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Renal > Microbiology of UTI > Flashcards

Microbiology of UTI Flashcards

1
Q

UTI definition?

A

microorganisms in urinary tract causing clinical infection

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2
Q

where is lower UTI?

A

confined to bladder (cystitis)

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3
Q

where is upper UTI?

A

ureters +/- kidneys (pyelonephritis)

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4
Q

describe distribution of bacteria in urinary tract

A

urine in kidneys and bladder = sterile

lower end of urethra colonised by coliforms and enterococci from large bowel

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5
Q

what is a complicated UTI?

A

UTI complicated by systemic symptoms or urinary structural abnormality/stones

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6
Q

what is bacteriuria?

A

bacteria in urine

not always infection - common in elderly patients or patients with catheters

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7
Q

what must be done for bacteriuria?

A

culture

dipstick not enough

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8
Q

who is UTI most common in?

A

women (urethra is shorter and wider and closer to anus)
catheterised patients
any abnormality in urinary tract

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9
Q

what can cause an ascending infection?

A

bacteria from bowel
perianal skin
lower end of urethra
bladder > ureters > kidneys

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10
Q

two common routes of infection in UTI?

A

ascending (most common)

bloodstream

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11
Q

what can cause bloodstream UTI?

A

septicaemia
seeded into kidneys
multiple small abscesses
bacteria in urine

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12
Q

when should urine sample be taken?

A

mid stream

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13
Q

when is dipstick useful?

A

young people with cystitis

not useful in older people or people with catheters as it doesn’t really tell you much, has lots of false positives

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14
Q

describe coliforms

A

gram -ve bacilli

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15
Q

biggest cause of UTI?

A

coliforms

  • E.coli (mainly)
  • also klebsiella and enterobacter
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16
Q

other non coliform causes of UTI?

A

pseudomonas

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17
Q

describe E. Coli

A

endotoxin in LPS layer

fimbriae (help it to attach)

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18
Q

describe proteus

A

foul smelling (burn chocolate)
produces swarming cultures
causes alkaline urine leading to precipitation of salts

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19
Q

what type of stone does proteus cause?

A 
struite stones (triple phosphate)
- due to alkaline urine
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20
Q

describe pseudomonas

A

gram -ve bacillus
NOT A COLIFORM
associated with catheters and urinary instruments

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21
Q

pseudomonas is resistant to most antibiotics except what?

A

ciprofloxacin

22
Q

describe the action of ciprofloxacin

A

inhibits bacterial DNA gyrase, preventing supercoiling of DNA
not used in children or pregnant women
C. Diff risk
active against pseudomonas, most coliforms, some enterococci but not staph

23
Q

what commonly causes UTI in hospitals?

A

enterococcus
- faecalis (mainly)
- faecium
(types of strep which live in the GI tract)

24
Q

who gets staph saphrophyticus UTI?

A

women of child bearing age

25
Q

who gets staph aureus UTI?

A

if bacteraemia is present

26
Q

symptoms of UTI?

A

dysuria
frequency
nocturia
haematuria

27
Q

what 3 features suggest involvement of upper urinary tract and should be taken seriously?

A

fever
rigors
loin pain

28
Q

cystitis vs pyelonephritis?

A

pyelonephritis more common in systemic disease (diabetes, immunosuppression etc)
pyelonephritis causes more systemic symptoms (fever, chills, malaise, nausea etc)

29
Q

how is UTI diagnosed?

A

mid stream specimen collection

  • can be suprapubic aspiration
  • straight in/out catheter
30
Q

describe process of collecting mid-stream specimen

A

wash perineum/urethral meatus with sterile saline (not antiseptic)
give patient wide mouth bowl
first urine passed into toilet
next part of stream collected in bowl without interruption
last urine passes into toilet
urine transferred into lab container

31
Q

what containers are used for urine specimen?

A 
boricon (stops bacteria multiplying to can last 24 hrs)
sterile universal (must reach lab within 2 hrs)
32
Q

other methods of urine collection?

A

clean catch (in children or cognitive/physical restriction)
bag urine (used in babies - negative finding is more useful to rule out UTI)
catheter specimen
suprapubic aspiration

33
Q

purpose of dipstick testing?

A

leukocyte esterase indicates WBCs in urine
nitrites indicates bacteria in urine
can show protein and blood (not useful for diagnosis)
NOT USED IN ELDERLY OR CATHETER SPECIMENS

34
Q

lab diagnosis of UTI?

A

microscopy not really used, can be used after culture
culture usually done
- >10x5 per ml = significant

35
Q

Kass criteria for culture diagnosis?

A

10 to power 5 organisms/ml of urine = probable UTI

36
Q

what is mixed growth?

A

2 or more organisms on culture

usually not significant if found on culture, even if > 10x5/ml

37
Q

management of uncomplicated UTI?

A

3 day course of antibiotic in women

anti-inflammatories can be as good as antibiotics in some cystitis patients

38
Q

what is abacterial cystitis/urethral syndrome?

A

symptoms of UTI and pus cells present in urine but no significant growth on culture
can be early phase of UTI, urethral trauma or urethritis due to STI

39
Q

how can abacterial cystitis be managed?

A

alkalinising the urine can help symptoms

40
Q

what is asymptomatic bacteriuria?

A

significant bacteriuria (>10x5/ml)
no symptoms, codition is detected incidentally
no pus cells in urine

41
Q

how is asymptomatic bacteria managed?

A

no antibiotics needed
all pregnant women are screened at 1st antenatal visit
antibiotics are given in pregnancy as can progress to pyelonephritis or lead to growth retardation in foetus

42
Q

when should catheterised patients be given antibiotics?

A

only if >10x5 organisms/ml and supporting evidence of UTI (fever, symptoms etc)
common to have colonising bacteria in catheter

43
Q

empirical female lower UTI management?

A

nitrofurantoin or trimethoprim orally for 3 days

44
Q

uncatheterised male UTI management?

A

get cultures

nitrofurantoin or trimethoprim orally for 7 days

45
Q

how is complicated UTI or pyelonephritis managed in GP?

A

co-amoxiclav or co-trimoxazole for 14 days

46
Q

how is complicated UTO or pyelonephritis managed in hospital?

A

amoxicillin and gentamicin IV for 3 days

- co-trimoxazole + gentamicin if penicillin allergic

47
Q

first line for coliforms?

A

gentamicin IV

48
Q

first line for enterococcus?

A

amoxicillin IV

49
Q

1st line UTI antibiotics?

A

amoxicillin
trimethoprim
nitrofurantoin
gentamicin

50
Q

2nd line UTI antibiotics if resistant?

A

pivmecillinam
co-amoxiclav
ciprofloxacin

51
Q

main features of gentamicin?

A 
only used in hospital
avoid in pregnancy
narrow therapeutic index
first line for coliforms
only give for 3 days

Renal (34 decks)

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