Catheter ass urinary tract infections

Question 1

How long before catheters need ot be changed

Answer 1

28 dyas or 3 months depending on coating
Male catheter is longer

Question 2

INdications for catheter

Answer 2

Urinary retention
Acute bladder outlet obstruction
Clinically ill eg sespis - accurately measure
Heal perinneal or sacral wounds for incontinent patinet - help w hygeine
Palleative
Immobilisation eg thoracic unstable injuries, pelvic fractures
Surgery esp if on urinary tract

Question 3

Risk factors for CAUTI

Answer 3

Catheter
Manipulation of catheter, trauma to epithelial lining or balloon
Catheter negates flow of urine to outside of body that naturally rotects against bacteria
Biofilm formation on prosthetic material

Question 4

Symptoms of CAUTI

Answer 4

New or worsening fever, rigors, altered mental status, malaise or lethargy with no other identified cause
Flank/loin pain, pelvic discomfort, costovertebral angle tenderness
Acute haematuria
Risk of urosepsis - bacteraemia - spesis

Question 5

Does dark cloudy or smelly urine automatically mean UTI

Answer 5

No - can also be dehydration

Question 6

What is purple urine bag syndrome

Answer 6

Benigin condition ass w colonisation specific bacteria - providencia spp metabolites (amino acid) of dietary tryptophan

Question 7

What causes purple urine bag syndrome

Answer 7

Indirubin - red, indigo (blue), metabolites (amino acid) of dietary tryptophan (milk, tuna, pultry, nuts, seeds, frutis, cheese) being metabolised by bacteria eg proviensia spp

Question 8

What condition makes purple urine bag syndrome more likely

Answer 8

Constipation
More metabolism when reduced GI transit eg constipation
May indicate CAUTI

Question 9

CAUTI diagnosis

Answer 9

NO DIPSTICK (permanently positive because of bacteria that always occurs)
URINE CULTURE - from catheter port site or following TWOC/recatheterisation , not catheter bag
Blood cultures - temp/systemically unwell
Culture urine before antibitoics - can cause false negatives

Question 10

Do you treat asymtpomatic CAUTI

Answer 10

No

Question 11

Treatment for CAUTI

Answer 11

Removal of catheter or catheter change
Antibiotics

Question 12

What is tWOC

Answer 12

tRIAL WITHOUT catheter

Question 13

When give antibiotics in CAUTI

Answer 13

Prev urine cultures see if prev results inform
Check local guidelines for UTI - 7 dyas for complicated UTI
If systemically unell - IV antibiotics for urosepsis, then rationalise from sensitivity resutls from urine culture

Question 14

CAUTI prevenetion

Answer 14

Avoidance of urinary tract catheters
Insertion by trained personal good aseptic technique
Unobstructed flow - no kinks in tubing, keep bag secured below level of bladder avoid back flow, empty draingae bag
Encourrage mobilsation, rcognise and treat dehydration, resolve constipation, encourage good hygeine
Remove catheter when no longer required
Routine catheter changes for long term catheters - Antibiotic prophylaxis not routinely given unless significant previous infection ass w catheter manipulatios

Question 15

Why dont give long term antibitoics for CAUTI

Answer 15

Make more colonisation of resistant bacteria
Same number of infections

Question 16

Why dont use methanamine hippurate

Answer 16

Cuase chemical cystitis - feel like UTI anyway
Not great UTI prevention evidence

Question 17

How lab microbiology work

Answer 17

Blood culture bottles -> incubator 37.5 degrees
Machine scans bottles for chang in colour in indicator dis on bottom - alert
Gram stain positive bottles -> molditoff (mass spectrometer and profiles)
Identification and snesitivities on agar plate

Question 18

What is M.TB stained by

Answer 18

Ziel niehsson for acid fast baccili

Question 19

Gram positive bacteria why resist decolourisation

Answer 19

Thick peptidoglycan cell wall - retains initial crystal violet stain - purple

Question 20

Gram positive Cocci clusters vs chains or pairs most likely

Answer 20

Clusters = Staph aureus - MSSA, MRSA
Pairs = strep pnuemoniae
Chains = enterococci
Other strep eg group A

Question 21

Gram positive Bacilli or rods most likely

Answer 21

Rods - clostridium perfingens (gangarene) , listeria, anthrax

Question 22

Coccobacilli most likely bacteria

Answer 22

Rods that are shorter and more curved
eg e coli

Question 23

Spirochetes likely bacteria

Answer 23

Treponema eg syphilis

Question 24

Gram negative cocci bacteria

Answer 24

Neisseria gonorrhea
Neissieria meningitidis

Question 25

Gram negative rods causes

Answer 25

Pseudomonas aeruginosa
enterobacterm proteus
E coli
Klebsiella pneumoniae
Salmonella SPP
enterobacter spp

Question 26

Sensitivity testing

Answer 26

Disc diffusion
E test (paper strip on agar at diff concs - egg shape, cut off value - MIC)

Question 27

Chocolate agar when use

Answer 27

Lysed blood releases NAD - factor V and haemin - factor X
H.influenzae reuire to grow

Question 28

Why use NYC agar plate for neissieria gonorrhea

Answer 28

Often outcompeted by other bacteria - wont see on normal agar plate
NYC - vancomycin and colistin inhibit most other bacter (gram + and -), so n.gonorrhea can grow

Question 29

How differentaite lactose fermenting bacteria t (e.coli)o non lactose fermenting bacteria (proteus)

Answer 29

Colour indicators eg CLED agar

Question 30

What does a gram negative bacilli that lactose fermenting organism

Answer 30

E.Coli, Klebsiella sp., Citrobacter sp. or Enterobacter sp

Question 31

Steps to gram staining

Answer 31

Fixation specimen to slide with heat or methanol
Appy crystal violet, rinse
Apply mordant - iodine - then rinse
dECOLOURISATION - acetone or ethanol - then rinse
Apply safranin then rinse
Blot dry

Question 32

What type of bacteria is clostridium perfringens

Answer 32

Gram positive bacilli

Question 33

What type of bacteria is Neisseria meningitidis

Answer 33

Gram negative cocci

Question 34

What type of bacteria staph aureus

Answer 34

Gram positive cocci in clusters
Coagulase +