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Nefrologia PT > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

infection that recurs with a different organism

A

reinfection

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2
Q

infection where organism persists in the urinary tract despite antimicrobial therapy, same organism

A

relapse

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3
Q

interleukin involved in UTI

A

IL8 (pyruria) IL6 (severity of infection, fever)

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4
Q

symptomatic men, cut of in urine culture

A

10^3

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5
Q

in and out catheter

A

10^2

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6
Q

more active in acidic urine

A

penicillin, tetracycline, nitrofurantoin

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7
Q

more active in alkakine urine

A

aminoglycosides, fluoroquinolones, erythromycin

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8
Q

antibiotic penetrate poorly in the prostate gland because of

A

no active antibx transport mechanism

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9
Q

antibx that penetrate in the prostate well and remain active

A

fluoroquinolones and macrolides

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10
Q

cause of cystitis

A

e. coli

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11
Q

in cystitits, infection occurs via the

A

ascending route

The pathogenesis of UTI begins with colonization of the vaginal introitus or urethral meatus by uropathogens from the fecal flora, followed by ascension via the urethra into the bladder. Pyelonephritis develops when pathogens ascend to the kidneys via the ureters.

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12
Q

second most frequent isolate and virtually unique to acute cystitis

A

S. saprophyticus

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13
Q

major risk factor for recurrent cystitis in women of any age

A

infection at a younger age

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14
Q

stongest association of recurrent acute cystitis in postmenopausal women

A

history of prior UTI

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15
Q

urine culture in cystitis should be obtained when

A
  • clinical presentation not characteristic
  • failure to respond to appropriate empiracal antimicrobial therapy
  • early symptomatic recurrence after therapy
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16
Q

mainstay of empirical treatment of acute cystitis

A

TMP/SMX (3 days)

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17
Q

recommended for women who experience more than 2 episodes in 6 months of UTI

A

low dose prophylactic antimicrobial therapy

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18
Q

only feasible behavioral intervention for recurrent infection

A

avoid spermicide use

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19
Q

strongest association to pyelonephritis in premenopausal women

A

recent sexual intercourse

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20
Q

independent risk factor for pyelonephritis

A

diabetes

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21
Q

imaging in pyelonephritis is required for

A

severe symptoms or treatment failure or early post treatment recurrence

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22
Q

initial imaging modality for pyelonephritis

A

ultrasonography

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23
Q

optimal diagnostic imaging for acute pyelonephritis

A

contrast enhanced CT

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24
Q

indications for hospitalization

A

pregnancy, unstable, compliance with oral, medical illness

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25
Q

preferred empirical regimen for pregnant women

A

ceftriaxone

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26
Q

clinical response after initiation of therapy

A

48-72 hours

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27
Q

recommended empirical antimicrobial

A

ciprofloxacin or levofloxacin

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28
Q

duration of treatment pyelonephritis

A

10-14 days

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29
Q

alternate microbial therapy for pregnant women when cephalosporin cannot be used

A

gentamicin

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30
Q

risk factors of a poor outcome for pyelonephritis

A

hospitalization, isolation of a resistant organism, DM, renal stones

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31
Q

major determinant of infection

A

host impairment

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32
Q

encrusted cystitis or pyelonephritis caused by

A

corynebacterium urealyticum

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33
Q

urease producing bacterium causing cystitis or pyelonephritis with urolithiasis

A

u. urealyticum

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34
Q

symptomatic UTI + repeatedly negative urine culture

A

fastidious organism

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35
Q

alkaline pH + pyuria + negative urine culture

A

urease producing organism

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36
Q

most frequent isolate in men older than 65

A

cons
E coli
enterococcus

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37
Q

screening and tx of asymptomatic bacteriuria

A

pregnant women and traumatic genitourinary tract procedure

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38
Q

when to screen pregnant for asymptomatic bacteriuria

A

end of 1st trimester

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39
Q

recommended regimen for asymptomatic bacteriuria in pregnant

A

5 or 7 day course of nitrofurantoid, 7 day course of amox, co-amox or cephalosporin

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40
Q

Urine CS should be done after treatment

A

monthly

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41
Q

urologic emergency with systemic manifestations

A

acute bacterial prostatitis

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42
Q

management of acute bacterial prostatitis

A
  • drainage of a urethral or suprapubic catheter
  • antibx
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43
Q

first line therapy for acute bacterial prostatitis

A
  • B lactam + aminoglycoside
  • FQ 6 weeks
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44
Q

if no clinical response (acute prostatitis)

