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Renal > UTI > Flashcards

UTI Flashcards

1
Q

Definition of bacteruria

A
  • Bacteria in MSU
  • Single organism>105 CFU/ml
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2
Q

Pyuria definition

A

WBC or pus on urine

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3
Q

Predisposing factors

AGE, SEX

A

AGE

  • Incidence increases with age

SEX

  • Short female urethra→UTI by ascending route
  • Symptomatic infection in females till age 50
  • Significant male infections after 50
    • Prostatic hypertrophy
    • UT abnormalities
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4
Q

Predisposing Factors

Structural/meurological abnormalities of UT

A
  • Vesico-uretric reflux
  • Urethral valves or strictures
  • Calculus formation
  • Postatic hypertrophy
  • Bladder diverticulum
  • Neurogenic bladder

NOTE: these are associated with residual urine

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5
Q

Most frequent predisposing factor in hospital

A

Indwelling urinary cathetr

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6
Q

Host factors that predispose to UTI

A
  • DM→risk of severe bacterial pyelonephritis
  • Immunosupression, steroids, cytotoxic drugs→ recurrent UTI and with unusual bacteria
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7
Q

How do fecal flora reach urinary tract

A

Ascending route

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8
Q

Micturition, females and UTIs

A

During micturtion, organisims may reach neck of bladder esp after instrumentation

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9
Q

What causes majority of UTIs

A

E.coli setorypes O2, O4, O6

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10
Q

E. coli with K1 antigen

A

Capsular Ag

associated with pyelonephritis more than cystitis

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11
Q

Most common cause of hematogenous infecion of kidney

A

S. aureus

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12
Q

E. coli

Characteristics

A

Causes

  • cystitis
  • pyleonephritis
  • Community and hospital inections
  • M and F
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13
Q

Staphy saprophyticus

A
  • Honeymoon cystitis
  • NOVOBIOCIN RESISTANT
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14
Q

Proteus Species

A

P. mirabilis

  • Indole negative
  • most frequent cause of proteus UTI

P. vulgaris

  • Indole positive
  • AMPICILLIN RESISTANT

BOTH

  • Associated with alkaline urine that encourages calculi formation (staghorn)
  • Pyelonephritis
  • Septecemia
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15
Q

Klebsiella, Enterobacter, Serratia

A
  • recurrent or HCA UTI
  • Assoicated with hospital outbreak
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16
Q

Psuedomonas

A
  • Resistant to many antiobiotics
  • Recurrent or HCA UTI
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17
Q

What is associated with renal or perinephric abcess

A

S. aureus

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18
Q

Adenovirus

A
  • Acute hemorrhagic cystitis in children
  • Allogenic BM transplant recipients
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19
Q

Candida common in

A
  • Indwelling catheter
  • On antibiotics
  • DM
  • Immunocompromised
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20
Q

Parisitic cause of UTI

A

Schistiosoma haematobium

  • Free swimming
  • Infective larval cercaria
  • Burrows into human skin in contaminated waters
  • Common in ME and Africa (EGYPT)
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21
Q

Midstream urnie use

A

To decrease number of urethral organisms

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22
Q

Catheter specimen urine

A

NOT bag

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23
Q

Suprapubic Aspiration of Bladder indicated in

A

BABIES

24
Q

Which is difficult to interpret

A

Adhesive bag

25
Q

Getting uretric urine

A

Cystoscopy

26
Q

Getting urine from kidney

A

Nephrostomy

27
Q

Timing for MSUs

A

First sample of day ie early morning since bacteria grow overnight in bladder

28
Q

Timing of specimen collection in Renal TB

A

3 early morning urine

29
Q

Timing of Specimen Collection in Schistosoma haematobium

A

Terminal portion of urine

30
Q

What should you do if specimen not reach lab within 2 hrs

A
  • Fridge at 4°C for 24hrs
  • Contain 1.8% boric acid
    • ​Inhibits bacteria
  • Dip slide or dip inoculum technique
    • Suitabl for general practice
    • Costly
    • NO cell count or quantification
31
Q

Lab UTI diagnosis involves

A
  1. Microscopy
  2. Semi-quantitative culture
  3. Succeptibility testing
32
Q

