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Year 2 > Microbiology of UTI > Flashcards

Microbiology of UTI Flashcards

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1
Q

In a normal urinary tract, where is the urine sterile and where might it pick up bacteria?

A

Sterile - kidney, ureter, bladder

Distal urethra is colonised by bowel flora (coliforms & enterococci)

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2
Q

Define UTI

A

Presence of bacteria in urine which is causing clinical infection

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3
Q

Define lower and upper UTI

A

Lower UTI - infection confined to bladder (cystitis)

Upper UTI - infection involving ureters +/- kidney (pyelonephritis)

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4
Q

Define complicated UTI

A

UTI associated with systemic sepsis OR stones OR urinary tract abnormality

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5
Q

Define bacteriuria

A

Bacteria in the urine

Nb - common in elderly people with catheters & does not always denote infection

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6
Q

Cystitis is infection of the bladder. T/F

A

False - inflammation of the bladder; infection is one cause but there are others

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7
Q

Who is at highest risk of UTI?

A

Women
Catheterised patients
Patients with structural abnormalities of the urinary tract

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8
Q

Why are women more at risk of UTI?

A

Shorter & wider urethra
Proximity of urethra to anus
Increased risk with sexual activity & pregnancy

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9
Q

Describe ascending infection

A 
Bowel bacteria on perineal skin -->
Urethra -->
Bladder -->
Ureter -->
Kidney
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10
Q

Describe bloodstream infection

A

Bacteraemia/septicaemia –>

Kidneys (multiple small abscesses)

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11
Q

What organisms commonly cause UTI?

A

E.coli
Klebsiella
Enterobacter

(more rarely proteus & other coliforms)

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12
Q

What are the features of UTI commonly associated with Proteus?

A

Calculi formation

Foul smelling urine

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13
Q

How does proteus cause the formation of renal stones?

A

Produces urease which breaks down uric acid into ammonia –> higher blood pH –> formation of salts

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14
Q

What are enterococci? Name two

A

Types of streptococci which live within the GI tract

Enterococci faecalis and faecium

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15
Q

What types of staph can cause UTI? State whether they are coagulase positive or negative

A 
Staph. saphrophyticus (neg)
Staph aureus (pos)
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16
Q

Who gets staph. saphrophyticus infection?

A

Women of child bearing age

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17
Q

Pseudomonas aeruginosa is a gram negative bacillus of the coliform family. T/F

A

False - not a coliform

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18
Q

What is pseudomonas aeruginosa infection associated with?

A

Catheterisation

Instrumentation

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19
Q

How is pseudomonas aeruginosa infection treated?

A

Ciprafloxacin (resistant to other oral antibiotics)

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20
Q

What are the clinical symptoms and signs of UTI?

A

Dysuria
Frequency
Nocturia
Haematuria

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21
Q

What are the clinical symptoms and signs of UTI with upper tract involvement?

A

Fever
Rigors
Flank/loin pain

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22
Q

What is important to remember about collecting urine samples? How is this overcome?

A

Bacterial contamination from the perineum is common on first samples.
Midstream specimen of urine (MSSU)

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23
Q

Describe how midstream specimen of urine is collected

A 
Perineum/meatus is washed with sterile saline
Sterile foil bowl given to patient
First pass urine on toilet
Mid urine collected in bowl
Last pass urine on toilet
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24
Q

Apart from MSSU, how else can urine be collected? When are these indicated

A

Clean catch - children & elderly
Bag urine - babies
Catheter specimen urine - catheter in
Suprapubic aspiration - outflow obstruction

