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Flashcards in Infections of the urinary Tract Deck (123)
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1

Nitrofurantoin is effective against most common uropathogens. It is____excreted from the urine but does ____. Therefore it is not useful for upper tract, complicated infections, or blood-borne infections It has minimal/maximal effects on the resident bowel and vaginal flora

Nitrofurantoin is effective against most common uropathogens. It is rapidly excreted from the urine but does not obtain therapeutic levels in most body tissues, including the gastrointestinal (GI) tract. Therefore it is not useful for upper tract, complicated infections, or blood-borne infections. It has minimal effects on the resident bowel and vaginal flora

2

___ the presence of white blood cells (WBCs) in the urine, is generally indicative of infection and/or an inflammatory response of the urothelium to __,__,___, or other conditions that can contribute to pyuria. Bacteriuria without pyuria is generally indicative of bacterial colonization without overt infection of the urinary tract. Pyuria without bacteriuria, or sterile pyuria, warrants further evaluation

Pyuria, the presence of white blood cells (WBCs) in the urine, is generally indicative of infection and/or an inflammatory response of the urothelium to bacteria, stones, an indwelling foreign body, or other conditions that can contribute to pyuria. Bacteriuria without pyuria is generally indicative of bacterial colonization without overt infection of the urinary tract. Pyuria without bacteriuria, or sterile pyuria, warrants further evaluation

3

Acute pyelonephritis is a clinical syndrome of __,__ and ___ that is accompanied by__ and __, a combination that is reasonably specific for an acute bacterial infection of the kidney.

Acute pyelonephritis is a clinical syndrome of chills, fever, and flank pain that is accompanied by bacteriuria and pyuria, a combination that is reasonably specific for an acute bacterial infection of the kidney.

4

Xanthogranulomatous pyelonephritis (XGP) is a rare form of ____ often associated with _____ and characterized by destructive replacement of normal renal parenchyma with ___; it is associated with____of renal function

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis often associated with stone disease and characterized by destructive replacement of normal renal parenchyma with granulomatous inflammation; it is associated with ipsilateral loss of renal function

5

factors of complicated UTI

6

UTIs may also be defined by their relationship to other UTIs:

1. A   first or isolated infection is one that occurs in an individual who has___ or has one ___ from a
previous UTI.

2. An unresolved infection is one that __ and is documented to be the __ with a similar ___.
3.  A   recurrent infection is one that occurs after documented, successful resolution of an antecedent infection. Consider these two different types of recurrent infection:

a.   Reinfection describes a ___ associated with ___ of bacteria into the urinary tract.
b.   Bacterial persistence refers to a recurrent UTI caused by the same bacteria ___ within the urinary tract, such as an __ or the ___.


• A   first or isolated infection is one that occurs in an individual who has never had a UTI or has one remote infection from a
previous UTI.
• An   unresolved infection is one that has not responded to antimicrobial therapy and is documented to be the same organism with a similar resistance profile.
• A   recurrent infection is one that occurs after documented, successful resolution of an antecedent infection. Consider these two different types of recurrent infection:

1.   Reinfection describes a new event associated with reintroduction of bacteria into the urinary tract.
2.   Bacterial persistence refers to a recurrent UTI caused by the same bacteria reemerging from a focus within the urinary tract, such as an infectious stone or the prostate.

7

The long-term effects of uncomplicated recurrent UTIs are not completely known, but, so far, there is no/there is association between recurrent infections and renal scarring, hypertension, or progressive renal azotemia has been established

The long-term effects of uncomplicated recurrent UTIs are not completely known, but, so far, no association between recurrent infections and renal scarring, hypertension, or progressive renal azotemia has been established

8

UTIs occur as a result of interactions between the uropathogen and the host. Successful infection of the urinary tract is determined in part by the virulence factors of the__, __ and___

UTIs occur as a result of interactions between the uropathogen and the host. Successful infection of the urinary tract is determined in part by the virulence factors of the bacteria, the inoculum size, and the inadequacy of host defense mechanisms

9

Gram-negative bacteria and their endotoxins, pregnancy, ureteral obstruction, and high lower tract pressures have a significant ____

Gram-negative bacteria and their endotoxins, as well as pregnancy, ureteral obstruction, and high lower tract pressures have a significant antiperistaltic effect

10

hematogenous spread: kidney is occasionally secondarily infected in patients with___ originating from oral sites or with ___

kidney is occasionally secondarily infected in patients with Staphylococcus aureus bacteremia originating from oral sites or with Candida fungemia

11

Direct extension of bacteria from the adjacent organs via lymphatics may occur in unusual circumstances, such as a __ or ___

Direct extension of bacteria from the adjacent organs via lymphatics may occur in unusual circumstances, such as a severe bowel infection or retroperitoneal abscesses.

