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Renal > UTI > Flashcards

UTI Flashcards

1
Q

How does normal flora differ along the urinary tract

A

Kidneys, bladder and prox urethra sterile

- distal urethra and external genital commensal flora

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2
Q

What is the risk of infection related to?

A

Host defences v bacterial virulence

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3
Q

Most common bacterial isolates in UTIs

A
  • e.coli
  • staph
  • proteus, strep, klebsiella, enterococcus, others
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4
Q

Are dogs or cats more resistant to UTIs?

A

Cats

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5
Q

How do pathogens affecting horses and cattle differ to smallies?

A

Corynebacterium + similar species to smallies

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6
Q

What are cows particularly prone to?

A

Pyelonephritis (though this may be due to time of tx or assessment of cows cf. smallies)

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7
Q

Outline host defence mechanisms of the urinary tract

A
  • normal micturition
  • anatomical and physiological barriers
  • mucosal defence barriers
  • anti microbial effects of urine
  • renal defence mechanism
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8
Q

How is normal micturition defined?

A
  • voiding frequent, complete, with an adequate flow
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9
Q

Clinical conditionss resulting in voiding abnormalities -?

A
  • urethral obstructions
  • spinal disease
  • bladder atony
  • poor husbandry
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10
Q

Outline the protective anatomical and physiological factors

A
  • urethral high pressure zone
  • surface characteristics of urethral urothelium
  • urethral peristalsis
  • prostatic antibacterial fraction
  • longer urethral length
  • ureterovesical valves and ureteral peristalsis
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11
Q

Clinical conditions that may ^ risk of UTI?

A
  • direct trauma eg. Catheterisation
  • ectopic ureters
  • urethral sphincter mechanism incontinence
  • anatomical abnormalities following surgery eg. Perineal urethrostomy
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12
Q

What are some anti microbial properties of the mucosa?

A

> protective factors

  • antibody
  • surface GAGs
  • intrinsic mucosal antimicrobial properties (waterproof etc.)
  • bacterial interference
  • exfoliation of cells
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13
Q

Clinical conditions that affect mucosal defence barriers and pdf UTIs

A
  • trauma eg. Catheters
  • disease processes eg. Neoplasia
  • chemical irritants eg. Cyclophosphamide
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14
Q

Antimicrobial properties of urine

A
  • extreme of pH (high or low)
  • hyperosmolality
  • high urea
  • organic acids
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15
Q

Which clinical conditions affect urine PDF UTIs?

A
  • older cats d/t poor concentration of urine

- dogs with DM glucosuria

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16
Q

Can anaerobes cause UTIs?

A

Not commonly

- so restricted range of feacal bacteria cause UTIs as majority are anaerobes

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17
Q

How do uropathogenic E. Coli over come host defences?

A
  • avoid flushing action (S or P-fimbraie)
  • complement resistant -> opsonoohagocytosis resistant
  • haemolysin production and iron chelation abilities
  • motility (some need to be able to move up urinary tract)
18
Q

How does urine culture differ to normal culture?

A
  • contaminants will give false positive if swab smeared on to agar
  • sample must prevent bacterial growth in the urine (rapid transport to lab, hold at 4* c, add boric acid [bacteriostatic])
  • 2ul onto blood and onto maconkey
  • aerobic incubation, 18hrs
  • look for >100,000 CFU/ml to demonstrate UTI (200 colonies from 2ul)
  • less than this indicates contaminant
19
Q

How does uropathogenic e.coli grow on agar?

A

Grows on blood, more on maconkey, is haemolytic

20
Q

What is considered to be “no significant growth” ?

A

-

21
Q

How does sensitivity testing differ in urine culture?

A
  • higher drug levels than normal disks (because drugs concentrated in the urine)
22
Q

How does recrudescence differ to recurrence?

A

Recrudescence or relapse (same strain, Tx failure)
Recurrence or reinfection (new strain, susceptibility of the animal)
> collect samples over several months from the same animal

23
Q

PDF factors for cats and dogs developing UTIs?

