTIs?

They lack evidence for efficacy and are unlikely to be harmful. Signup and view all the answers

What should the decision to begin therapy for recurrent UTIs be based on?

Patient preference and local resistance patterns Signup and view all the answers

Which of the following is NOT recommended as an antibiotic prophylaxis for recurrent uncomplicated UTIs in women?

Doxycycline Signup and view all the answers

What is the recommended dosage of Nitrofurantoin for continuous antibiotic prophylaxis?

50 mg to 100 mg daily Signup and view all the answers

For the treatment of complicated lower UTIs, which of the following is considered an Ist line antibiotic?

Ciprofloxacin Signup and view all the answers

Which antibiotic is suggested as a treatment option for Methicillin Resistant Staphylococcus (MRSA)?

Vancomycin Signup and view all the answers

Which of the following is an IInd line drug for the treatment of simply upper UTIs?

Ampicillin Signup and view all the answers

Which drug combination is indicated for the treatment of Enterococcus spp. infections?

Aminoglycosides + Glycopeptides Signup and view all the answers

What is the role of beta-lactamase inhibitors in the treatment of complicated lower UTIs?

They enhance the efficacy of cephalosporins Signup and view all the answers

Which antibiotic is recommended for treating Candida spp. infections?

Fluconazole Signup and view all the answers

Study Notes

Urinary Tract Infections (UTIs)

UTIs are a common bacterial infection affecting the urinary tract, divided into upper and lower UTIs.
Lower UTIs affect the bladder, urethra, and prostate, while upper UTIs affect the kidneys and pelvis.
40-50% of hospital-acquired infections and 10-20% of community-acquired infections are UTIs.
UTIs are more common in newborns (boys), middle-aged women (10x more than men), and those older than 60 (men).

UTI Defense Mechanisms

Urine flushing washes bacteria from epithelial surfaces.
Normal flora bacteria provide protection.
Mucus epithelium provides protection.
Tamm-Horsfall protein helps prevent infection.

UTI Predisposing Factors (Upper)

Structural abnormalities in the urinary tract.
Urinary reflux (urine flowing back into the kidneys).
Presence of kidney stones (renal calculi).

UTI Predisposing Factors (Lower)

Bladder obstruction or tumor.
Pregnancy.
Catheterization.
Autoinfection.
Anatomical abnormalities.
Neurological defects.
Sexual activity.
Age.

UTI Routes of Infection

Ascending infection (most common): bacteria enter the urethra and ascend to the bladder and kidneys.
Hematogenous spread: bacteria enter the bloodstream and travel to the urinary tract. (e.g., Staphylococcus aureus)
Lymphatic spread: bacteria travel through lymph vessels to the urinary tract.
Tissue contiguous: infection spreads from adjacent tissues.
Fistula: abnormal connection between the urinary tract and another organ (e.g., intestine, vagina).

UTI Symptoms (Newborns)

Non-specific symptoms: fever, vomiting, failure to thrive.

UTI Symptoms (Children > 1 year old and adults, Lower UTI)

Painful urination (dysuria).
Frequent urination (frequency).
Blood in the urine (hematuria).
Fever is usually absent (but it may be present in catheterized patients).

UTI Symptoms (Children > 1 year old and adults, Upper UTI)

Fever (>38.5°C).
Chills.
Pain in the kidney area.
Severe cases: vomiting, diarrhea, tachycardia.

UTI Consequences

Uro (sepsis): UTI can lead to sepsis and in newborns, 20-30% result in sepsis.
Renal failure.
Hypertension.
Pregnancy and childbirth complications.

UTI Principal Pathogens (Community-acquired)

E. coli (mostly).
Staphylococcus saprophyticus.
Proteus spp.
Klebsiella spp.
Staphylococcus spp.
Enterococcus spp.
Streptococcus spp.
Viruses, fungi, and parasites.

UTI Principal Pathogens (Hospital-acquired)

E. coli.
Enterobacter spp.
Proteus spp.
Serratia marcescens.
Acinetobacter spp.
Pseudomonas spp.
Stenotrophomonas maltophilia.
Providencia stuartii.
Staphylococcus spp.
Enterococcus spp.
Corynebacterium urealyticum.
Certain fungi (e.g., Candida spp.).

UTI Diagnosis

Symptoms.
Urinalysis (urine strip tests, microscopic observation, flow cytometry).
Urine sample culture.
Imaging methods (e.g., ultrasound).
Blood cultures (in cases of pyelonephritis).

UTI - Urine Examinations

Microscopy: check for pyuria (white blood cells), hematuria (red blood cells), and proteins.
Urine strips: detect leukocyte esterase (bacteria), nitrates (bacteria), and pH (identify certain bacteria).
Culture: determines presence and type of bacterial infection.

UTI - Urine Culture (Diagnosis)

Recognition of UTI in community-acquired patients: based on symptoms.
Strip tests/microscopy/flow cytometry of urine sediment: evaluate presence of infection.
Culture of positive samples: assesses the species of infection.

UTI - Urine Culture (Specimen Collection)

Midstream urine, clean catch urine.
Catheter urine samples.
Bag urines (not recommended for children).
Suprapubic aspiration (SPA).

