urinary tract infections

Question 1

e coli characteristics

Answer 1

gram negative. facultative. lactose fermenter. indole positive. H2S negative. maybe motile or immotile. normal GI flora.

Question 2

what virulence factors does e coli have?

Answer 2

can acquire many from plasmids, etc.

Question 3

does e coli ferment lactose?

Answer 3

yes

Question 4

indole and h2s?

Answer 4

indole positive, sulfur negative.

Question 5

what kind of metabolism?

Answer 5

facultative.

Question 6

what does e coli cause?

Answer 6

gastroenteritis, UTIs, bloody stool, meningitis and pneumonia .

Question 7

do hosts carry uropathogenic strains of e coli as normal flora?

Answer 7

yes of course, thats why UTI are so common

Question 8

what virulence factor do the uropathogenic strains have?

Answer 8

P fimbriae.

Question 9

what risk does UTI with e coli confer?

Answer 9

bacteremia with urinary obstruction.

Question 10

how do we diagnose e coli UTI

Answer 10

physical, blood culture, semiquantitative urine culture.

Question 11

what is the treatment for e coli UTI

Answer 11

sulfa-trimethylprim or ampicillin.

Question 12

what if the e coli has become septic or extended UTI?

Answer 12

third generation cephalosporin (cefotaxime)

Question 13

what can be used as prevention for recurrent UTI?

Answer 13

cranberry juice. must be taken early enough for home remedy to be effective.

Question 14

how does e coli become an ascending infection?

Answer 14

attachment by pili access to deeper and higher regions by exfoliation and inflammation

Question 15

what gram are the klebsiella/enteric/serratia groups

Answer 15

gram negative rods.

Question 16

klebsiella motility, capsule and sulfur?

Answer 16

nonmotile, encapsulated and H2S (-)

Question 17

do klebsiella and enterics ferment lactose?

Answer 17

yes they do

Question 18

are klebsiella and enteric normal flora?

Answer 18

yes. also usually opportunistic nosocomial

Question 19

who is at higher risk for klebsiella and enteric?

Answer 19

men, neonates, elderly

Question 20

what is a major problem for the klebsiella/enterics

Answer 20

antibiotic resistance

Question 21

who is predisposed to klebsiella pneumonia?

Answer 21

elderly, alcoholics, diabetics, chronic respiratory disease. this is a common nosocomial outbreak

Question 22

what protects klebsiella for pathogenesis?

Answer 22

the polysaccharide capsule. it defends against phago, complement.

Question 23

what other klebsiella pathogenesis is involved in infection

Answer 23

adhesins bind the gut wall, and siderophores bind iron.

Question 24

what is the most lethal presentation of klebsiella pneumonia?

Answer 24

current jelly sputum. seen from lobar pneumonia with necrosis inflammation and hemorrhage

Question 25

what are the less lethal forms of klebsiella

Answer 25

bronchitis, UTI, wound infection, catheter infection

Question 26

enterobacter found where?

Answer 26

ICU nosocomial infections

Question 27

what is the mortality related to with enteric infection

Answer 27

the underlying disease.

Question 28

what is a problem with enteric infection?

Answer 28

antibiotic resistance

Question 29

S. marcenscens found where?

Answer 29

opportunistic nosocomial

Question 30

where does S. marcenscens infection adults?

Answer 30

bloodstream, lower respiratory tract, urinary tract, surgical wounds, skin and soft tissues.

Question 31

where does S. marcenscens infection children>

Answer 31

meningitis, wound infection, arthritis.

Question 32

where does S. marcenscens infection heroin addicts?

Answer 32

endocarditis, osteomyelitis.

Question 33

how do we diagnose klebsiella/enterics/serratia?

Answer 33

exam: nosocomial infection. Ab resistance, gram stain and culture.

Question 34

what appearance does klebsiella have

Answer 34

mucoid appearance

Question 35

what appearance does S. marcenscens have

Answer 35

red-pigmented colonies.

Question 36

treatment for klebsiella/enterics/serratia?

Answer 36

need to do Ab resistance testing. begin with amino glycoside + cephalosporin for K and S. need to consult for enterics.

