26. Urinary Tract Infections Flashcards
above the vesicleurerteral vvalves
upper tract
below the vesicoureteral valves
lower tract
involvement of tissue structures with instruments or comorbidities, usually male
complicated
pus in the kidney causing inflammed kidney, calyces, pelvis
pylenonephritis
bladder inflammation
cystitis
3 or more UTI/yearas
recurrence
recurrence in a month with the same organism
relapse
relapse but <1 month usually a different orgnanism
reinfection
in this group, males predominate with urogenital malformations more common
neonates
at this time, females predominate for UTI frequency at 80%
childbearing years
prior history, uncircumcised, sexual intercourse especially with frequency, inherited factors like IgA deficiency, structural abnormalities associated with reflux like vesico-ureteral reflux and duplicated collection system, obstruction like prostate enlargement and ureteral stones, foreign body especially foley chronic indwelling catheter
risk factors for UTI
10^5 CFU/mL sungle species in clean catch urine, e coli 80%, staph saprophyticus 15% particularly in sexually active females, other gram -
symptomatic UTI definition
> 10^5 CFU/mL single species in clean catch urine, treat in pregnany, renal transplant, and before urogenital surgery, common in nursing home residents, don’t treat, do not treat or check with foley in place, UTI with/from foley can lead to sepsis, therefore is symptomatic*** UTI
asymptomatic UTI definition
gram positive cocci catalase positive coagulase negative novobiocin resistant
staphylococcus saprophyticus
gram negative rod lactose fermenting fast
escherichia coli
random, first void, clean catch, catheter, will show pH specific gravity, protein, glucose, ketones, bilirubin, leukocyte esterase, results will show WBC, RBC, epithelial cells, bacteria, casts, crystals, squamous epithelial cells (epis) represent a urethral or labial wash but doesn’t tell you anything about the bladder thus is unimportant
urinalysis types
gram positive cocci catalase negative alpha hemolytic optochin sensitive bile soluble
streptococcus pneumoniae
gram positive cocci, catalase negative, alpha hemolytic, optochin and bile solubility negative,
streptococcus mutans and mitits
gram positive cocci, catalase negative, gamma hemolytic, grows in 6.5% NaCl
enterococcus faecium/faecalis
gram positive cocci, catalase negative, gamma hemolytic, doesn’t grow in 6.5% NaCl
streptococcus bovis
gram positive cocci, catalase negative, beta hemolytic, bacitracin sensitive
streptococcus pyogenes
pH 4.5-8 hints at potential genus, specific gravity 1.005-1.025 which identifies SIADH and solutes, glucose is usually negative unless diabetic patients, ketones are usually negative but can be elevaetd in dehydration and toxins, blood is negative specifically in hemoglobin (perioxidase cross reacts), bilirubin is usually negative (direct/conjugated) hepatic disease, protein is negative usually unless nephrotic syndrome or renal failure, urobilinogen is negative or small (Ehrlich U) identifies hemolysis ***
UTI UA dipstick
gram positive cocci, catalase negative, beta hemolytic, not bacitracin sensitive
streptotoccus agalactiae
gram positive rod, spore forming, anaerobic
clostridium/clostridiodies
RBC between 0-5 is normal, need to be physical/intact, compare to dipstick, WBC between 0-5 is normal, correlated it with leukocyte esterase, few bacteria but is not a gram stain so not specific enough ***
UTI UA microbiology
27 year old male presents with pain and burning on urination, differential cystitis and urethritis, work up with split urine first void then clean catch, on first void pH 6.5, specific grabity 1.015, negative glucose, ketones, bilirubin, urobilinogen, nitrite, protein, leukocyte esterase, moderate red blood cells, moderate white blood cells, ***, result I was pyuria, result II was clean, interpreted as urethritis with no cystitis, differential of sexually transmitted disease, mechanical, irritative, gonorrhea/chlamydia DNA by polymerase chain reaction
case I
for urethritis, differentiate infection from irritation ***
UTIs by geography
46 year old female with abdominal pain, initial UTI was pH 6.5, specific grabity of 1.005, negative glucose, ketones, bilirubin, urobilinogen, nitrites, protein, leukocyte esterase, trace RBC and WBC, 0-3 RBC, 5-10 WBC, 20-50 epithelial cells, no better after 3 days of TMP/SMX,
18 year old female with pain and burning on urination, no other symptoms, negative past history, normal physicla exam, differential of cytitis and urethritis of various types including infectious, first UA, clean catch, *** caution on fluoroquinolones
gram positive rod, spore forming, aerobic, motile, gelatin hydrolytic, hemolytic
bacillus cereus
gram positive rods, spore forming, aerobic, non-motile, no gelatin hydrolysis, non-hemolytic
bacillus anthracis
gram positive rods, not spore forming
corynebacterium/listera monocytogenes
gram negative rod, slow lactose fermenting
citrobacter/serratia
gram negative rod, non-lactose fermenting, oxidase positive
pseudomonas aeruginosa
gram negative rod, non-lactose fermenting, oxidase negative, H2S positive
salmonella/proteus
gram negative rod, oxidase negative, H2S negative
shigella/yersinia
gram negative, curved rod, oxidase positive, urease positive
helicobacter pylori
gram negative, curved rod, oxidase positive, growth at alkaline pH
vibrio
gram negative, curved rods, oxidase positive, growth at 42C
campylobacter
gram negative coccobacilli
haemophilus influenzae, pasturella, brucella, bordatella, franciscella, acinetobacter
gram negative diplococci, aerobic, maltose positive
neisseria meningitidis
gram negative diplococci, aerobic, maltose negative, uses glucose
neisseria gonorrhoeae
gram negative, diplococci, aerobic, maltose negative, glucose negative
moraxella catarrhalis
bacteria not usually gram stained, recticulate body and elementary body formation
chlamydia trachomatis/pneumoniae
bacteria not usually gram negative, spirochete
borellia, treponema pallidum, leptospira
bacteria not usually gram stained, no cell wall
mycoplasma
bacteria not usually gram stained, unique cell wall
myobacterium