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25
List one drawback and one positive about bag urine collection?
Often contaminated with bowel flora | Negative culture results are reassuring
26
Which two containers can be used for urine collection? State the timeframes in which they should be delivered to the lab, respectively
Boricon container - 24 hours (preservative) | Sterile universal container - 2 hours
27
Which results on dipstick urine testing would indicate infection?
Leukocyte (WBC in urine) Nitrite (bacteria in urine) Blood Protein
28
Which bacterias will not test positive for nitrites on dipstick?
Enterococci (which is absolutely fabulous because they're a common pathogen)
29
Which two tests can be done on the urine in a laboratory? When are these indicated?
Microscopy - urgent cases (look for pus, bacteria & red cells) Culture - significant bacteraemia suspected
30
Describe Kass's criteria for defining urine culture results. Who does this criteria apply to?
>10^5 organisms/ml - probable UTI
31
Mixed growth in urine culture is not significant as UTIs are usually caused by one infecting organism. T/F
True - single organism in large majority of patients but may not stand true for those who are catheterised or who have structural abnormalities
32
What are ESBL producing bacteria?
Extended spectrum beta lactamase producing bacteria (i.e bacteria resistant to all cephalosporins and most penicillins)
33
Which antibiotics may be useful against ESBL producing bacteria?
Nitrofurantoin (oral) Temocilin (IV) (& others)
34
What are carbapenemase producing enterbacteria (CPE)?
Gram negative coliform bacilli that are resistant to Meropenem (i.e all current antibiotics)
35
How does CPE resistance spread? What are some strains associated with?
Plasmids | Travel to indian sub-continent
36
What are the features of an antibiotic useful in treating UTI?
Excreted in high concentrations in urine Few side effects Oral
37
How long a course of antibiotics should be given to uncomplicated lower UTI's in women?
3 days
38
What are the first line antibiotics for UTI?
Amoxicillin (IV or oral) Trimethoprim (oral or IV cotrimoxazole) Nitrofurantoin (oral) Gentamicin (IV)
39
What are the second line antibiotics for UTI?
``` Pivmecillinam (oral) Temocillin (IV) Cefalexin (oral) Co-amoxiclav (IV, oral) Ciprofloxacin (IV, oral) ```
40
Is amoxicillin safe in pregnancy?
Yes
41
Which organisms will amoxicillin treat?
``` Enterococci faecalis Some coliforms (50% are resistant) ```
42
How does trimethopram work?
Inhibits bacterial folic acid synthesis
43
Is trimethopram safe in pregnancy?
Avoid in first trimester (3 months)
44
What is co-trimoxazole a combination of?
Trimethopram and sulphamethoxazole
45
What risk do sulphonamides carry?
Stevens Johnsons syndrome (i.e toxic epidermal necrolysis)
46
Which organisms will trimethopram treat?
Most coliforms Staph aureus MRSA NOT pseudomonas
47
In which clinical presentation of UTI is nitrofurantoin useful? Why?
Lower uncomplicated UTI | Only reaches effective concentrations in bladder urine
48
Is nitrofurantoin safe in pregnancy?
Avoid in late pregnancy (neonatal haemolysis) , breast feeding and in children
49
Which organisms will nitrofurantoin treat?
Most coliforms Staph aureus MRSA NOT proteus or pseudomonas
50
Is gentamicin safe in pregnancy?
No
51
What does gentamicin toxicity cause? How common is this?
Renal toxicity 8th cranial nerve damage (deafness and balance issues) Narrow therapeutic index - must be carefully monitored
52
How is gentamicin administered? What then must be checked?
Once daily IV infusion (7mg/kg) | Must check blood levels 6-14 hours later
53
Which organisms will gentamicin treat?
Most coliforms Staph aureus MRSA NOT enterococci
54
When is gentamicin clinically indicated? How long for?
Severe gram negative (i.e coliform) sepsis | NO MORE THAN 3 DAYS
55
Pivmecillinam is useful in what clinical context?
Lower uncomplicated UTI
56
What bugs is pivmecillinam effective against?
Resistant coliforms
57
What bugs is pivmecillinam NOT effective against?
Strep Staph Pseudomonas Enterococci
58
Can pivmecillinam be used in pregnancy?
Nope
59
Which bugs is temocillin effective against? Which is it NOT effective against?
Resistant coliforms Strep Staph Enterococci Pseudomonas
60
Temocillin is useful in which clinical context?
Complicated UTI/urosepsis where the patients renal function isn't good enough to introduce gentamicin
61
Can cefalexin be used in preganancy?
Yes
62
Why is cefalexin not used if it can be avoided?
Broad spectrum antibiotic increases risk of c.diff infection
63
Which organisms do cefalexin treat?
Coliforms | Staph
64
What is co-amoxiclav?
Combination of amoxicillin and clavulanic acid
65
Is co-amoxiclav safe in pregnancy?
Yes
66
Which organisms does co-amoxiclav treat? Why is it not used more often?
Staph Coliforms Enterococci C.diff infection risk
67
When is ciprofloxacin not used?
Young children | Pregnant woman
68
Why is ciprofloxacin not used more often?
C.diff infection risk because broad spectrum antibiotics
69
Which organisms does ciprofloxacin treat? Why is worth remembering about this antibiotic?
Pseudomonas Coliforms Enterococci Only ORAL agent that treats pseudomonas
70
How is female lower UTI treated?
Trimethoprim OR Nitrofurantoin orally 3 days
71
How is uncatheterised male UTI treated?
Trimethoprim OR Nitrofurantoin orally 7 days
72
How is a complicated UTI/pyelonephritis treated in the community?
Co-amoxiclav OR Co-trimoxazole 14 days
73
How is a complicated UTI/pyelonephritis treated in the community?
Amoxicillin/co-trimoxazole AND gentamicin 3 days Step down treatment
74
When can you diagnose asymptomatic bacteraemia?
>10^5 organisms/ml Asymptomatic patient NO pus in the urine
75
How is asymptomatic bacteraemia treated?
It isn't - especially not in old people
76
How is asymptomatic bacteraemia treated in a pregnant woman? What happens if you don't treat?
Antibiotics May develop into pyelonephritis --> Intra-uterine growth retardation (IUGR) or premature labour
77
What is abacterial cystitis/urethral syndrome?
UTI symptoms Pus in urine No significant growth in culture
78
What can the cause of abacterial cystitis?
Early phase of UTI Urethral trauma Chlamydia/gonorrhoea causing urethritis
79
What is honeymoon cystitis?
Urethral trauma due to vigorous sexual intercourse
80
How can urethral syndrome be treated?
Alkalising the urine for symptomatic relief
81
Does catheterisation increase the incidence of UTI? What increases the risk?
Yes | Increasing length of catheter
82
When should catheterised patients be given antibiotics?
>10^5 organisms/ml | Symptomatic
83
Giving unnecessary antibiotics to catheterised patients causes what?
Colonisation of catheter with increasingly resistant organisms

Year 2 (72 decks)

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