EXAM 3 UTIs Flashcards
(46 cards)
what is bacteriuria?
- bacteria in urine
- often colonization, not infection
what is a UTI?
bacterial infection of lower or upper urinary tract
what is acute cystitis?
- bacterial infection of the bladder
- infection (and symptoms) confied to lower urinary tract
what is acute pyelonephritis?
bacterial infection of upper urinary tract (ureters, renal pelvis, kidney parenchyma)
what are criteria of uncomplicated UTIs?
- not pregnant
- normal urinary anatomy
- no co-morbitities (healthy, outpatient)
- *patients with uncomplicated UTIs should meet ALL of these criteria
what are the criteria for complicated UTIs?
- pregnant
- abnormal urological anatomy or function
- diabetes melitis
- immune compromise
- indwelling bladder catheter
- male gender
- *patients should be diagnosed with complicated UTI if they meet ANY of these criteria
by age ___, half of women have had at least one UTI
32
cystitis (lower UTI) is more common than pyelonephritis (upper UTI)
UTI develops in >___% of patients with indwelling urinary catheters
10
in healthy individuals in the absence of infection, which bacteria typically colonizes the lower urinary tract?
A. s. aureus
B. proteus species
C. eschericia coli
D. none of the above
D. none of the above
in young healthy individuals, the urinary tract should be sterile
T or F
the urinary tract is normally sterile in young, healthy patients
true
85% of bacteria that cause UTIs are ___ colonizers of the GI tract
gram negative
what are the main bacteria that cause UTIs that are gram negative colonizers of the GI tract
- e. coli (predominant pathogen in UTIs: 75-95%)
- proteus mirabilis
- klebsiella pneumoniae
- staphylococcus saprophyticus
describe the pathogenesis of UTIs
- GI pathogens colonize peri-urethral mucosa
- ascend through urethra to bladder
- urethra is shorter in women than men
- prostatic fluid has anti-bacterial properties
- continue to ascend to ureters/kidney
- less clear how this occurs
- most untreated lower UTI will not progress to pyelonephritis
uropathogenic e. coli have multiple virulence factors. what are they?
- pili
- flagella
- adhesins
- siderophores
- toxins
- polysaccharide coating
the following symptoms are suggestive of what type of UTI?
pain or burning with urination (dysuria)
increased frequency of urination
increased urgency of urination
suprapubic pain
cystitis (lower UTI)
the following symptoms are suggestive of what type of UTI?
fever (>38.3*C)/ chills
flank or costo-vertebral angle pain
nausea/vomiting
pyelonephritis
can also have +/- symptoms of cystitis
what is the gold standard for diagnosis of UTIs?
- symptoms + urine culture demonstrating >105 colony-forming units of uropathogenic bacteria per mL
a positive culture without symptoms = ___?
asymptomatic bactereuria
important distinction to make as this changes management (no antibiotics for asymptomatic bacteriuria)
describe a normal urinalysis
- specific gravity = urine density/ density of water
- nitrite negative = metabolic byproduct of some uropathogenic bacteria
- RBCs and WBCs in urine should be less than 5 per high power field
- some labs also report leukocyte esterase - a surrogate for presence of WBCs
describe an abnormal urinalysis
- cloudy urine with increased specific gravity
- presence of nitrites suggest nitrogen-metabolizing organisms are present
- hematuria and pyuria present
what is the purpose of UA (urinalysis) / microscopy utility for UTI diagnosis?
to rule out UTI based on absence of pyuria (<10 WBC/hpf or negative leukocyte esterase)
when is obtaining UA or microscopy not necessary for UTI diagnosis?
when specific UTI signs or symptoms are clearly present or absent
___ alone is not an indication for antibiotics.
pyuria
it is not specific to UTI or sufficient to differentiate symptomatic UTI from asymptomatic bacteriuria
pyuria is common in patients with ___
asymptomatic bacteriuria
