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Renal Week 4 2017/18 > 3: Microbiology of UTI > Flashcards

3: Microbiology of UTI Flashcards

(66 cards)

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1
Q

What is a UTI?

A

Microorganisms in the urinary tract which are causing INFECTIOUS SYMPTOMS

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2
Q

What is a lower UTI?

A

Confined to the bladder (cystitis)

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3
Q

What is an upper UTI?

A

Infection involving the ureters AND/OR kidneys

(pyelonephritis)

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4
Q

Urine is normally ___.

A

sterile

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5
Q

What is a complicated UTI?

A

Symptoms of UTI (e.g dysuria, urgency, increased frequency) with any of:

SYSTEMIC SYMPTOMS (fever, rigors, N&V…)

RENAL STONES

ANATOMICAL ABNORMALITIES

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6
Q

Does bacteruria mean infection?

A

Not without symptoms

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7
Q

What is a common site for colonisers of the urinary tract?

A

Catheter

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8
Q

(Men / women) are more likely to develop UTIs.

A

women

shorter, wider urethras

sex

pregnancy

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9
Q

People with ___ are more likely to get UTIs.

A

catheters

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10
Q

What are the two routes of infection in UTI?

A

Ascending route

Haematogenous

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11
Q

What is the most common organism causing UTIs?

A

E. coli

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12
Q

Why is E. coli well adapted to causing UTIs?

A

Common bowel commensal

Have fimbriae (sticky appendages which let them climb all over the place)

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13
Q

Which investigations are used to

a) rule out
b) properly diagnose

UTIs?

A

a) Dipstick

b) Urine culture

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14
Q

What is the best investigation for UTI?

A

Urine culture

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15
Q

What are coliforms?

A

Gram negative bacilli

most commonly E. coli

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16
Q

E. coli is also called a ___ fermenter.

A

lactose fermenter

along with Klebsiella, Enterobacter

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17
Q

What organisms commonly cause UTIs?

A

Escherichia

Klebsiella

Enterobacter

Proteus

Pseudomonas

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18
Q

What does E coli produce to cause sepsis?

A

Endotoxin

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19
Q

What renal disease is Proteus associated with?

A

Renal stones

particularly struvite stones

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20
Q

Which UTI organism is associated with renal stones?

A

Proteus

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21
Q

Which type of renal stone is commonly seen in Proteus infection?

A

Staghorn calculus

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22
Q

Is Pseudomonas a coliform?

A

NO

but it is a Gram -ve bacillus

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23
Q

What is Pseudomonas UTI associated with?

A

Catheters

Surgery

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24
Q

How is Pseudomonas UTI treated?