A

CT or MRI and transrectal UTZ guided aspiration

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45
Q

diagnosis for chronic bacterial prostatitis

A

paired culture of midstream + post prostatic massage urine specimens

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46
Q

most common isolates for chronic bacterial prostatitis

A

enterbacteriacease and p. aeruginosa

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47
Q

first line for susceptible organisms in chronic bacterial prostatitis

A

ciprofloxacin and levofloxacin

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48
Q

second line drugs for chronic bacterial prostatitis and preferred for gram + infections

A

doxycycline and macrolides

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49
Q

chronic pelvic pain syndrome + negative culture

A

4 week trial of antimicrobial

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50
Q

prophylaxis for the 1st 6 months after transplant for UTI

A

TMP/SMX

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51
Q

occupy the retroperitoneal fat and fascia around the kidney

A

perinephric abscess

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52
Q

most likely originated with hematogenous spread

A

s. aureus

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53
Q

preferred imaging modality for abscesses

A

CT

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54
Q

Cut off size of abscess that responds to antibx without drainage

A

5 cm

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55
Q

most effective in localizing infected cyst

A

PET with deoxyglucose F18

56
Q

optimal duration recommended for infected renal cysts

A

4 weeks of (cotri, chloramphenicol, quinolones, levox)

57
Q

acute necrotizing infections characterized by gas formation

A

emphysematous cystitis and pyelonephritis

58
Q

most common isolates in emphysematous cystitis

A

E. coli and K. pneumonia

59
Q

optimal imaging technique for emphysematous cystitis

A

CT

60
Q

destruction and replacement of the renal parenchyma by granulomatous tissue containing histocytes and foamy cells

A

xanthogranulomatous pyelonephritis

61
Q

vesicle empyema, purulent fluid collection in a nonfunctioning bladder

A

pyocystis

62
Q

early finding in GUTB

A

erosions of renal calyx, papillary necorsis, hydronephrosis, cavitation

63
Q

thickened ureteric wall and strictures (distal 3rd)

A

ureteric TB

64
Q

reduced bladder volume with wall thickening, ulceration and filling defects

A

bladder TB

65
Q

most common finding on CT

A

renal calcification

66
Q

diagnosis of GUTB

A

growth of M. TB in urine or tissue culture

67
Q

tx for GUTB

A

HRZE x 2 months then HR 4 months

68
Q

when is nephrectomy indicated in GITB

A

intractable pain, untreatable infection proximal to a stricture, uncontrollable hematuria or hypertension or drug resistance

69
Q

first line treatment for superficial bladder tumors and carcinoma in situ

A

intravesical vaccine instillation of BCG

70
Q

bcg bladder instillation followed by local irritative symptoms > 48 hours

A

BCG infection

71
Q

treatment of BCG infection

A

isoniazid for 14 days

72
Q

when to tx asymptomatic candiduria

A

neutropenia or before a traumatic urologic procedure

73
Q

most common fungi growth

A

candida albicans

74
Q

treatment of chocie for candida UTI

A

fluconazole 200-400 mg od x 2 weeks

75
Q

alternative tx for resistant strains (c. glabrata)

A

amphotericin 0.3 to 0.6 mkd for 7 days-2 weeks

76
Q

indicated for treatment of canida uti as a single agent

A

5-flucytosine

77
Q

most common viral cause of uti

A

adenovirus, parvovrus B1, CMV

78
Q

most common and important parasitic infestation of the urinary tract

A

schistosoma hematobium

79
Q

functional abnormality early in the disease of parasitic infestation

A

obstruction of the bladder neck

80
Q

risk factor for SCCA of the bladder

A

s. hematobium infection

81
Q

thickening of the bladder wall, granulomatous changes, hydronephrosis, bladder or ureteric calcification