A
  • bitches more common
  • older cats more common
  • mostly bacterial (fungal rare, viral implicated as causal factor for FLUTD, incidence Unknown)
  • parasitism possible 3rd world, not UK
24
Q

Define UTI

A

Adherence, multiplication and persistence of an infectious agent in the urogenital system

25
Q

Define microburia

A
  • presence of microbes in the urine
26
Q

Define bacteruria

A
  • presence of bacteria in the urine
    > 10^5 organisms/ml = infection
    >10^3 suggestive on infection but depends on collection technique
27
Q

Define funguria

A
  • presence of funghi in the urine
28
Q

Define pyuria

A
  • ^ noWBCs in the urine >5/hpf
    > cystocentesis >3-5 significant
    > catheter/free catch >5-10 significant
  • NB: WBCs do not mean infection necessarily, just inflammation
29
Q

How does the nomenclature of trueperella / corynebacterium differ??

A
  • trueperella pyogenes causes abscesses in farm animals

- corynebacterim renale causes pyelonephritis

30
Q

Hx and PE Findings with UTIs?

A
  • may or may not be associated with clinical dz
    > predominant site (upper v lower)
    > presence of preddisposign factors (calculi, DM, neooplasia)
    > UPPER
  • renal/lumbar pain, haematuria, septicaemia
    > LOWER
  • pollakuria, stranguria, dysuria, innapropriate urination
31
Q

How can UTIs be Dx?

A 
> gold standard 
- quantitative culture of urine 
> not diagnostic but indicative 
- urinalysis and sediment
 - gross appearance and smell
32
Q

Best method of sample collection for urine? Other ways?

A 
> aseptically ideal 
- cystocentesis best 
- catheterisation good if done carefully 
- free catch not ideal 
> no Abx for a week before sampling
33
Q

What other samples besides urine can be collected?

A

Urolithiasis for culture

34
Q

How should pathological urine samples be transported ?

A
  • sealed sterile containers
  • fridge
  • boric acid sometimes used as bacteriostatic (may not be appropriate)
  • Royal Mail regulations
  • costs
35
Q

Tx of UTIs?

A

> Abx mainstay

  • empirical initially, but ideally based on culture sensitivity
  • first occourence, pending culture results only!
36
Q

Ideal ABx choice for s UTI

A
  • bacteriocidal
  • based on C + S
  • excreted in urine
  • easy to administer
  • cheap
  • good penetration to other tissues (eg. prostate) if required
  • cascade
  • not newer/broad spec products
37
Q

Outline empirical Abx Tx of a UTI

A 
- short course (5-7 d) most likely to hit E. Coli and Staph 
> best appropriate
- ampicillin
- potentiated amoxicillin
- cefalexin
- TMS (side effects) 
> use top end of dose range 
> if signs recur must do sensitivity
38
Q

What is a therapeutic culture?

A
  • using bacteriology to monitor tx
  • if UTI high morbidity or mortality (prostatitis, pyelonephritis, immunosuppression)
  • antibx is toxic (gentamicin, amikacin)
  • if signs not improving after 3-5d
  • before discontinuing Abx after serious infection
39
Q

What is surveillance culture?

A

> provide info after Abx discontinued

  • ensure Tx successful
  • if signs recur
  • Concerns about underlying causes (FLUTD, incontinence, recessed vulva)
40
Q

Why may Tx of UTIs fail?

A
  • infection not the cause
  • inadequate delivery (client or animal effective drug or delivery)
  • Abx resistance (intrinsic eg. Penicilinase producing bacteria, acquired)
  • undiagnosed or untx PDF -> superinfection (don’t Tx catheterised animals until Catheter removed!)
41
Q

What do you suspect if poor clinical response is seen

A

> culture

  • no bacterial growth?
  • same bacteria susceptible to current Abx?
  • same bacteria resistant to current ABx
  • new speceies
42
Q

Most common source of UTIs?

A

Feacal flora most common, may be skin flora

Renal (23 decks)

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