Question 37

prevention of klebsiella/enterics/serratia?

Answer 37

removal of catheters, maintain respiratory devices, minimize hospital stays.

Question 38

proteus/providencia/morganella more or less pathogenic than enterics?

Answer 38

less.

Question 39

proteus/providencia/morganella gram stain and lactose? H2S, where are they found?

Answer 39

they are gram negative rods and lactose fermenters. proteus is H2S (+). they are normal flora usually opportunistic.

Question 40

what special characteristics do proteus/providencia/morganella have?

Answer 40

they produce phenylalanine deaminase and urease.

Question 41

what does proteus do that is unique?

Answer 41

they swarm or produce H2S

Question 42

what is problematic with proteus/providencia/morganella

Answer 42

they are AB resistant

Question 43

how do proteus/providencia/morganella cause UTIs

Answer 43

fimbriae attach to urinary tract. mobile bacteria can move upward.

Question 44

what does urease do?

Answer 44

raises the urine pHand leads to stones. the stones causes worse infection. untreated leads to bacteremia.

Question 45

what else does proteus cause?

Answer 45

pneumonia and wound infections

Question 46

what else does providencia cause?

Answer 46

gastroenteritis, ocular infections, endocarditis.

Question 47

what does morganella cause?

Answer 47

wound infections, sepsis, pneumonia.

Question 48

which is the rarest proteus/providencia/morganella to get infected with?

Answer 48

morganella.

Question 49

how do we diagnose proteus/providencia/morganella

Answer 49

exam: UTI, flank pain, beta-lactam Ab therapy

Question 50

labs for proteus/providencia/morganella

Answer 50

gram stain and culture, UTI then urine culture, enzyme immunoassays to determine between the groups.

Question 51

treatment for proteus/providencia/morganella

Answer 51

remove infected catheters. drain abscesses. Ab need to test for sensitivity.

Question 52

what do we start with for proteus/providencia/morganella

Answer 52

aminoglycoside and sulfa-trimethylprim.

Question 53

how do we prevent proteus/providencia/morganella

Answer 53

remove catheters.

Question 54

enterococcus species?

Answer 54

faecalis and faecium

Question 55

how do the enterococcus grow?

Answer 55

cocci in chains, grow in high salt.

Question 56

what are the enterococcus resistant too?

Answer 56

penicillin

Question 57

what is the enterococcus metabolism?

Answer 57

facultative anaerobes.

Question 58

where are the enterococcus found?

Answer 58

normal flora, they cause opportunistic

Question 59

what kind of AB resistance do the enterococcus have?

Answer 59

intrinsic and acquired. they are becoming a more serious pathogen

Question 60

what does VRE stand for?

Answer 60

vancomycin resistant enterococcus

Question 61

what is the pathogenesis of the enterococcus

Answer 61

they escape the GI due to a medical procedure and seed various regions.

Question 62

where are the most common places for the enterococcus to seed>

Answer 62

UTI, surgical site (wound infections and intraabdominal), blood (endocarditis, and meningtis), clinic (nosocomial infections)

Question 63

what are the risk factors for infection with enterococcus

Answer 63

recent use of broad spectrum AB particularly 3rd gen cephalosporins. because they kill all the competing bacteria

Question 64

what is interesting about the enterococcus

Answer 64

they are not particularly pathogenic but they are extremely resistant q

Question 65

how do we diagnose enterococcus

Answer 65

echo for endo, CT or ultra for abscess or bowel, take samples before starting ABs. any positives need sensitivity

Question 66

treamtent for the enterococcus

Answer 66

may not be necessary. swap out the catheters, drain the abscesses, treat principle pathogens. could just need replenishment of the normal flora. similar to C diff.

Question 67

what to treat uncomplicated enterococcus with?

Answer 67

ampicillin

Question 68

what to treat allergic enterococcus with?

Answer 68

vancomycin

Question 69

what to treat VRE?

Answer 69

nitrofurantoin

Question 70

what if endocarditis enterococcus

Answer 70

treat with ampicillin/vancomycin plus gentamicin/streptomycin/ceftrixone