UTI IDiOMs

The following are true, EXCEPT:

• Pyuria & appearance or smell of urine, should not be used to diagnose UTI when found in isolation.

• Pyuria is frequently found in catheterized patients with bacteriuria, whether they have symptoms or not.

• Odorous or cloudy urine has been demonstrated to be indicative of either bacteriuria or UTI.

• No clear benefits using antibiotic-coated urinary catheters or prophylactic antibiotics to reduce the risk of catheter associated UTI.

• There is a limited role for urine testing for isolated mental status changes eg for older patients with an indwelling urinary catheter and a change in functional or mental status.

In elderly patients, urine cultures are useful EXCEPT in the following questions:

I. UFEME leucocyte positive in asymptomatic bacteriuria.

II. In presence of focal urinary tract symptoms.

III. In systemic signs of infection.

IV. Acute delirium changes on those with CBD.

• I & IV

• I & II

• II & III

• III & IV

Which of the following is FALSE:

• A. US kidneys has nearly 100% sensitivity for detection of large stones (> 5 mm) and hydronephrosis.

• B. US kidneys has less accuracy for detection of small stones < 3 mm.

• C. Disadvantage of US compared with CT is lower rate of detection of acute pyelonephritis & renal abscess.

• D. There is sufficient evidence to support use of CTU for detection of suspected acute pyelonephritis in the complicated patient.

RENAL ABSCESS

Which one of the following are not risk factors for renal abscesses?

(UpToDate)

• Diabetes mellitus

• Pregnancy

• Urinary tract abnormalities

• Renal stone

• Continous bladder drainage

  (CBD)

Factors NOT associated with complicated UTI (cUTI):

(EAU)

• Foreign body

• Vesicoureteric reflux

• Pregnancy

• Incomplete voiding

• Female

Which should be screened and treated for symptomatic bacteriuria?

(IDSA 2019)

• Renal transplant > 1 month prior to operation.

• Neutropenia < 100 cells / mm3 patients.

• Impaired voiding post-spinal cord injury.

• Pre-urological procedure.

• Pre-pregnancy.

In pregnancy

• A. Urine cultures are tested only in certain trimesters.

• B. There is role in repeating urine cultures for everyone.

• C. Nitrafurantoin is safe across all trimesters.

• Postcoital prophylaxis is used in women with history of recurrent UTIs prior to pregnancy with cefuroxime.

Do you need to treat all positive urine cultures in patients who are asymptomatic of urinary tract infections?

• Yes

• No

Answer explanation

Treat asymptomatic bacteriuria in patients who are pregnant or will undergo urology procedures.

Do you need to give antibiotic prophylaxis for all patients who will undergo urology procedures?

• Yes

• No

Answer explanation

Antibiotic prophylaxis is likely not required in patients undergo penile surgery.

How long is the duration of antibiotic prophylaxis for most of urology procedures?

• A. Single dose

• B. Up to 24 hours

• C. 3 days

• D. 1 week

• E. > 1 week