16 UTIs Bensman Flashcards
What needs to be looked at in order to classify what type of UTI it is?
Anatomical location. Complication. Recurrence. Symptoms
What epidemiology of UTIs has the highest prevalence?
Females > males. Increase in prevalence in females after puberty. 1/3 of females experience a UTI by age 24. Up to 50% of females will have an episode of a UTI within their lifetime
What are the 3 different routes of entry into the urinary tract?
Ascending. Descending. Lymphatic
What are the characteristics of ascending entry into the urinary tract?
Urethra is colonized by fecal flora and this is transferred to bladder. Most common type. Usually lower infection
What are the characteristics of descending entry into the urinary tract?
Infection of kidneys by hematogenous spread from distant primary infection in the body. < 5% of documented UTIs
What are the characteristics of lymphatic entry into the urinary tract?
Communication between bowel and kidney; kidney and bladder. Very little/limited evidence of this occuring
What is the primary result of the 3 different routes of entry into the urinary tract?
Once the bacteria gets to the site of infection, infection is determined by the organism (size of infectious inoculum and virulence) and competence of host defense mechanisms
What are the host defenses like for innate immunity?
Bacteria stimulates an inflammatory response. Limits tissue invasion and spread
What are the host defenses like for humoral immunity?
Increase in antibodies during UTIs. Role is not clearly defined
What are the host defenses with urine?
Osmolarity, pH, urea/organic acids. Inhibits growth and kills bacteria
What are the host defenses like for micturition?
Bacteria stimulate bladder emptying. Limits initiation and maintenance of UTIs
What are some different virulence factors that bacteria can have that cause UTIs?
P Fimbriae (excreted by E. coli, acts as an adhesion). Hemolysin and aerobactin (secreted by almost all UTI bacteria, scavenges for iron; needed for bacteria growth)
What are the special populations that have an increased risk for UTIs?
Infants. Pregnant women. Elderly
What are the health conditions that have an increased risk for UTIs?
Spinal cord injuries. Catheters. Diabetes. Multiple sclerosis. HIV. Urologic abnormalities
What are the risk factors that increase risk of UTIs with intercourse?
Diaphragms. Condoms. Spermicides. Increased frequency
What is required to diagnose UTIs?
Urine laboratory findings (UA, urine culture) + clinical findings
What can be done for Urine Cultures?
Bacterial count (depending on the classification of the bacteriuria, there are different cut-offs). Gram Stain (begins process for identifying organism). Culture + Sensitivity (identifies the causative organism(s), determines antibiotic susceptibilities for directed therapy)
What is a drawback with Urine Cultures?
Takes several days to get all the results
What is the diagnostic bacterial count for Asymptomatic Bacteriuria (ASB)?
> 10^5 of urine. Women: 2 consecutive voided urine specimens w/ isolation of same bacterial species. Men: 1 clean-catch voided urine specimen w/ 1 bacterial species
What is the diagnostic bacterial count for Catheter Associated Asymptomatic Bacteriuria (CA-ASB)?
> 10^5 of urine. 1 catheterized urine specimen w/ 1 bacterial species
What is the diagnostic bacterial count for Symptomatic Bacteriuria (UTI)?
> 10^2 of urine
What is the diagnostic bacterial count for Catheter Associated Symptomatic Bacteriuria (CA-UTI)?
> 10^3 of urine. > 1 bacterial species + s/sx of a UTI with no other source of infection identified
What are the common urine findings that are looked for in a Urine Analysis?
Visual appearance. Leukocyte Esterase (LE). Nitrite (made from bacteria converting nitrate). White Blood Cells (> 5-10 is (+) for UTI). White Cell Casts. Protein. Hematuria
What is some general information of Urinalysis (UA)?
UA helps to identify pyuria and may aid in reducing delay to antibiotic start in UTI (symptomatic). In asymptomatic bacteriuria, pyuria is not diagnostic of infection. Turn around time in minutes
What are the clinical signs and symptoms of Cystitis?
Dysuria. Urinary frequency. Urinary urgency. Suprapubic discomfort. Localized
What are the clinical signs and symptoms of Pyelonephritis?
Fever. Flank pain. Nausea. Vomiting. + Cystitis symptoms. Systemic
What are the clinical signs and symptoms of Acute Prostatitis?
Fever. Chills. Malaise. Myalgia. Prostate tenderness/pain. Urinary retention. + Cystitis symptoms. Systemic
What are the clinical signs and symptoms of Chronic Prostatitis?
Urinating difficulty. Lower back pain. Perineal pressure. “Boggy”. Enlarged prostate. May be asymptomatic
What are the clinical signs and symptoms of CA-UTI (catheter associated)?
New onset or worsening (fever, rigors, altered mental status, malaise or lethargy with no other identified cause). Pelvic discomfort. Flank pain. Costovertebral angle tenderness. Acute hematuria. Urinary symptoms in those whose catheters have been removed (dysuria, urgent or frequent urination, or suprapubic pain/tenderness). Spinal cord injury (increased spasticity, autonomic dysreflexia, or sense of unease)
What is the Bacterial Etiology that cause asymptomatic bacteriuria (ASB) in women?
PEK (E. coli most common). Coag (-) Staph. Enterococcus spp. GBS. Gardnerella vaginalis
What is the Bacterial Etiology that cause asymptomatic bacteriuria (ASB) in men?
PEK (Proteus: males > females). Coag (-) Staph. Enterococcus
What is the Bacterial Etiology that cause asymptomatic bacteriuria (ASB) in patients with Urologic Device (catheter)?
Usually polymicrobial. P. aeruginosa, P. mirabilus, P. stuartii, M. morganii
What is the most common cause of community acquired UTI?
E. coli
What is the most common cause of hospital acquired UTI?
No one bacteria is most common. PEK, Enterobacter, Pseudomonas aeruginoa, Enterococcus, Staphylococcus
What is the most common cause of Prostatitis?
PEK (E. coli 75%). P. aeruginosa, Enterobacter, Serratia, Staphylococcus
What are the different Antibiotic Therapies used in UTIs?
Amoxicillin. Cephalexin. Bactrim. Nitrofurantoin. Fosfomycin. Ciprofloxacin. Levofloxacin