UTI-Hunter Flashcards by michelle granstrom

What are the infections of the lower urinary tract?

urethritis (urethra)

cystitis (urinary bladder) -prob w/ accompanying urethritis

How well did you know this?

Not at all

Perfectly

What is an upper urinary tract infection?

pyelonephritis (kidney & ureter)

perhaps a perinephric abscess

How well did you know this?

Not at all

Perfectly

Which gender are UTIs more common in?

Females! 30:1

incidence increases w/ age & sexual activity

How well did you know this?

Not at all

Perfectly

T/F Postmenopausal women have lower rates of UTIs.

False. bladder or uterine prolapse & hormonally induced changes–increases rates of infections

How well did you know this?

Not at all

Perfectly

What is a case where males sometimes get UTIs?

in their 50s b/c of incomplete voiding of bladder due to BPH

How well did you know this?

Not at all

Perfectly

What are the most common cause of uncomplicated UTI?

80-90% E coli

2. Staph Saprophyticus for females 13-40 who are sexually active.

How well did you know this?

Not at all

Perfectly

What is a complicated UTI? What are the most common organismal causes of this?

resulting from anatomic obstructions or catheterization or weird bugs.
E coli
Proteus Mirabilis
Klebsiella pneumonia
Enterococcus
pseudomonas aeruginosa

How well did you know this?

Not at all

Perfectly

T/F Fungal UTIs are common.

False. Uncommon but serious. Ex: candida.

How well did you know this?

Not at all

Perfectly

T/F UTI (particularly nosocomial) are frequently caused by multi-drug resistant organisms

True.

How well did you know this?

Not at all

Perfectly

What is the vesicoureteral reflux?

reflux of urine from bladder to kidney, can increase risk of UTIs

How well did you know this?

Not at all

Perfectly

Other risk factors for UTI?

pregnancy–like BPH causes incomplete voiding
calculi in urinary tract
catheters

How well did you know this?

Not at all

Perfectly

What can lead to urethral colonization?

contamination of periurethral region w/ fecal organisms

then ascension = UTI

How well did you know this?

Not at all

Perfectly

What facilitates the ascension of organisms w/ UTIs?

bacterial fimbrae (flagella like) that bind to uroepithelial cells

How well did you know this?

Not at all

Perfectly

What are some host factors that prevent UTIs?

urine flow
uroepithelial cell sloughing
lactobacilli in vagina (alter pH to prevent colonization)

How well did you know this?

Not at all

Perfectly

T/F Blood borne infections of the urinary tract is common.

False. Infrequent. In rare cases this happens w/ staph aureus b/c it has SO many virulence factors.

How well did you know this?

Not at all

Perfectly

What are the virulence factors of E Coli?

Type I Fimbriae
P Fimbrae
Hemolysin
**genes for these carried on pathogenecity islands

How well did you know this?

Not at all

Perfectly

What are Type I Fimbriae?

bind to mannose-containing epithelial receptors. can cause cystitis (not pyelonephritis)
Gene: fimH
Note: found in all E Coli

How well did you know this?

Not at all

Perfectly

What are P fimbrae?

bind glycosphingolipid epithelial receptor (found in kidney). Cause pyelonephritis & sometimes bacteremia.
Gene: papGAP
Note: only found on some E coli

How well did you know this?

Not at all

Perfectly

What does hemolysin do?

damages uroepithelium

How well did you know this?

Not at all

Perfectly

If an Ecoli bug didn’t have P fimbrae (often they don’t)…which UTI type could they NOT cause?

pyelonephritis

How well did you know this?

Not at all

Perfectly

What is cystitis? What is it always accompanied by?

infection of bladder

accompanied by urethritis

How well did you know this?

Not at all

Perfectly

What are the signs & symptoms of cystitis?

frequent & urgent urination
oliguria
dysuria
suprapubic tenderness w/ voiding

How well did you know this?