UTI - Urine Culture (Storage/Transport)

Transport to lab within 30 minutes or less.
Storage (if necessary):
- Sterile container to 24 hours, 4°C; or to 48 hours, 4°C + boric acid
- Uromedium (transport-growth medium) at 37°C or room temperature.

UTI - Urine Culture (Microscopic Observation)

On physician request.
Presence of > 10⁵ CFU/ml in a urine sample indicates the presence of infection.
Helpful to determine the cause of sterile pyuria.
Prepared with unconserved/uncentralized urine sample.

Sterile Pyuria Definition

Presence of 10 or more white blood cells per microliter of urine in absence of bacteria, diagnosed by aerobic lab techniques.

Sterile Pyuria Reasons

Antimicrobials.
Sexually transmitted diseases (STDs) e.g., Gardnerella vaginalis, Mobiluncus spp., Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum.
Tuberculosis.
Urinary tract injuries.
Systemic diseases e.g., tumor/cancer, sarcoidosis, hypertension.

Urine Culture Quantitative Examination

Transport-growth medium (CLED/MCA): used for transport and growth of bacteria, aids in quantifying microbial growth .
Dilution method: quantifies amount of bacteria in sample (colony forming units per milliliter).
Hoeprich method: also used for quantitative analysis of bacteria in a urine specimen.
Colony counts determined.

Contamination of Urine Sample

Non-invasive specimen collection: less than 10³ CFU/ml.
Invasive specimen collection: less than 10² CFU/ml.

Significant Bacteriuria (Urine Culture) – Adults

Midstream urine: >10⁵ CFU/ml (complicated UTIs, recurrent in women, upper UTIs without complications) or > 10³ CFU/ml (lower UTIs).
Catheter-collected urine: > 10³ CFU/ml (symptoms), >10⁵ CFU/ml (without symptoms).

Significant Bacteriuria (Urine Culture) – Children

Catheter or suprapubic bladder puncture: ≥5 * 10⁴ CFU/ml (with or without pyuria),.
Midstream sample with symptoms: ≥10⁵ CFU/ml.

Asymptomatic Bacteriuria (Urine Culture)

Women: 2 consecutive midstream urine cultures (within 24 hours) with ≥10⁵ CFU/ml in same bacterial species.
Men: Only one culture with ≥10⁵ CFU/ml of the same species.
Catheterized patients (men or women): ≥10² CFU/ml.
Without pyuria.
Without clinical symptoms.

Asymptomatic Bacteriuria Treatment

Pregnant women
Patients before planned surgery in the urinary tract
Catheterized patients, if bacteriuria persists for 48 hours after catheter removal.

UTI Definitions

Recurrent UTI: Same bacterial species within 10-14 days after completing treatment or 3 or more uncomplicated UTIs within 12 months..
Reinfection: Another bacterial species or the same bacterial species within 2-3 weeks after completing treatment.

Prophylactic Measures Against Recurrent Uncomplicated UTI

Conservative measures (limiting spermicide use, postcoital voiding): not proven effective, but unlikely to harm.
Cranberry products: Conflicting evidence on effectiveness.
Continuous antibiotic prophylaxis effectively prevents UTIs.
Postcoital antibiotic prophylaxis (within 2 hours of intercourse): Effective in preventing UTIs.
Self-start antibiotic therapy: Safe option for uncomplicated recurrent UTIs; 3-day regimen.
Vaginal estrogen creams/rings: May reduce UTI risk in postmenopausal women.

UTI Treatment – Lower UTI (First and Second Line Drugs)

First line: Co-trimoxazole, fluoroquinolones (norfloxacin), nitrofurantoin, furagin.
Second line: Cephalosporins I (cephalexin, cefadroxil), II generation (cefaclor), fluoroquinolones.

UTI Treatment – Upper UTI (First and Second Line Drugs)

First line: Co-trimoxazole, fluoroquinolones.
Second line: Penicillins with beta-lactamases inhibitors, cephalosporins II & III generations

UTI Treatment – Complicated Lower UTI (per os and intravenous)

First line: Co-trimoxazole, Penicillins with beta-lactamases inhibitors, ciprofloxacin.
Second line: Penicillins with beta-lactamases inhibitors + aminoglycosides, ampicillin + aminoglycosides, II generation cephalosporins + aminoglycosides.

UTI Treatment – Specific Bacteria (Pseudomonas spp., Gram-positive cocci, Methicillin-resistant Staphylococcus, Enterococcus, and Candida spp.)

Pseudomonas spp.: Ceftazidime + aminoglycosides, piperacillin/carbenicillin + aminoglycosides, carbapenem + aminoglycosides.
Gram-positive cocci: Cephalosporins I or II generation + aminoglycosides, penicillins + beta-lactamase inhibitors + aminoglycosides.
Methicillin-resistant Staphylococcus (MRSA): Glycopeptides.
Enterococcus spp.: Aminoglycosides + glycopeptides, aminoglycosides + ampicillin.
Candida spp.: Fluconazole + flucytosine, amphotericin B + flucytosine.

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Description

Test your knowledge about urinary tract infections (UTIs), including their causes, defense mechanisms, and predisposing factors. This quiz covers the differences between upper and lower UTIs and highlights critical information relevant to understanding this common condition.