A

Ciprofloxacin

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25
How does ciprofloxacin work?
**Affects bacterial DNA**
26
What are the 4Cs?
**Co-amoxiclav** **Ciprofloxacin** **Clindamycin** **Cephalosporins**
27
What's the difference between **Enterobacter** and **Enterococcus**?
**Enterobacter** is a Gram -ve bacillus **Enterococcus** are Gram +ve
28
What is a **Gram positive** coccus which causes UTI?
**Enterococcus** (faecalis) **Staph. saphrophyticus**
29
What is a type of Staphylococcus associated with UTIs in women of child bearing age?
**Staph. saphrophyticus**
30
What are the symptoms of UTI?
**Dysuria** **Haematuria** (not always) **Nocturia** **Increased frequency** **Constitutional symptoms**
31
What symptoms suggest an **upper UTI**?
**Loin pain** **Constitutional symptoms** Fever, rigors, N&V...
32
What **type** of urine sample is taken to diagnose UTI? Why?
**MIDSTREAM urine sample** First portion of urine will be contaminated by commensals
33
What is an MSU?
**Midstream urine sample**
34
How long after a urine sample is collected must it reach the lab?
**\< 2 hours**
35
What positives on **urinalysis** may indicate infection?
**Leukocytes** **Nitrites** remember dipsticks aren't the ideal investigation
36
Why might positive **nitrites** indicate a UTI?
**Coliforms** convert nitrates to nitrites
37
In general, **\_\_\_** shouldn't be used to investigate UTI. What should be used instead?
**urinalysis** **MSU culture**
38
More than ___ organisms on microscopy indicates UTI.
**105**
39
More than ___ organisms on a urine culture indicates **infection**.
**105**
40
Which type of **growth** in a urine culture is probably not significant?
**Mixed growth** i.e more than one organism
41
What is **abacterial cystitis**?
**Symptoms of UTI without bacterial growth on culture**
42
Why may a patient have **abacterial cystitis**?
- Early UTI - Urethral trauma - **"Honeymoon cystitis"** - STI - Patient has taken antibiotics before urine culture collected
43
What is **abacterial cystitis** associated with **urethral trauma** also known as?
**Honeymoon cystitis**
44
How may **abacterial cystitis** be managed?
**Stay hydrated** **Good hygiene** **Refrain from having sex until symptoms stop** **Alkalinise urine** (symptomatic relief only)
45
What is **asymptomatic bacteriuria**?
**\> 105 organisms in urine** but NO SYMPTOMS OF INFECTION
46
How is **asymptomatic bacteriuria** treated? What's the exception?
**Supportively** i.e no antibiotics ## Footnote **Pregnant women are given antibiotics**
47
Why are **pregnant women** given antibiotics if they have **asymptomatic bacteriuria**?
**Complications include:** pyelonephritis premature labour growth retardation in child
48
People with **catheters** are more at risk of UTI. When would you give antibiotics to someone with bacteriuria and a catheter?
**\> 105 organisms AND symptoms of infection**
49
How do you treat an **uncomplicated UTI** in **women**?
**Nitrofurantoin** OR **Trimethoprim** **(3 days)**
50
How do you treat an **uncomplicated UTI** in **men**?
**Nitrofurantoin** OR **Trimethoprim** **(7 days)**
51
Which drug could you give to a **pregnant** **women** with an uncomplicated lower UTI?
**Cefalexin** because trimethoprim is teratogenic in the 1st trimester and nitrofurantoin is teratogenic in the 3rd (but generally alright to use)
52
Why are **nitrofurantoin** or **trimethoprim** used to treat **lower** UTIs only?
**They aren't effective in the upper urinary tract**
53
How do you treat a **complicated UTI** or **pyelonephritis** in **primary care**?
**Co-amoxiclav** (14 days)
54
How do you treat a **complicated UTI** in **primary care** in a patient who is allergic to penicillin?
**Co-trimoxazole** (14 days)
55
How do you treat a **complicated UTI** or **pyelonephritis** in **hospital**?
**Amoxicillin** + **Gentamicin IV** (3 days)
56
If a patient in hospital develops a complicated UTI and you treated them with **amoxicillin** + **gentamicin IV** for 3 days, what would you then **step down** to?
**Co-trimoxazole PO** (4 days) For a total of **7 days** on antibiotics
57
How do you treat a **complicated UTI** or **pyelonephritis**, in hospital, in a patient who is allergic to penicillin?
**Co-trimoxazole** + **Gentamicin IV** (3 days) then step down to **Co-trimoxazole** **PO** (4 days)
58
**Gentamicin** can only be used in hospital - why?
**Has to be given IV**
59
Is **gentamicin** safe in pregnancy?
**No**
60
How is **gentamicin** dose calculated?
**Weight**
61
What are possible effects of **gentamicin toxicity**?
**Nephropathy** **CN VIII** **damage** - hearing loss, balance problems
62
If a bacterium has **beta lactamase**, which antibiotics won't work on it?
**Penicillins** **Cephalosporins**
63
**Carbapenemase-resistant** bacteria are resistant to which antibiotics?
**All of them**
64
What can be given as an alternative to **gentamicin** in some patients?
**Aztreonam IV**
65
In which trimesters should a) **trimethoprim** b) **nitrofurantoin** be avoided? Why drug could be given to a pregnant women with a UTI instead?
**a) 1st trimester** **b) 3rd trimester** Cefalexin PO
66
What is the combined form of **trimethoprim** which can be given to patients with **complicated UTIs**? What is a rare side effect of using it?
**Co-trimoxazole** Stevens-Johnson syndrome (severe blistering disease)

Renal Week 4 2017/18 (4 decks)

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