A

s. hematobium

82
Q

time of maximal egg passage when urine specimen should be collected

A

1100-1300H

83
Q

diagnosis of parasitic infections

A

identification of parasite eggs in the urine or biopsy

84
Q

treatment of s. hematobium

A

one dose of praziquantel 40 mk

85
Q

follow up urine specimen for parasite examination should be done

A

after 3 months

86
Q

commonly transmitted sexually

A

t. vaginalis

87
Q

tx for t. vaginalis

A

metronidazole single dose 2 g or tinidazole 2 g

88
Q

incidental finding of a cyst in the kidneys, ureters, bladder or testes

A

echinococcus granulosus infestation

89
Q

recommended for patients with hyatid disease

A

peioperative albendazole therapy

90
Q

CS specimen

A
  1. clean catch voided specimen with no periurethral cleaning
  2. transport immediately if not refrigerate 4C
  3. short term cath: puncture port
  4. long term cath: replace
91
Q

major adhesions for ecoli

A

Type 1 Film H and P fim

92
Q

found in cystitis, superficial infection

A

IgA

93
Q

most frequently isolated organism among premenopausal women causing acute cystitis

A

e coli

94
Q

most common post menopausal

A

K. pneumonia

95
Q

time dependent antibx

A

B lactam

96
Q

Concentration dependent

A

FQ, aminoglycoside

97
Q

necessary characteristic for bladder infection

A

FimH

98
Q

False positive nitrites

A

blood urobilunogen dyes

99
Q

false negative nitrite

A

non nitrate bacteria or short dwell time

100
Q

for esbl organisms

A

carbapenems

101
Q

marker for bacteremia, not predict outcome

A

procal

102
Q

Associated with prolonged hospitalization and post discharge recurrence

A

crp

103
Q

most impt rf for fungal uti

A

In dwelling cath/uro device
broad spectrum antibb
dm

104
Q

tx for fungus balls

A

Surgery
remove devices when possible

105
Q

Tx for cmv uti

A

Ganciclovir or foscarnet

106
Q

tx for adenocirus

A

cidofovor vidarabine ganci rinbavirin

107
Q

adverse effect of nitrofurantoin

A

peripheral neuropathy

108
Q

major risk factor in home care

A

functional impairment

109
Q

most common organisms in stones

A

p. mirabilis

110
Q

most common lesion location of gi tb

A

distal 3rd ureter

111
Q

prostatitis syndrome class I

A

acute bacterial prostatitis

112
Q

class 2 prostate

A

chronic bacterial prostatitis

113
Q

Class III

A

chronic pelvic pain syndrome

114
Q

Class IIIa

A

inflammatory cpps
leukocytes in semen, in urine after prostate massage or in expressed prostate secretions

115
Q

Class IIIb

A

noninflammatory cpps
absence of leukocytes in specimens

116
Q

Class IV

A

Asymptomatic inflammatory prostatitis, leukocytes with no symptoms

117
Q

multiple bilateral and cortical abscesses cause

A

hematogenous route

118
Q

risk factors for abscesses

A

dm, aki, wbc >20k

119
Q

tx for emphysematous pyelo

A

percutaneous aspiration or open drainage vs partial nephrectomy

120
Q

tx for xanthogranulomatoys pyelo

A

Nephrectomy

121
Q

Cause of xanthogranulomatous pyelo

A

P. mirabilis, e coli

122
Q

histiocytes and foamt cells

A

xanthogranulomatous pyeloneph

123
Q

chyluria and lymphatic obstruction

A

filiarisis, w. bancroftu

124
Q

hyatid cyst in the kub

A

echinococcus

125
Q

tx for hyatid cyst

A

surgery

126
Q

cintilografia renal estatica DMSA

A

avalia a função tubular e a estrutura anatômica do córtex renal. É um método confiável e acurado para o diagnóstico e acompanhamento de cicatrizes renais.

127
Q

Cintilografia Renal Estática (DMSA)
avalia a função tubular e a estrutura anatômica do córtex renal. É um método confiável e acurado para o diagnóstico e acompanhamento de cicatrizes renais.

A
128
Q
A
129
Q

Acute simple cystitis*

Acute UTI that is presumed to be confined to the bladder

A

There are no signs or symptoms that suggest an upper tract or systemic infection (refer to below)

Acute complicated UTIAcute UTI accompanied by signs or symptoms that suggest extension of infection beyond the bladder:

Fever (>99.9°F/37.7°C)¶

Chills, rigors, significant fatigue or malaise beyond baseline, or other features of systemic illness

Flank pain

Costovertebral angle tenderness

Pelvic or perineal pain in men

Special populations with unique management considerations

Pregnant women

Renal transplant recipients

We categorize UTI as either acute simple cystitis or acute complicated UTI based on the extent and severity of infection. This categorization informs management and differs somewhat from other conventions. Specifically, cystitis or pyelonephritis in a nonpregnant premenopausal woman without underlying urologic abnormalities has traditionally been termed acute uncomplicated UTI, and complicated UTI has been defined, for the purposes of treatment trials, as cystitis or pyelonephritis in a patient with underlying urologic abnormalities or other significant comorbidities. Individuals who do not fit into either category have often been treated as having a complicated UTI by default. Rather than use this convention, we favor an approach to treatment based on the presumed extent of infection and severity of illness. Patients categorized as having acute uncomplicated cystitis according to traditional definitions would fall under the category of acute simple cystitis that we use here.