12

___ is by far the most common cause of UTIs, accounting for 85% of community-acquired and 50% of hospital-acquired infections. Other gram-negative Enterobacteriaceae, including ___ and ____, and gram-positive ___ and __ are responsible for the remainder of most community-acquired infections.

E. coli is by far the most common cause of UTIs, accounting for 85% of community-acquired and 50% of hospital-acquired infections. Other gram-negative Enterobacteriaceae, including Proteus and Klebsiella, and gram-positive Enterococcus faecalis and Staphylococcus saprophyticus are responsible for the remainder of most community-acquired infections.

13

___ is a rare pathogen that causes UTIs in older adults with significant comorbidities, including some urologic malignancies

Aerococcus urinae is a rare pathogen that causes UTIs in older adults with significant comorbidities, including some urologic malignancies

14

_____, is a gram-negative rod that has been associated with UTIs in immunocompromised patients 

 

____ a gram-negative rod commonly found in environmental sources such as soil, has been identified as the causative agent in UTIs in immunocompromised patients and is particularly dangerous because of its extensive drug resistance

Raoultella planticola, is a gram-negative rod that has been associated with UTIs in immunocompromised patients (Skelton et al., 2017).

Myroides odoratimimus, a gram-negative rod commonly found in environmental sources such as soil, has been identified as the causative agent in UTIs in immunocompromised patients and is particularly dangerous because of its extensive drug resistance

15

____ merits special attention as a rapidly emerging cause of multidrug-resistant infections, including UTI

E. coli sequence type ST131 (serotype O25b:H4) merits special attention as a rapidly emerging cause of multidrug-resistant infections, including UTI

16

Urinary tuberculosis (UTB) most commonly occurs with __,, __, ___ and ___ with or without systemic symptoms such as __ and ___. Diagnosis and subsequent treatment are often delayed because of nonspecific symptoms, potentially contributing to impaired renal function and eventual renal failure. _____for M. tuberculosis has replaced acid-fast staining as the ideal method of diagnos

Urinary tuberculosis (UTB) most commonly occurs with hematuria (either gross hematuria, microhematuria, and/or sterile pyuria), storage symptoms, and/or dysuria, with or without systemic symptoms such as fever and weakness. Diagnosis and subsequent treatment are often delayed because of nonspecific symptoms, potentially contributing to impaired renal function and eventual renal failure. Polymerase chain reaction for M. tuberculosis has replaced acid-fast staining as the ideal method of diagnos

17

The steps of UPEC pathogenesis include (6)

The steps of UPEC pathogenesis include (1) UPEC colonization of the periurethral and vaginal tissue as well as the urethra; (2) ascending infection into the bladder lumen and within the urine; (3) adherence to the surface urothelium and interaction with the bladder epithelial cell defense mechanism; (4) biofilm elaboration; (5) invasion and replication by forming bladder Intracellular Bacterial Communities (IBCs), in which quiescent intracellular reservoirs (QIRs) can form and stay dormant in the underlying urothelium; (6) and, in some cases, renal colonization and host tissue damage with high risk for sepsis

18

___ are commonly expressed on nonpathogenic and pathogenic E. coli

Type 1 pili are commonly expressed on nonpathogenic and pathogenic E. coli

19

some bacteria grown in a broth medium express pili, whereas the same strain grown on the same medium in a solid state will cease production of pili. This is called

phase variation

20

Natural Defenses of the Urinary Tract (3)
 

Periurethral and Urethral Region

Urine

Bladder

21

Uromodulin (Tamm-Horsfall protein), a kidney-derived mannosylated protein that is present in an extraordinarily high concentration in the urine (>100 mg/mL), may play a defensive role by saturating all the mannose-binding sites of the type 1 pili, thus potentially blocking bacterial binding to the uroplakin receptors of the urothelium