Microscopy for centrifuged and uncentrifuged urine

A

Uncentrifuged

  • For WBC
  • RBC
  • Bacteria
  • Epithelial cells

Centrifuged

  • CASTS→imp for glomerulonephritis
33
Q

Microscope result interpretation

WBC

A

WBC<10/mm3→NORMAL

WBC>10/mm3

  • UTI
  • UT tumor
  • UT calculi
  • Urinary catheter
  • Chlamydia
  • TB of UTI
  • Partially treated UTI
34
Q

Microscope Interpretation

RBC

A
  • UTI
  • Calculi
  • Tumor
  • Vasculitis
  • GN
  • Renal TB
35
Q

Proteinurea and UTI

A

Common but <2g/day

36
Q

Overall, what suggests UTi in microscope

A

>10 WBC, protein, bacteria and or RBC

37
Q

What suggests upper UTI

A

Presence of casts

38
Q

When should specimen be repeated

A

Presence of epithelial cells ie contaminated

39
Q

Rapid screening methods

A

A. Leukocytes estrase test

  • High sensnitivity for wbc including lysed
  • FALSE NEGATIVES
    • Vit C
    • High protein
    • Glucose
    • Cephalosporins
    • Nitrofurantoin

Nitrate Reductase Test

  • Nitrate→NitRITE
  • Detect 40-80% of positive cultures
  • False Negatives
    • Diuretics
    • Low nitrate in diet
    • Pseudomonas, group b strep, enterococcus do not prodce nitrate
40
Q

Semi quantitative culture methods of MSU

A

Calibrated loop technique

  • MSU: use standard bacteriological loop at 2µl size
  • SPA, uretric urine, urine from kidney: loop size at 100µl

Poor plate method

  • Time consuming
41
Q

What qualifies as significant bacteriuria in MSU

A

Pure growth of one organism

AND

>105bacteria CFU/ml of urine

if present in one urine sample: 80% confident its UTI

Confidence inreases with pyuria and symptoms

42
Q

What qualifies as no evidence of UTi in pt not on antibiotics

A

Bacteria count less than 103 CFU/ml

43
Q

What does bacteria coun of 104-5CFU/ml indicate

A

Equivocal results

OR

Infection with fungi or S aureus and pus cells

44
Q

What indicates probable contamination

A
  • Mixed growth in MSU
  • Count < 103 CFU/ml
  • Epithelial cells in microscopy
45
Q

Interpreting SPA or uretric samles

A
  • Significant bacteruria doesnt apply
  • Single colony may be significant
  • <103 CFU/ml is significant
  • Even if mixed, can use it to identify bacteria, report and significance?
46
Q

Interpreting Urine catheter

A
  • >105 CFU/Ml is evidence of infection
  • 2 organisms common in indwelling catheter
  • Less than 104-5 may still be significant
47
Q

Interpreting blood culture

A
  • If systemic infection is possible as in Upper UTIs
48
Q

Management involves

A
  • Hydration
  • Samples for urinalysis, culture and sensitivity
  • Antibiotics
  • Manage underlying disease
  • Investigate and manage obstruction or structural abnormality
49
Q

Treatment of symptomatic patients

A
  • Empirical treatment according to local resistance data
50
Q

Treatment for uncomplicated lower UTI (f)

A

Antibiotics for 3-5 days

Nitrofurantoin or trimeohoprim sulfamethoxazole

51
Q

When are antibiotics indicated fro 7-10 days

A
  • Lower UTI
    • MEN
    • children
    • females with previous uti
52
Q

Managment of relapse

A
  • Consider structural abnormalities
    • calculi
    • obstruction
    • chronic prostatis
  • urological investigations
    • Urine cultures
    • RFT
    • Imaging
  • Prophylaxis
    • Low dose TMP/SMZ or NItrofurantoin for _>_6months
  • Cranberry juice
53
Q

Management of re infection

A
  • If related to sex
    • Post coital voiding
    • Single dose antibiotic
  • No precepitating event
    • Long term prophylaxis esp f child at risk for renal damage
  • Pregnancy
    • B latams eg cefotaxime
54
Q

Managemennt of Acute Pyelonephritis

A
  • Admit
  • Hydration and antipyretics
  • Antibiotics
    • IV for 14 days
    • Ceftriaxone or amoxicillin-clavulanic acid with amikacin
  • Surgery
    • predisposing condition
    • NOt respond to tehraoy
    • Complicated by renal abscess
55
Q

Follow up of Acute Pyelonephritis

A
  • Repeat culture
  • IVP
  • Nuclear scan
  • US
  • Cystoscoy
  • MCUG
  • Surgery

Renal (9 decks)

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