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Week 16-Renal > 16.3 Microbiology- Urinary tract infections > Flashcards

16.3 Microbiology- Urinary tract infections Flashcards

1
Q

What is the most common aetiological agent causing UTIs?

A

E. coli

Community acquired: 80%

Hospital acquired: 40%

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2
Q

What is an aetiological agent that more commonly causes UTIs in males?

A

Proteus species

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3
Q

Where does Staph. saprophyticus live?

A

Skin, genital tract and peritoneum

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4
Q

What especially causes UTIs in hospital? What %?

A

Other GNRs (Klebsiella, Enterobacter, Serratia, Pseudomonas), G+ bacteria (Enterococcus, other Staph)

48% of hospital acquired UTIs

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5
Q

What happens in CMV UTIs?

A

Urine is potentially contaminated and could transmit the infection

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6
Q

How do most UTIs spread?

A

Ascending, up urethra, cause cystitis (sometime pyelonephritis)

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7
Q

Which bacteria can access the urinary tract via the blood? (3)

A

Staph. aureus (renal abscesses)
Salmonella Typhi (systemic, first sign often bronchitis)
TB

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8
Q

What is an innate immunity (epithelial) in the urinary tract?

A

Transitional epithelium resists colonisation by most bacteria

(epithelium is also relatively resistant)

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9
Q

What is a common source of UTI aetiological agents?

A

Microbiota that live in urethra and peritoneum

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10
Q

Why are UTIs more common in females? (2)

A

Short urethra, and urethra opens in the peritoneum

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11
Q

What could a young boy with a UTI indicate?

A

Abnormal urinary tract (so don’t just prescribe antibiotics)

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12
Q

What is vesicoureteric reflux? How can we diagnose this?

A

When bladder contracts and urine is pushed up into urethra (and even into kidneys)

Contrast up urethra into bladder

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13
Q

How do microbial factors such as adhesions (2 types) contribute to colonsiation?

What organism expresses these?

A

Type 1 pili: allow adherance to baldder

PAP (polynephritis associated pili): allow bacteria to adhere to transitional epithelium

Both expressed by E.coli

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14
Q

What has a polysaccharide capsule (contributing to colonosation)?

A

E.coli, Klebs (we don’t know how)

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15
Q

What forms a biofilm? What is this (and another example elsewhere)?

A

E.coli

It is a community of bacteria within a matrix (e.g. streptococcus producing acid within mouth from sugar)

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16
Q

What can haemolysin do?

A

Breaks down RBCs, can contribute to kidney damage (E.coli)

17
Q

What are siderophores? What produces them?

A

Acquire iron (to grow better). Some E.coli produce

18
Q

What produces urease? What does this do?

A

Proteus (males esp.) produces urease, promoting stone formation via change in urine pH

19
Q

What are 3 virulence determinants of E.coli? Where do they have an effect?

A

PAP (kidneys)
Flagella (ureters)
Type I pili (bladder)

20
Q

What is a filament forming bacteria (that contributes to virulence)?

A

E.coli

21
Q

What is the most common (suspected UTI) sample? Why?

A

Mid-stream urine (prevent confusion from normal urethral microbiota and avoid prosthetic secretions)

22
Q

What do we do if a UTI is suspected in a baby? What does this tell us?

A

Can collect sample from bag (not sterile), so only a negative culture is useful (this would exclude UTI)

23
Q

How do we collect urine for sampling from a catheter?

A

Collect from catheter itself, NOT bag

24
Q

When do we see eggs in the urine? What may be a symptom?

A

Shishtosoma, may see blood in urine

25
Q

What are normal values for WBCs and RBCs in urine?

A

WBCs: 10^4/mL (raised: 10^5)

RBCs 10^4

26
Q

What is normal for squamous epithelial cell count in urine? What does a raised value suggest?

A

Normal is 0 (raised suggests poorly collected sample)

27
Q

What is a normal quantitative culture for bacteria?

What indicates infection?

A

10^5 (especially if one species isolated)

28
Q

What is a suspicious catheter sample?

What is a suspicious SPA?

A

> 10^2 CFU/mL

Any growth significant for SPA

29
Q

What is sterile pyuria? What are 3 causes?

A

No growth with WBC consistently >10^5/mL

Non-infectious conditions, partial treatment and difficult to grow bacteria (e.g. TB)

30
Q

How do you treat uncomplicated cystitis?

A

Alkanilise urine, Trimethoprin OR cephalexin OR co-amoxyclav OR nitrofuratoin

31
Q

How do you treat pyelonephritis? What do you need to check for?

A

Co-amoxyclav OR cephalexin OR trimethoprim (10-14 days), if severe sepsis: ami/amoxycillin + gentamycin

Check for urinary tract abnormality

32
Q

What is asymptomatic bacteriuria? When is it significant?

A

Repeated >10^5 CFU/mL without symptoms

Significant in pregnancy (premature delivery and other obstetric problems associated)

33
Q

What is the threshold for recurrent UTIs in women?

A

> 2 UTIs in 6 months (most are re-infections)

Week 16-Renal (9 decks)

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