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Microbiology Unit 3 > 1 UTIs > Flashcards

1 UTIs Flashcards

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1
Q

Urinary tract infections refer to infections residing in the…

A

Kidneys, ureters, bladder, or urethra

Examples:
Pyelonephritis (kidneys and ureters)
Urethritis (urethra)
Cystitis (bladder)

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2
Q

UTIs are usually initiated as the infecting bacteria contaminates…

A

The opening of the urethra and moves UPWARD into the urinary tract

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3
Q

UTIs are more common in…

A

Adults vs children

Female vs men

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4
Q

Risk factors for UTIs

A 
Obstructions (stones)
Conditions —> incomplete bladder voiding
Immunosuppression
Sexual activity
Use of diaphragms as BC
Enlarged prostate
Catheterization
Pregnancy
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5
Q

Risk factors for UTI specific to children

A

Poor hygiene

Partial blockage

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6
Q

Typical SSx of a Lower UTI

A 
Bladder inflammation
Dysuria
Frequent urination
Urinary urgency
Cloudy, malodorous or bloody urine
Lower abdominal pain or pressure
MILD FEVER****
Burning with urination (urethritis)
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7
Q

Do you get a fever with a lower UTI?

A

You can but it would be mild

Usually due to inflammation rather than the bacteria themselves

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8
Q

SSx of an upper UTI (Pyelonephritis)

A 
HIGH FEVER (>101˚F)
Shaking
Chills 
Nausea
Vomiting
Flank pain
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9
Q

SSx of UTIs in newborns

A

Fever or hypothermia
Poor feeding
Jaundice

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10
Q

SSx of UTIs in infants

A

Vomiting
Diarrhea
Poor feeding

(Mimics GI infection)

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11
Q

SSx of UTIs in Children

A 
Irritability
Eating poorly
UNEXPLAINED FEVER
Loss of bowel control (loose stools)
Change in urination patterns
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12
Q

What is the URI-cult CLED/EMB?

A

Paddles used to make a presumptive ID of pathogen and CFU/ml in UTIs

ID and NUMBER***

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13
Q

What is the EMB side of the CLED/EMB selective for?

A

Gram negative bacteria

Contains BILE salts, which kill off G(+) organisms

(emB = BILE)

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14
Q

What does the CLED side of the CLED/EMB select for?

A

Growth of G+ and G- organisms

Determines ability to ferment LACTOSE

(cLed = LACTOSE)

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15
Q

Why is it important that the CLED/EMB paddles provide a somewhat quantitative measure of the number of organisms?

A

B/c a lot of these pathogens are also a part of our normal flora, so you need at least a certain amount for it to be considered an active infection

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16
Q

How should your urine specimen be collected in order to diagnose a UTI?

A

Midstream clean catch

Catch or aspiration in infants and young children

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17
Q

What U/A microscopy findings indicate an active infection requiring treatment?

A

2-5 or more WBCs or 15 bacteria per high powered microscopic field in a centrifuged urine sample

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18
Q

What additional diagnostic testing should be done in men presenting with UTI symptoms?

A

Prostate exam

Assume that there is an anatomical abnormality present that is causing it

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19
Q

What populations should have an U/S or CT done when diagnosing a UTI?

A

Children - 50% of infants with UTI have an anatomical abnormality

Adults with recurrent infections

Blood in urine

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20
Q

Most common bacteria causing UTI

A

E.coli (75-90% of all UTIs)

Specifically, Uropathogenic E.coli (UPEC)

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21
Q

Other less common bacterial causes of UTIs

A 
Klebsiella spp 
Proteus spp
Enterococcus spp
Staphylococcus saprophyticus
Streptococcus Group B
Pseudomonas aeruginosa

Super rare:
Candida
Adenovirus

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22
Q

Klebsiella UTIs are rare but more common in …

A

Immunocompromised patients

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23
Q

Bacteria to be suspected in sexually active females

A

Staphylococcus saprophyticus

24
Q

Bacteria to be suspected in neonatal UTIs

A

Group B Strep

25
Q

Candida UTIs are super rare but when they occur, they are often the result of…

A

Catheterization

26
Q

Super rare cause of UTI that can cause hemorrhagic cystitis

A

Adenovirus

27
Q

Flagellated, gram-negative enteric bacillus

A

E.coli

28
Q

What strains of E.coli are associated with meningitis?