Not at all

Perfectly

urinary frequency, burning, urgency. no back pain or costovertebral angle tenderness. sexually active. no vaginal discharge. suprapubic tenderness. WBCs & a little blood on UA. urine pH=5.6 neutrophils & gram neg. rods. Treatment?

no vaginal discharge–prob not STD
no back pain or costovertebral angle tenderness–not pyelonephritis.
WBCs, a little blood, urinary changes, suprapubic tenderness–cystitis.
low pH–>not proteus mirabilis
gram neg. rod–>E Coli!!!
Treatment: trimethoprim-sulfamethoxazole (bactrim) OR ciprofloxacin for 3 days

How well did you know this?

Not at all

Perfectly

Which lab tests should be done when you suspect a UTI?

UA
dipstick test (UA)-to check pH, bacteria, leukocyte esterase etc.
gram stain of urine

How well did you know this?

Not at all

Perfectly

What is pyuria?

leukocytes in the urine.

Is a urine pH of 5.6 normal?

depends on diet & time of day | but doesn't get above 7.5ish.

What is the presentation of Proteus mirabilis UTI?

pH>7.9 bacteria & WBCs in urine note: this bug is urease-producing

What is the purpose of checking for bacteria in urine?

you want to know if it is resistant

What are you looking for when you are looking for bacteria?

NITRITES-bacteria | gram neg causes of UTI--make nitrites in the urine from nitrates

When you do want to count the cultures in the urine w/ a UTI?

when the patient is super sick & you suspect bacteriuria-->proven w/ >100K colony-forming units per mL

T/F Asymptomatic bacteriuria is common.

True. And should be treated if you are pregnant, renal transplant pts, and those undergoing genitourinary tract surgery.

What are the possible complications for pregnant women w/ asymptomatic bacteriuria?

pyelonephritis | preterm delivery

What is a possible complication of pyelonephritis? Can also be a complication of bacteremia...

perinephric abscess

What are the symptoms of pyelonephritis?

``` fever (>38° C) nausea and vomiting flank pain and tenderness costovertebral angle tenderness + symptoms of cystitis ```

The patient was a 22-year-old female with a history of urinary tract infection 3 months prior to admission. She had been treated with trimethoprim-sulfamethoxazole (Bactrim) without complications. One day before admission she developed left flank pain, nausea, vomiting, fever, and chills. She noted increased urinary frequency and foul-smelling urine on the day of admission. She presented with a temperature of 38.7° C, and physical examination showed left costovertebral angle tenderness. Urinalysis of a clean-catch urine sample was notable for leukocyte esterase (+), >50 WBC and 10 RBC per high-power field, and 3+ bacteria. Urine culture was subsequently positive for a gram-negative, beta hemolytic organism identified as Escherichia coli. What does this patient have? suggested treatment?

acute pyelonephritis--flank pain, costovertebral angle tenderness, fever, cultures >100K. + cystitis symptoms. Treatment: same as cystitis but for longer. trimethoprim-sulfamethoxazole (bactrim) for 14 days. After susceptibility test of E Coli. Could also switch to ceftriaxone.

What is the gross appearance of acute pyelonephritis?

kidney enlarged | discrete, yellowish, raised abscesses on surface

What is the histo appearance of acute pyelonephriits?

suppurative necrosis or abscess formation

What is the gross appearance of the kidneys in chronic pyelonephritis?

gross scars on kidneys, inflammatory changes in pelvic wall, papillary atrophy, blunting

What does the parenchyma of a kidney with pyelonephritis show?

interstitial fibrosis w/ inflammatory infiltrate--lymphocytes, plasma cells, neutrophils a little.

How do you diagnose a perinephric abscess? How does it come to be?

blood work/UA see evidence of pyelonephritis. Ex: see left shift leukocytosis OR less commonly can be secondary to bacteremia CT scan reveals it.

What is the treatment for a perinephric abscess?

drain abscess percutaneously | IV antibiotics

What is the mortality rate of a perinephric abscess?

45%!!!!

If you see a lot of neutrophils--think what? If you see lymphocytes everywhere--think what?

neutrophils-bacteria | lymphocytes--viruses

What is proteus mirabilis?

motile gram neg. rod can cause UTI swarming growth on agar

What does proteus mirabilis produce?

produces urease--causes stones urease-->breaks urea to ammonia & CO2. ammonia can cause ammonium phosphate kidney stones (struvite calculi, stag horn) also increases urine pH

What is the risk of recurrent kidney stones?

location in which bacteria can escape antibiotics | recurrent UTI

A 59-year-old man presents to his primary care physician with a complaint of sharp left flank pain that has been getting progressively worse for two months. His vital signs are temperature 38.7°C, blood presure 130/82, respirations 18, and pulse 78. He has oliguria, dysuria, and hematuria. A clean catch urine sample reveals a pH of 7.9 and >100,000 CFUs per milliliter. Gram stain shows gram-negative rods; What does the patient have? What might the CT show? Treatment?

proteus mirabilis CT--struvite kidney stone ceftriaxone urology will remove stone

Patients with proteus mirabilis often present with what? Risk factors?

Patient often present with cystitis, pyelonephritis, or prostatitis Risk factors include: catheterization, recurrent UTI, anatomical defects

How should moderately ill patients with pyelonephritis be treated?

trimethoprim-sulfamethoxazole OR ciprofloxacin for 14 days

How should patients with severe pyelonephritis be treated?

hospital setting IV antibiotics-ceftriaxone or fluoroquinolone until 24 hours after fever stops, then oral antibiotics for the rest of 14 days

How should women with recurrent infections be treated?

