219b UTI Flashcards
UTI - primary defense
healthy urinary tract; bug requires lots of virulence factors to infect (type I pili - bladder, E pili - kidney)
risk: catheter, kidney stone, reflux (easier to acquire with fewer virulence factors)
bacterial virulence UTI - where do bugs come from?
ascending from gut –> urethra –> bladder
female has shorter urethra
bug must adhesins w/ pili to invade host
e coli adherins
very specific - genetic prediction of some people for e coli attaching to cells
UTI pathogensis
e coli can block NF-KB for a short time (signal in epi cells after TLR recognition of LPS)
decreases IL-8 recruitment of WBCs
risk for UTI
things that promote colonization... sexual activity - increase inoculation spermicide - increase binding estrogen depletion - increase binding antimicrobials - decrease indigenous flora
things that facilitate ascent... catheterization urinary incontinence fecal incontinence residual urine w/ ischemia of bladder wall
reduced outflow…
outflow obstruction, BPH, PC
neurogenic bladder
dehydration
pathogens for UTI
E Coli - 80% out, 50% in
Staph Saprophyitics - women only, younger women
Proteus, Klebsiella, enterococci, pseudomonas, serratia, acinetobacter –> hostpial patients only
outpatient - think E Coli
In patient - think of the rarer causes from resident hospital bugs
UTI - symptoms
cystitis - dysuria, urgency, frequency
pyelonephritis - same as above + fever, chills, flank pain
UTI - dx
look at urine
if rbc, wbc, bacteria –> infection
void > 1000
catheter > 100
SPA > 10
best drug for UTI
3 days except nitro…
trimethoprim sulfamethoxazole (TMP/SMX) x 3 days for most cases
fluro-quinolone for cause of recent anti-bacterial therapy or if TMP/SMX doesn’t work
nitroflurantoin (7 days)
fosfomycin
recurrent infections with different bugs
prophylaxis - nightly or peri intercourse
old women (65+) with asymptomatic bacteriuira
don’t treat
recurrent infections with same bug - P. mirabilis
forms stone - image
pyelonepthirits vs abscess
more than 5 days of fever = abscess
