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Renal > Microbiology of UTI's > Flashcards

Microbiology of UTI's Flashcards

1
Q

What is the definition of a UTI? what is the difference between a lower and upper UTI?

A

presence of microorg.s in tract causing an environmental infection

Lower - confined to bladder
Upper - involves ureters +/- kidneys

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2
Q

what is the definition of a complicated UTI?

A

UTI + systemic sepsis or urinary structural abnormality or stones

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3
Q

what is:

  • bacteruria
  • cystitis?
A

Bacteruria - bacteria in urine (not always a UTI)

cystitis - inflammation of bladder

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4
Q

what is the colonisation of the normal urinary tract?

A

Kidneys/ureter/bladder - sterile

Lower urethra - coliforms/enterococcus

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5
Q

Why are women more susceptable to UTI’s? what increases the risk of UTI’s?

A

Short (5cms) wide urethra that’s in close proximity to the anus

Increased risk if: pregnant, sexual intercourse, catheter, abnormal urinary tract

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6
Q

What are the two different routes of UTI?

A

Ascending or from bloodstream due to bacteraemia/septicaemia

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7
Q

what are the 4 different coliforms assoc. with UTI’s?

A

coliforms = gram -ve bacilli

-e.coli
-klebsiella
-enterobacter sp
-proteus sp
other coliforms

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8
Q

What is a UTI due to proteus assoc. with?

A

stone formation: produces urease that breaks down urea = ammonia = increases the urinary pH = precipates salt

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9
Q

What gram -ve bacilli that is not considered a coliform can cause UTI’s? What are UTI’s due to this organism assoc. with?

A

pseudomonas aeruginosa

  • assoc. with catheters and other instrumentation
  • resistant to most abiotic except ciprofloxacin
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10
Q

What gram positive organisms cause UTIs?

A
  • Enterococcus
  • staphylococcus saphrophyticus
  • staph aureus
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11
Q

Enterococcus:

- what type of organism is this?

A

Gram positive streptococci that occur as diplococci or in strips
-gamma haemolytic (do not cause haemolysis)

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12
Q

Staphylococcus saphrophyticus

  • What type of organism is this?
  • what demographic of patients does this affect?
A

coagulase negative staphylococcus

-affects women of child bearing age

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13
Q

What are the 7 s/s of UTI?

A 
Dysuria
frequency
nocturia
haematuria
fever
loin pain
rigors
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14
Q

what type of urine sample is important when testing for UTI’s in general?

A

MSSU

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15
Q 
When would:
-clean catch urine
-bag urine
-catheter specimen
-suprapubic aspiration
be used to collect a urine sample?
A

Clean catch: babies/elderly

Bag urine: attach a bag to urethral meatus in babies - often contaminated with bowel flora so if positive have to do a suprapubic aspiration to confirm

catheter specimen - aspirate from tube

suprapubic aspiration - babies/young children

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16
Q

What is the difference between a boricon container and a sterile universal container when sending urine?

A

Boricon (red top) has preservative that works for about 24hours

sterile universal container must reach lab within 2 hours

17
Q

What different dipstick urine tests would suggest UTI?

A
  • leukocyte esterase
  • nitrites (some bacteria convert nitrates to nitrites)
  • protein/blood
18
Q

How does the lab diagnose UTI’s?

A

-microscopy urine if urgent: look for polymorphs (pus cells), bacteria +/- RBCs

  • Culture urine on all samples: look for a significant bacteruria (only UTI if there’s a significant amount colonisation of 1 bacteria)
  • if there is a mixed growth probably not significant (doesn’t apply for abnormal tracts)
19
Q

What is kess’s criteria?

A

applies to women of childbearing age:
>10^5 organisms/ml = significant (probable UTI)
<10^3 organisms/ml = not significant
10^4 organisms/ml = contaminated? infection? repeat

20
Q

What is the empirical treatment for female lower UTI?

A

Trimethoprim/nitrofurantoin - 3 day course

21
Q

What is the empirical treatment for an uncatheterised male lower UTI?

A

trimethoprim/nitrofurantoin - 7 day course

22
Q

What is the empirical treatment for complicated UTI/pyelonephritis in the community?

A

co-amoxiclav or cotrimoxazole - 14days

23
Q

What is the empirical treatment for a complicated UTI/pyelonephritis in the hospital setting?

A

amoxicillin and gentamicin IV - 3 days
(if allergic penicillin cotrimoxazole instead of amox.)
(cotrimoxazole is IV trimethoprim)

24
Q

Trimethoprim:

  • how does it work?
  • when to avoid?
  • what organisms does it cover?
A

inhibits folic acid synthesis of bacteria, good conc. in urine and prostate, cheap
-avoid in first trimester pregnancy

Organisms:

  • range but not pseudomonas
  • most coliforms/s. aureus including MRSA
25
Q

Nitrofurantoin:

  • when can this only be used and why?
  • when to avoid
  • what organisms does it cover?
A
  • Can only be used in lower uncomplicated UTI as only reaches effective conc. in the bladder
  • avoid in late pregnancy, breast feeding and <3mths babies

Organisms:

  • not proteus/pseudomonas
  • most coliforms, enterococci, staph. aureus inc MRSA
26
Q

Gentamicin:

  • how is this given? when is a level taken?
  • how long can it be prescribed for?
  • risks?
  • organisms covered?
A

Given IV in hospital, 7mg/kg once daily and then measure blood levels 6-14hrs later
-prescribe for 3 days only

Risks:

  • avoid in pregnancy
  • narrow therapeutic index, toxicity causes renal and VIIIth CN damage

Organisms:

  • most coliforms
  • pseudomonas
  • staph aureus inc MRSA
  • not enterococcus
27
Q

Antibiotic resistance in UTI’s, lots of organisms are becoming antibiotic resistant - what type of bacteria that causes UTI’s are becoming antibiotic resistant? what abiotics are useful in these scenarios?

A

Extended spectrum B lactamase (ESBL) producing bacteria

Useful antibiotics:

  • temocillin (also used in those who can’t take gent.)
  • pivmecillinam (not recommended in pregnancy)
28
Q

Which abiotic if amox and trimeth. resistant? is this safe in pregnancy?

A
  • Cephelexin
  • safe in pregnancy
  • trying to reduce use as high risk recurrant UTIs post-treatment
29
Q

If there is a significant bacteruria with no pus cells and asymptomatic in a non-pregnant patient what is the treatment?

A

nothing

30
Q

In pregnancy - why are women screened for asymptomatic bacteruria?

A

All pregnant women are screened at the first antenatal visit and if they are left untreated 20-30% progress to pyelonephritis (which can lead to intra-uterine growth retardation or premature labour)

31
Q

What is the treatment for UTI/asymptomatic bacteruria in pregnancy

A

1st or 2nd trimester nitrofurantoin MR 100mg bd or 50mg qds.
3rd trimester trimethoprim 200 mg bd (unlicensed).

2nd line (any trimester) cefalexin 500 mg tds or as per sensitivities.

Treat for 7 days and sample for test of cure

32
Q

What is abacterial cystitis/urethral syndrome? What are the causes of this?

A

UTI symptoms bu no significant growth (pus cells might be present)

Causes:

  • early phase UTI
  • urethral trauma ‘honeymoon’
  • urethritis caused by chlamydia/gonorrhea

(alkalising urine may help)

33
Q

When would an antibiotic be considered for a catheterised patient?

A

-if significant culture and symptoms (otherwise increasingly resistant microorg. will colonise)

Renal (20 decks)

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