``` long term low dose antibiotic treatment high fluid intake cranberry juice-tannins empty bladder avoid spicy foods, caffeine ```

How can you treat sexually active women with recurrent UTIs?

avoid spermicide containing contraception | antimicrobial agent prior to intercourse

HOw can you treat postmenopausal women w/ recurrent UTI?

oral or vaginal estrogen-gets more lactobacilli going

what is the most common bug to cause prostatitis? Others?

Most common: E Coli | Others: Klebsiella, Pseudomonas, Enterobacter, Serratia, Proteus, and Enterococcus

T/F Sexually active males are more likely to get prostatitis.

True.

How does prostatitis happen?

ascension of fecal organisms that have colonized distal end of urethra

Which virulence factors does E coli depend on to cause prostatitis?

same ones as it depends on for female UTIs

What do infiltrating neutrophils around the acini of the prostate mean?

intraductal desquamation | cellular debris

Aside from neutrophils, what are other things that invade the prostate tissue?

lymphocytes plasma cells macrophages

What is the presentation of a patient with prostatitis?

symptoms of urethritis, cystitis, pyelonephritis rectal exam shows swollen, warm, tender prostate PSA elevated

A 55-year-old male patient presents to your clinic complaining of fever, chills and bodyaches, especially in the low back. He reports painful urination and urinary frequency over the last 3 days. He has had no prior similar symptoms. Vital signs are pulse 104, temperature 100.2°F, blood pressure 132/88, and respirations 18. On physical exam you note suprapubic abdominal tenderness and a distended bladder. Digital exam reveals a warm, tender, and enlarged prostate. Labs show a mildly elevated WBC count; BUN and creatinine are normal. Suspecting prostatitis, you order a urine sample which comes back leukocyte esterase (+), nitrite (+), and bacteria (3+). The lab reports large numbers of a gram-negative rods consistent with Escherichia coli. Based on this patient's symptoms, exam and lab findings, you diagnose him with ? Treatment?

acute bacterial prostatitis | Bactrim

T/FSome infections of the prostate can be prevented by using a condom during sexual interactions

True.

UTI-Hunter Flashcards

(62 cards)