Urinary Tract Infections Quiz

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Questions and Answers

Which organism is most commonly associated with urinary tract infections (UTIs)?

E.coli (correct)

Pseudomonas spp.

Enterobacter spp.

Staphylococcus saprophyticus

What is a key indicator of pyuria in urinalysis?

Presence of leucocytes (correct)

Presence of nitrates

Urine pH > 7

Presence of red blood cells

Which method is NOT typically used in the diagnosis of UTIs?

Imaging methods (USG)

Blood cultures

Urine sample culture

MRI scans (correct)

Which of the following indicators is commonly tested using urine strips?

Leucocyte esterase (A) Signup and view all the answers

In urinalysis, what does a urine pH greater than 7 indicate?

Urease-positive bacteria (C) Signup and view all the answers

What constitutes recurrent uncomplicated UTI?

Three or more uncomplicated UTIs in 12 months (C) Signup and view all the answers

Which prophylactic measure has confirmed effectiveness in preventing recurrent uncomplicated UTI?

Continuous antibiotic prophylaxis (D) Signup and view all the answers

What should be considered when choosing therapy for recurrent uncomplicated UTI?

Local resistance patterns and patient preference (C) Signup and view all the answers

What are the common symptoms of lower urinary tract infections in adults?

Painful urination and blood in urine (D) Signup and view all the answers

Which of the following statements is true regarding cranberry products for UTI prevention?

They have conflicting evidence for their efficacy (B) Signup and view all the answers

Which of the following is NOT a predisposing factor for urinary tract infections?

Increased fluid intake (A) Signup and view all the answers

Which statement accurately describes the use of vaginal estrogen for postmenopausal women in preventing UTIs?

It may reduce the risk of clinical UTIs compared to placebo. (C) Signup and view all the answers

Which age group is most likely to experience urinary tract infections significantly more in women than in men?

Middle-aged individuals (C) Signup and view all the answers

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

Ascending route (C) Signup and view all the answers

Which symptom is indicative of pyelonephritis rather than a lower urinary tract infection?

Fever over 38.5°C (D) Signup and view all the answers

Which bacterium is associated with hematogenous urinary tract infections?

Staphylococcus aureus (A) Signup and view all the answers

Which statement about urinary tract infection consequences is false?

UTIs do not contribute to hypertension. (A) Signup and view all the answers

Which of the following defense mechanisms does NOT protect against urinary tract infections?

Increased kidney size (A) Signup and view all the answers

Which antibiotic is considered a first-line drug for treating uncomplicated lower urinary tract infections?

Co-trimoxazole (A) Signup and view all the answers

Which of the following antibiotics is suggested for postcoital prophylaxis of recurrent UTIs?

Trimethoprim/sulfamethoxazole 80 mg/400 mg (A) Signup and view all the answers

What is the second-line treatment option for complicated lower urinary tract infections?

Fluoroquinolone (B) Signup and view all the answers

In treating Pseudomonas spp. infections, which of the following is an approved antibiotic?

Ceftazidime (B) Signup and view all the answers

Which drug is listed as a treatment option for both Enterococcus spp. and Methicillin Resistant Staphylococcus (MRSA)?

Aminoglycosides (C) Signup and view all the answers

Which of the following is NOT a first-line drug for upper urinary tract infections?

Ampicillin (A) Signup and view all the answers

Which antibiotic is recommended as a first-line treatment for methicillin-resistant infections?

Glycopeptides (A) Signup and view all the answers

What is a suitable treatment option for Candida spp. infections?

Fluconazole (B) Signup and view all the answers

What is the recommended urine collection method for children?

Catheter urine sample (A), Suprapubic aspiration (C) Signup and view all the answers

Which incubation temperature is ideal for urine culture?

37 °C (B) Signup and view all the answers

What constitutes significant bacteriuria in midstream urine for adults with uncomplicated UTI symptoms?

≥ 10^4 CFU/ml (D) Signup and view all the answers

What is sterile pyuria defined by?

