UTIs

Question 1

What are some sx that a UTI now involves the upper urinary tract (pyelonephritis)

Answer 1

Fever over 101 F**

Flank Pain**

Chills

Nausea/vomiting

Shaking

Question 2

Do we see fevers with lower UTIs (simple cystitis)?

Answer 2

Yes, mild fevers 101 or below

Question 3

What are the signs of UTI in newborns?

Answer 3

Fever or hypothermia

Poor feeding

Jaundice

Question 4

What are the signs of UTI in Infants (not newborns)

Answer 4

Vomiting

Diarrhea

Poor feeding

(Wow wouldn’t that make you think of a GI problem)

Question 5

What are the signs of UTI in children?

Answer 5

UNEXPLAINED FEVER

Irritability

Loss of bowel control

Change in urination patterns

Eating poorly

Question 6

What is a URI-cult CLED/EMB?

Answer 6

It is a paddle that has 2 types of media on it that is used to make a presumptive ID of the pathogen causing a UTI as well as the number of pathogens

Question 7

What are the 2 types of culture media on a URIcult CLED/EMB, and what kinds of organisms do they select for?

Answer 7

EMB- selective for Gram negative. (Has bile salts)

CLED- grows both G+ and G-, but determines the ability to ferment lactose

Question 8

What are the 2 things a URIcult EMB/CLEB can tell you?

Answer 8

• the pathogen

- # of pathogens (CFUs/mL)

Question 9

What are the 2 kinds of urinalysis we can do on a urine sample when evaluating a UTI?

Answer 9

Microscopy: (2-5 or more WBCs or 15 bacteria per HPF)

Dipstick

Question 10

What are the common pathogens that cause UTI?

Answer 10

E. coli (75-90%)

Klebsiella

Proteus

Enterococcus

Staph saprophyticus- especially in floozies

Group B Strep- esp in neonates

Pseudomonas

Question 11

When might you see a UTI caused by candida?

Answer 11

Following catheterization

Question 12

What is the SPECIFIC type of E. coli that causes most UTIs

Answer 12

UPEC strains (Uropathogenic E Coli)

Question 13

E. coli

Gram:

Flagellated?

Answer 13

Gram negative

Flagellated

Question 14

How do UPEC E. coli get to the UTI

Answer 14

Fecal contamination

Question 15

What are the SPECIFIC virulence factors that only UPEC E. coli have?

Answer 15

P fimbriae (Pili)

Dr adhesins -lead to formation of complex structures surrounding the bound bacterial cells

Alpha and Beta Hemolysins

K (capsular) antigen

Question 16

Can UPEC E. coli cause hemolysis?

Answer 16

Yes they have Alpha and Beta hemolyins that can lyse RBCs and uroepithelial cells

(Blood in urine? E. coli is our first guess every time)

Question 17

What is the specific antigen that UPEC E. coli can produce?

Answer 17

K antigen- seen in glycocalyx, and is associated with increased formation of Biofilms
**

Question 18

Proteus species:

Gram:

Shape:

Answer 18

Gram Negative

Bacilli

Question 19

What are the 2 types of proteus species?

Answer 19

P. Mirabilis- community acquired

P. vulgaris- infects immunocompromised *

Question 20

What kind of bacteria will exhibit “swarming” on cuture agar?

Answer 20

Proteus species ***

Radiating pattern from initial colony

Question 21

What kind of agar will Proteus NOT “swarm” on

Answer 21

CLED- we put an ingredient in CLED to stop swarming so they’re easier to count

Question 22

What happens when you put proteus on culture agar?

Answer 22

SWARMING

Question 23

Where do we find proteus in the environment?

Answer 23

Normal flora in intestine

Hospitals/nursing homes- can be isolated from mouth and nose of employees

Question 24

What are the virulence factors of Proteus?

Answer 24

UREASE

IgA Protease ZapA

Fimbriae

Question 25

What does urease do?

Answer 25

It is an enzyme that makes urine more alkaline by hydrolyzing the urine to ammonia

Question 26

What would Struvite kidney stones make you think of

Answer 26

A Proteus infection, since proteus makes UREASE which will increase the pH, leading to formation of struvite stones *******

Question 27

Staph saprophyticus

gram:

Shape:

Answer 27

Gram +

cocci

(It’s staph duh)

Question 28

Your young female patient has a UTI, and when you do a gram stain of her urine culture, you see a bunch of GRAM POSITIVE COCCI!!
howwwww do you tell if it is from Staph Aureus or a different kind of staph?

Answer 28

Coagulase test***

No blood clots= not staph aureus**

Question 29

Where does staph saprophyticus normally live

Answer 29

Vagina

Question 30

What is “honeymoon cystitis”

Answer 30

It is a UTI caused by Staph saprophyticus

Most cases occur 24 hrs after having sex. Sex feels like razor sharp pains 🔪

Question 31

Who usually gets UTIs caused by staph saprophyticus?

Answer 31

Sexually active females age 17-27

Question 32

Is staph saprophyticus very virulent?

Answer 32

Not extremely.

Has adhesins and thats about it

Question 33

You’ve done a gram stain of your patients urine culture and its gram positive cocci. You do a coagulase and its negative, so you know its not staph aureus. What’s the next test to do to see if it’s staph saprophyticus?

Answer 33

See if it is resistant to Novobiocin (an antibiotic)

If novobiocin does NOTHIGN to the growth of it, it is resistant, and you have staph saprophyticus

Question 34

Gram + cocci

Coagulase negative

Novobiocin resistant

What fo you have

Answer 34

Staph saprophyticus

Question 35

When you get a UTI from staph saprophyticus, do you have a LOT of the bacteria or a little

Answer 35

Low bacterial numbers, difficult to diagnose

Question 36

what is another name for Strep agalactiae?

Answer 36

Group B Strep GBS

Question 37

What will Strep agalactiae look like when you grow it on blood agar

Answer 37

Gray-white colonies with a narrow zone of B-hemolysis

Question 38

What are the virulence factors of Strep agalactiae?

Answer 38

Capsular polysaccharide

Hyaluronidase

Collagenase

Hemolysin

Question 39

Which lab test is specific for Strep agalactiae ?

Answer 39

CAMP factor***

its’ the accentuation of hemolysis due to interaction with staph on blood agar

Question 40

Where does strep agalactiae normally live?

Answer 40

Normal flora