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PHARM 232 Final > UTI > Flashcards

UTI Flashcards

1
Q

What are the rates of infections in 65+ between men and women? Under 65?

A

The same rate in both genders
Under 65: females get it more

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2
Q

Where is urine sterile? Where is it not?

A

Sterile: kidney, bladder
Non-sterile: Urethra

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3
Q

What type of tests quantitative/qualititative of urine examination can yield meaningful results?

A

Quantitative

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4
Q

Define where Lower vs Upper UTI are from? What are they called?

A

Lower: cystitis (bladder, urethra)
Upper: pyelonephritis (kidney, renal pelvis)

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5
Q

Differentiate between ascending and descending (hematogenous blood-borne) route of infections?

A

Ascending route
- self-inoculation of the urethra with fecal bacteria

Descending route
- usually a result of bacteremia
- spread of bacteria from bloodstream to other organs
- not person to person
- movement of urine in body

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6
Q

What are risk Factors of UTI

A
  • Diabetes
  • Obstruction of urine flow (kidney stones, tumour)
  • female
  • Catheterization
  • Previous antibiotic use
  • Pregnancy
  • Hospitalization
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7
Q

What are the 4 host defence mechanisms. Give examples of the first 2.

A
  1. inhibit bacterial growth:
    - Low pH, prostatic secretions in male
  2. Anti-adherence factors:
    - Glycosaminoglycan (found on bladder), Tamm-Horsfall protein (uromodulin)
  3. Lactobacillus in vaginal flora
  4. Estrogen level
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8
Q

What are potential microflora that are present in the distal portion of urethra (3)

A
  • coagulase negative staph (Epidemidis, saprophyticus)
  • lactobacilli (non-spore forming)
  • diphtheroids
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9
Q

What are potential pathogens that can be transient colonizers in the urethra (2)

A
  • enterobacteriaceae (gram-neg aerobic)
  • occasional yeast
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10
Q

What bacteria accounts for uncomplicated UTI

A

E. coli

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11
Q

Which bacteria accounts for complicated UTI (3)

A
  • Enterobacteriacae (klebsiella, proteus)
  • Pseudomonas species
  • some gram-positive bacteria
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12
Q

Which bacteria is common in UTI with sexually active women

A

Staph Saprophyticus

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13
Q

Which gram-positive bacteria is the most common pathogen in UTI

A

Enterococci

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14
Q

When can you isolate Candida Albicans (yeast) species from (3)

A
  1. Catheterized patients receiving antibacterial therapy
  2. Diabetic individuals
  3. Hospitalized patients
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15
Q

What are examples of virulence factors of E. coli (2)

A

Fimbriae (bacterial adhesion)
Hemolysin (a cytotoxic proteins that lyses cells)

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16
Q

Which is more severe? lower UTI, Upper UTI

A

Upper UTI

17
Q

What are signs of symptoms of lower UTI?

A
  • frequency of micturition
  • dysuria
  • suprapubic heaviness
  • urgency
  • Darker browner urine (gross hematuria)
18
Q

What are signs and symptoms of Upper UTI?

A
  • Pain and tenderness involving the flank
  • Fever
  • Nausea
  • Chills
  • malaise, headache
19
Q

T/F Clinical symptoms correlate highly with PRESENCE or EXTENT of infection

A

False

20
Q

Explain the condition acute urethral syndrome?
Who gets it?
Quantitative culture result #?
Most common symptom + lab findings?

A

Explain
- symptomatic abacteriuria (not caused by bacteria)

Who gets it?
- most common in sexually active women

Quantitative culture result #?
- less than 10^5 CFU/mL urine

Most common symptom?
- Pyuria (presence of WBC in urine)
- 8+ WBCs/mL of unspun urine OR
- 2-5 WBC/HPF of centrifuged urine

21
Q

What do gram stain microscopic examination help with?

A

Differentiating between bacteria or yeast

22
Q

What do pyuria microscopic examination test for? Lab values for diagnosis? Is it a definite diagnosis?

A

Examine urine for leukocytes
- 8+ WBC of unspun urine OR
- 2-5 WBC HPF of centrifuged urine

Pyuria can also be associated with other diseases

23
Q

Explain leukocyte esterase test

A
  • host response to infections in the prescence of PMNs (polymorphonuclear neutrohpils)
24
Q

Explain Nitrate Reductase Test

A

Looks for presence of urinary nitrite, indicator of UTIs
- Pathogens reduce nitrate to NITRITE, looks for enzyme nitrate reductase

25
Q

Which 2 tests if positive are strongly suggestive of a bacterial UTI

A

Positive leukocyte esterase & nitrate reductase test

26
Q

What are reasons Nitrate tests may be negative? What strains?

A
  • if the pathogen cannot reduce nitrates
    ex. Staph saprophyticus and Enterococcus faecalis
  • or if the bacteria are few in the urine
27
Q

What are limitations of screening methods for sensitivity (1) and specificity (2)

A

Sensitivity: not enough specimen
Specificity:
- cannot differentiate pyuria (bacterial) vs sterile pyuria (cannot culture, could be yeast)
- Some bacteria cannot reduce nitrate

28
Q

How do we culture the urine? What are limitations of culturing the urine?

A

MacConkey agar
- 24+ hrs and 35 degrees anaerobically

Limitations
- not all bacteria can be cultured (eg. funghi)

29
Q

What are diagnostic criteria for UTI (4)
1. Symptomatic patients
2. Symptomatic female
3. Asymptomatic patients
4. growth where?

A
  1. Symptomatic patients: 10^5+ CFU/mL
  2. Symptomatic FEMALE: 10^2+ CFU/mL
  3. Asymptomatic patients 10^5+ CFU/mL in 2 consecutive tests
  4. Any growth in the suprapubic aspiration (sticking needle in bladder) in a symptomatic patient
30
Q

What examples of patients with UTI who can yield LESS THAN 10^5 CFU/mL (2)

A
  1. Patients who received antimicrobial agents
  2. Patients with urinary obstruction
31
Q

Which condition is confused with UTI that has less than 10^5 CFU/mL as well?

A

Acute urethral syndrome
- do NOT have UTI
- symptoms not caused by bacteria

32
Q

Explain sterile pyruria (abacterial pyuria)? What factors can cause this? (3)

A

UTI but no bacterial growth

Factors
- Chlamidya, trichonomas or virus
- Anaerobic bacteria (chlamydia)
- Kidney disease or autoimmune disease

33
Q

Which treatments are used for UTI (3)? and complicated UTI (1 class)

A

Sulfamethoxazole, nitrofurantoin, cephalexin

Complicated UTI: fluoroquinolines (eg. cipro, levo)

PHARM 232 Final (5 decks)

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