Presence of 10 or more white cells/µl without bacteria (C) Signup and view all the answers

In which scenario should asymptomatic bacteriuria be treated?

Only in pregnant women (A), For catheterized patients with persistent bacteriuria after catheter removal (D) Signup and view all the answers

What type of urine sample is preferred for contamination testing with invasive methods?

< 10^2 CFU/ml (C) Signup and view all the answers

Which conditions can lead to sterile pyuria?

Sexually transmitted diseases (A), Unrelated urinary tract injuries (D) Signup and view all the answers

What is the ideal time frame to transport urine samples after collection?

Up to 30 minutes (D) Signup and view all the answers

What does the presence of >10^5 CFU/ml in urine culture indicate?

Significant bacteriuria (C) Signup and view all the answers

Regarding urine culture results from catheter-collected urine, what indicates a UTI with symptoms?

≥ 10^3 CFU/ml (B) Signup and view all the answers

When is pyuria considered significant in young children?

When associated with symptoms of UTI (C) Signup and view all the answers

Which of the following is NOT a recommended specimen for urine culture?

Bag urines (B) Signup and view all the answers

What indicates recurrent UTI?

Same species within 10-14 days after therapy (D) Signup and view all the answers

What is a common method used for quantitative examination in urine cultures?

Hoeprich method (D) Signup and view all the answers

Which of the following is a valid transport method for urine samples?

Transporting at room temperature (D) Signup and view all the answers

Study Notes

Urinary Tract Infections (UTIs)

UTIs are a common infection affecting the urinary system.
Approximately 40-50% of hospital-acquired infections are UTIs, 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 over 60 (men).

Types of UTIs

Lower UTIs: Conditions affecting the bladder (cystitis), urethra (urethritis), and prostate (prostatitis).
Upper UTIs: Conditions affecting the kidneys and their pelvis (pyelonephritis).

UTI Defense Mechanisms

Flushing: The constant flow of urine washes bacteria away from the urinary tract lining.
Normal Flora: The natural bacteria present in the urinary tract can help prevent infection.
Mucus Epithelium: The protective mucous layer defends against pathogens.
Tamm-Horsfall Protein: This protein plays a role in preventing infections.

Risk Factors for UTIs

Upper Part:
- Structural problems in the urinary system.
- Urinary reflux (urine flowing back into the kidneys).
- Kidney stones (renal calculi).
Lower Part:
- Bladder obstructions or tumors.
- Pregnancy.
- Urinary catheters.
- Autoinfection (bacteria spreading from another part of the body).
- Anatomical issues in the urinary tract.
- Neurological problems affecting bladder control.
- Sexual activity.
- Age.

UTI Routes of Infection

Ascending: The most common route, where bacteria enter the urethra and travel upwards.
Hematogenous: Bacteria spread through the bloodstream (e.g., Staphylococcus aureus).
Lymphatic: Bacteria spread through the lymphatic system.
Tissue contiguous: Infection spreads from nearby infected tissue.
Fistula: Direct connections between the urinary tract and another organ or area. For example, between the urinary tract and the intestines (uretero-vesico-intestinal) or the vagina/uterus.

UTI Symptoms

General: 50% of UTIs don't produce noticeable symptoms.
Newborns: Often present with non-specific symptoms such as fever, vomiting, and failure to thrive.
Older Children/Adults (Lower UTI):
- Painful urination (dysuria).
- Frequent urination (frequency).
- Blood in the urine (hematuria - about 50% of cases).
- Fever (often absent).
Older Children/Adults (Upper UTI):
- Fever (> 38.5°C).
- Chills.
- Kidney pain.
- More severe cases include vomiting, diarrhea, and rapid heartbeat.

UTI Complications

Sepsis: UTIs can lead to a life-threatening bloodstream infection.
- UTIs are a significant source of sepsis especially after other infections and in newborns (20-30% risk).
Renal Failure.
High Blood Pressure (Hypertension)
Pregnancy/Childbirth complications.