130
Q
A
131
Q

What are independent risk factors for early urinary tract infections in renal transplants?

A
  1. Female Gender
  2. Prolonged use of foley
  3. Stent use
  4. Older age
  5. Delayed Graft function.
132
Q

tto cistite

A

Duration 3 days therapy is as effective as 5-10 days treatmentFirst Line Antibiotics1. Trimethoprim 200 mg bd or cotrimoxazole 960 mg bd(Nice Guidelines)Longer course 7-10 days therapy1. Nitrofurantoin 100 mg bd (not in renal impairment)Second line drugs 1. Fluoroquinolones such as ciprofloxacin 500 mg bd or levofloxacin250 mg bd2. Fosfomycin 3 g single dose

(Avoid ampicillin not effective in eradicating vaginal and periuretheral colonization)

•

Encourage Fluid intake>2 L/da

133
Q
A

E Coli77%56%69%

Proteus

4%6%3%

Klebsiella sp4%7%9%

Enterococcus4%9%6%

Pseudomonas2%4%-

S Saprophyticus

4%–

Staph aureus

-2.5%-

134
Q

catheter-associated bacteriuria as follows

A

Symptomatic bacteriuria (urinary tract infection [UTI]) – Culture growth of ≥103 colony forming units (cfu)/mL of uropathogenic bacteria in the presence of symptoms or signs compatible with UTI without other identifiable source in a patient with indwelling urethral, indwelling suprapubic, or intermittent catheterization. Compatible symptoms include fever, suprapubic or costovertebral angle tenderness, and otherwise unexplained systemic symptoms such as altered mental status, hypotension, or evidence of a systemic inflammatory response syndrome.

●Asymptomatic bacteriuria – Culture growth of ≥105 cfu/mL of uropathogenic bacteria in the absence of symptoms compatible with UTI in a patient with indwelling urethral, indwelling suprapubic, or intermittent catheterization.

Patients who are no longer catheterized but had urethral, suprapubic, or condom catheters within the past 48 hours are also considered to have catheter-associated UTI or asymptomatic bacteriuria if they meet these definitions.

Because periurethral contamination is less likely in catheterized specimens, a relatively low threshold for bacteria growth in a symptomatic patient is likely to represent true bladder bacteriuria. Although the IDSA guidelines acknowledge that growth as low as 102 cfu/mL has been associated with bladder bacteriuria in the setting of symptoms, the threshold of 103 cfu/mL was chosen since many labs do not quantify growth below that threshold.

135
Q

itu cateter

A

The duration of catheterization is an important risk factor for catheter-associated bacteriuria and UTI and is a major target of prevention efforts [11,12]. (See ‘Prevention’ below.)

Other risk factors include [13-15]:

●Female sex

●Older age

●Diabetes mellitus

●Bacterial colonization of the drainage bag

●Errors in catheter care (eg, errors in sterile technique, not maintaining a closed drainage system, etc.)

136
Q

pathologia itu cateter

A

Urinary tract infection (UTI) associated with catheterization may be extraluminal or intraluminal. Extraluminal infection occurs via entry of bacteria into the bladder along the biofilm that forms around the catheter in the urethra [16-19]. Intraluminal infection occurs due to urinary stasis because of drainage failure, or due to contamination of the urine collection bag with subsequent ascending infection. Extraluminal is more common than intraluminal infection (66 versus 34 percent in one study) [20].

Rarely, there can be purple discoloration of the urine, collecting bag, and tubing (the purple urine bag syndrome) [21]. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora break down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes (indoxyl sulfatase and indoxyl phosphatase) are present. The breakdown products, indigo and indirubin, appear blue and red, respectively [22,23]. Bacteria capable of producing these enzymes include Providencia spp, Klebsiella, and Proteus.

Nefrologia PT (112 decks)

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