___, a kidney-derived mannosylated protein that is present in an extraordinarily high concentration in the urine (>100 mg/mL), may play a defensive role by saturating all the mannose-binding sites of the type 1 pili, thus potentially blocking bacterial binding to the uroplakin receptors of the urothelium

22

The early diagnosis of RPN is important to improve prognosis and reduce morbidity. In addition to chronic infection, patients with ___ may have an increased incidence of urothelial tumors; routine urinary cytologic examinations may be helpful to diagnose these tumors early

The early diagnosis of RPN is important to improve prognosis and reduce morbidity. In addition to chronic infection, patients with analgesic abuse–associated papillary necrosis may have an increased incidence of urothelial tumors; routine urinary cytologic examinations may be helpful to diagnose these tumors early

23

Renal PAPILLARY NECROSIS: __ and ___ can minimize a decline in renal function. A patient who suffers from an acute ureteral obstruction caused by a sloughed papilla and who has a concomitant UTI has a urologic emergency. In this case, immediate removal of the obstructing papilla by ___ or____ of the kidney by ureteral catheter or percutaneous nephrostomy is necessary

adequate antimicrobial therapy to control infection and early recognition and treatment of ureteral obstruction caused by sloughed necrotic tissue can minimize a decline in renal function. A patient who suffers from an acute ureteral obstruction caused by a sloughed papilla and who has a concomitant UTI has a urologic emergency. In this case, immediate removal of the obstructing papilla by stone basket or acute drainage of the kidney by ureteral catheter or percutaneous nephrostomy is necessary

24

UTIs are fivefold more prevalent in ___than in control subjects  The pathologic bacteria include higher rates of ___ and ___ in HIV positive patients.

UTIs are fivefold more prevalent in HIV-positive individuals than in control subjects (Schonwald et al., 1999). The pathologic bacteria include higher rates of Acinetobacter and Salmonella species in HIVpositive patients.

25

Of all patients with bacteriuria, no group compares in severity and morbidity with those who have ___

Of all patients with bacteriuria, no group compares in severity and morbidity with those who have SCI. 

26

painless gross hematuria, or microhematuria
in the absence of a positive culture, should always raise the suspicion for___ , and a ___ must be initiated.

painless gross hematuria, or microhematuria
in the absence of a positive culture, should always raise the suspicion for urologic malignancy, and a hematuria evaluation must be initiated.

27

Before sample collection in circumcised men, the glans should
be cleansed with a ___. For those uncircumcised, the foreskin should be ___ and the glans cleansed with the ___ before specimen collection. A ___specimen should be obtained by collecting it in a sterile cup.

Before sample collection in circumcised men, the glans should
be cleansed with a 2% castile soap towelette. For those uncircumcised, the foreskin should be retracted and the glans cleansed with the towelette before specimen collection. A midstream specimen should be obtained by collecting it in a sterile cup.

28

Situations in which a catheterized sample should be considered include when the voided sample shows clear evidence of ___ (i.e., many ___), a patient has a___, the patient is unable to provide an adequate clean-catch sample, or the patient cannot provide any sample at all.

Situations in which a catheterized sample should be considered include when the voided sample shows clear evidence of contamination (i.e., many squamous epithelial cells), a patient has a pessary, the patient is unable to provide an adequate clean-catch sample, or the patient cannot provide any sample at all. Although

29

Leukocyte esterase is produced by the ____. Its presence is an indication of ___, but not ___specifically. the presence of WBCs and therefore leukocyte esterase is uncommon/not uncommon   in   women   with   vaginal   contamination.   Nitrites   are   present   when bacteria reduce ___, via ___ activity.   ALL /NOT  ALL   bacteria   produce   nitrites.

Leukocyte esterase is produced by the breakdown of WBCs in the urine. Its presence is an indication of pyuria, but not bacteria specifically. As mentioned previously, the presence of WBCs and therefore leukocyte esterase is not uncommon   in   women   with   vaginal   contamination.   Nitrites   are   present   when bacteria reduce dietary nitrates, via bacterial nitrate reductase activity.   Not   all   bacteria   produce   nitrites,   though,   so   the   absence   of   nitrites does not mean bacteria are not present

30

Other conditions known to cause pyuria include aside from UTI: (4)

 

GU tuberculosis, urolithiasis, injury to the urothelium (including chlamydial urethritis), and interstitial nephriti