UTI Pathogens

Community-acquired*:
E. coli (90%)
Staphylococcus saprophyticus
Proteus spp.; Klebsiella spp.
Staphylococcus spp.
Streptococcus spp.
Enterococcus spp.
Viruses, fungi, parasites (Rare)
Hospital-acquired*:
E. coli (50%)
Enterobacter spp.
Proteus spp.
Serratia marcescens
Acinetobacter spp.
Pseudomonas spp.
Stenotrophomonas maltophilia
Providencia stuartii
Staphylococcus spp.
Enterococcus spp.
Corynebacterium urealyticum
Fungi (Candida spp.)

UTI Diagnosis

Symptoms: Patient's reported signs and symptoms.
Urinalysis:
- Urine strip tests (leukocyte esterase, nitrates).
- Microscopic exam (pyuria, bacteria, hematuria).
- Flow cytometry (for specific cell counts).
Urine Culture: Testing urine for specific bacteria in a lab setting.
Imaging (e.g., Ultrasound - USG): Used to identify structural abnormalities.
Blood Cultures: Done in cases of suspected kidney infection or sepsis.

Urine Culture Details

Specimen Types: Midstream urine, catheter urine, suprapubic aspiration.
Transport: Transport to lab within 30 minutes, in room temperature.
Storage (if necessary): In sterile containers at 4°C up to 24 hours or 4°C+boric acid for up to 48 hours; stored in uromedium (a transport/growth medium).
Microscopic exam: for bacteria and white blood cell counts
Culture: Grow bacteria using special media (e.g. CLED, MCA). Quantification method based on CFU/ml (Colony Forming Units / millilitre).

UTI Definitions

Recurrent UTI: Same bacteria in urine within 10-14 days of treatment. 3 or more uncomplicated UTI's in 12 months.
Reinfection: A different bacteria in urine, within 2-3 weeks of prior infection.

UTI Prevention

Limiting spermicide use
Postcoital voiding
Avoiding harmfulness of cranberry products
Continuous or postcoital antibiotic prophylaxis

UTI Treatment

Lower UTI*:
First line: Co-trimoxazole, fluoroquinolones (e.g., norfloxacin), nitrofurantoin, furagin.
Second line: Cephalosporins (e.g., cephalexin, cefadroxil), generation II cephalosporins, fluoroquinolones
Upper UTI*:
First line: Co-trimoxazole, fluoroquinolones
Second line: Penicillins with beta-lactamases inhibitors, cephalosporins, and generation II and III cephalosporins
Complicated Lower UTI*:
First line/second line Per Oss/In Vena treatment:*
Co-trimoaxole/penicillins + beta-lactamases inhibitors/ciprofloxacin/penicillins +/- ampicillin + aminoglycosides/II generation Cephlasporin +/- aminoglycosides*

Additional Treatment-specific Considerations

Pseudomonas spp.: Cephatazidime +/- Aminoglycosides; Piperacillin/carbenicillin +/- aminoglycosides; Carbapenems +/- aminoglycosides.
Gram-positive cocci: Cephalosporins I or II generation + aminoglycosides; penicillins + beta-lactamases inhibitors +/- aminoglycosides
Methicillin-Resistant Staphylococcus spp.(MRSA): Glycopeptides.
Enterococci: Aminoglycosides + glycopeptides; aminoglycosides + ampicillin
Candida spp.: Fluconazole + Flucytosine; Amphotericin B + Flucytosine.
Asymptomatic bacteriuria: Treatment may be recommended for pregnant women, pre-surgery patients, patients with indwelling catheters with persistent bacteriuria post-catheter removal.

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Description

Test your knowledge on urinary tract infections (UTIs) with this quiz that covers common causes, symptoms, and prevention methods. Discover key indicators used in urinalysis and the effectiveness of various prophylactic measures. This quiz is perfect for students studying medical or healthcare subjects.