A

Encapsulated (K1) strains

Meningitis infections are rare in adults but can follow neurosurgical trauma

29
Q

Virulence factors for UPEC E.coli

A

P fimbriae (Pili)

Dr adhesins

Alpha and beta hemolysins

K (capsular) antigen

30
Q

What do P fimbriae and Dr adhesins do to help UPEC E.coli infect the urinary tract?

A

Bind to the uroepithelial cells and erythrocytes

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

31
Q

The alpha and beta hemolysins in UPEC E.coli result in…

A

Lysis of both uroepithelial cells and erythrocytes

Blood in urine? Think E.coli

32
Q

When would you see K (capsular antigens)?

A

In upper UTI and chronic UTI due to increased formation of biofilms

33
Q

Gram negative bacilli possessing fimbriae that target organism to the tissue of the UT

A

Proteus

34
Q

What are the two Proteus spp that can cause UTI?

A

P. mirabilis - community acquired

P. vulgaris - predominantly infects immunocompromised

35
Q

Which proteus species is community acquired?

A

P. mirabilis

36
Q

Which proteus species predominantly infects immunocompromised?

A

P. vulgaris

37
Q

“Swarming” on culture agar

A

Proteus

38
Q

On what medium does proteus NOT swarm?

A

CLED

39
Q

Where is proteus most commonly found?

A

Long-term care facilities and hospitals

Can be isolated from oral cavity and nasopharynx of hospital staff

40
Q

Proteus virulence factors

A

Fimbriae (pili) promote attachment to uroepithelial cells
—> inflammation —> apoptosis of host cells —> sepsis

Produces UREASE —> hydrolyzes urea to ammonia —> alkaline urine

41
Q

Struvite stones are very indicative of infection by what organism?

A

Proteus

Increased pH (due to UREASE) leads to formation of stones (magnesium ammonium phosphate)

42
Q

Gram positive, coagulase negative staph tha tis the second leading cause of UTIs

A

S. saprophyticus

More prominent in females ages 17-27, incidence increased in sexually active females (organism displaced from normal flora to the urethra)

43
Q

“Honeymoon cystitis”

A

S. saprophyticus

Most cases occur 24 hours after having sex - may manifest with razor sharp pains during intercourse

44
Q

Test that will tell staph aureus apart from staph saprophyticus

A

Coagulase reaction

Staph aureus is the ONLY coagulase positive staph

45
Q

How do you differentiate S. saprophyticus from other coagulase negative staph?

A

Novobiocin resistance - other coagulase negative staph are sensitive to novobiocin

Novobiocin is an abx not used clinically but diagnostic tool

46
Q

Is S. saprophyticus very virulent?

A

No

Possesses adhesives but not a lot of destructive ability

No exotoxins

Usually low bacterial numbers (makes it harder to diagnose)

47
Q

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

A

S. agalactiae

48
Q

S. agalactiae is also known as…

A

Group B Strep

49
Q

S. agalactiae infections in adults are strongly linked with …

A

Underlying immunodeficiencies

50
Q

S. agalactiae virulence factors

A

Capsular polysaccharide

Hyaluronidase

Collagenase

Hemolysin

51
Q

Diagnosis of S. agalactiae includes detection of …

A

CAMP factor (Christie, Atkins, Munch-Peterson)

Accentuation of hemolysis due to interaction w/ staph ß-lysin

Other presumptive tests: ID of group CHO is insensitive and DNA probe

52
Q

Why does S. agalactiae require a definitive diagnosis?

A

Because it’s an unusual cause of UTI

Requires isolation from urine, blood, CSF

53
Q

Treatment of a lower UTI is much more difficult if…

A

Prostate is infected - put to 1 month of abx may be required

54
Q

An uncomplicated UTI typically requires ______ day course of abx

A

1-7 day (depending on organism)

55
Q

How do you treat an upper UTI?

A

IV fluids and abx (10-14 days) if uncomplicated

Complicated cases may require treatment courses lasting many weeks

56
Q

If a patient is diagnosed with pyelonephritis AND has one of the following, they should be admitted…

A

Pregnant

Have not improved with outpatient abx treatment

Underlying immunocompromised status or on immunosuppressive

Unable to keep anything in stomach due to N/V

Previous kidney disease within the last 30 days

Kidney stones

Catheterized

Microbiology Unit 3 (10 decks)

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