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Renal Week 4 2017/18 > 3: Microbiology of UTI > Flashcards

3: Microbiology of UTI Flashcards

1
Q

What is a UTI?

A

Microorganisms in the urinary tract which are causing INFECTIOUS SYMPTOMS

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2
Q

What is a lower UTI?

A

Confined to the bladder (cystitis)

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3
Q

What is an upper UTI?

A

Infection involving the ureters AND/OR kidneys

(pyelonephritis)

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4
Q

Urine is normally ___.

A

sterile

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5
Q

What is a complicated UTI?

A

Symptoms of UTI (e.g dysuria, urgency, increased frequency) with any of:

SYSTEMIC SYMPTOMS (fever, rigors, N&V…)

RENAL STONES

ANATOMICAL ABNORMALITIES

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6
Q

Does bacteruria mean infection?

A

Not without symptoms

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7
Q

What is a common site for colonisers of the urinary tract?

A

Catheter

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8
Q

(Men / women) are more likely to develop UTIs.

A

women

shorter, wider urethras

sex

pregnancy

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9
Q

People with ___ are more likely to get UTIs.

A

catheters

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10
Q

What are the two routes of infection in UTI?

A

Ascending route

Haematogenous

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11
Q

What is the most common organism causing UTIs?

A

E. coli

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12
Q

Why is E. coli well adapted to causing UTIs?

A

Common bowel commensal

Have fimbriae (sticky appendages which let them climb all over the place)

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13
Q

Which investigations are used to

a) rule out
b) properly diagnose

UTIs?

A

a) Dipstick

b) Urine culture

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14
Q

What is the best investigation for UTI?

A

Urine culture

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15
Q

What are coliforms?

A

Gram negative bacilli

most commonly E. coli

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16
Q

E. coli is also called a ___ fermenter.

A

lactose fermenter

along with Klebsiella, Enterobacter

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17
Q

What organisms commonly cause UTIs?

A

Escherichia

Klebsiella

Enterobacter

Proteus

Pseudomonas

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18
Q

What does E coli produce to cause sepsis?

A

Endotoxin

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19
Q

What renal disease is Proteus associated with?

A

Renal stones

particularly struvite stones

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20
Q

Which UTI organism is associated with renal stones?

A

Proteus

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21
Q

Which type of renal stone is commonly seen in Proteus infection?

A

Staghorn calculus

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22
Q

Is Pseudomonas a coliform?

A

NO

but it is a Gram -ve bacillus

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23
Q

What is Pseudomonas UTI associated with?

A

Catheters

Surgery

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24
Q

How is Pseudomonas UTI treated?

A

Ciprofloxacin

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25
Q

How does ciprofloxacin work?

A

Affects bacterial DNA

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26
Q

What are the 4Cs?

A

Co-amoxiclav

Ciprofloxacin

Clindamycin

Cephalosporins

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27
Q

What’s the difference between Enterobacter and Enterococcus?

A

Enterobacter is a Gram -ve bacillus

Enterococcus are Gram +ve

28
Q

What is a Gram positive coccus which causes UTI?

A

Enterococcus (faecalis)

Staph. saphrophyticus

29
Q

What is a type of Staphylococcus associated with UTIs in women of child bearing age?

A

Staph. saphrophyticus

30
Q

What are the symptoms of UTI?

A

Dysuria

Haematuria (not always)

Nocturia

Increased frequency

Constitutional symptoms

31
Q

What symptoms suggest an upper UTI?

A

Loin pain

Constitutional symptoms

Fever, rigors, N&V…

32
Q

What type of urine sample is taken to diagnose UTI?

Why?

A

MIDSTREAM urine sample

First portion of urine will be contaminated by commensals

33
Q

What is an MSU?

A

Midstream urine sample

34
Q

How long after a urine sample is collected must it reach the lab?

A

< 2 hours

35
Q

What positives on urinalysis may indicate infection?

A

Leukocytes

Nitrites

remember dipsticks aren’t the ideal investigation

36
Q

Why might positive nitrites indicate a UTI?

A

Coliforms convert nitrates to nitrites

37
Q

In general, ___ shouldn’t be used to investigate UTI.

What should be used instead?

A

urinalysis

MSU culture

38
Q

More than ___ organisms on microscopy indicates UTI.

A

105

39
Q

More than ___ organisms on a urine culture indicates infection.

A

105

40
Q

Which type of growth in a urine culture is probably not significant?

A

Mixed growth

i.e more than one organism

41
Q

What is abacterial cystitis?

A

Symptoms of UTI without bacterial growth on culture

42
Q

Why may a patient have abacterial cystitis?

A
  • Early UTI
  • Urethral trauma - “Honeymoon cystitis”
  • STI
  • Patient has taken antibiotics before urine culture collected
43
Q

What is abacterial cystitis associated with urethral trauma also known as?

A

Honeymoon cystitis

44
Q

How may abacterial cystitis be managed?

A

Stay hydrated

Good hygiene

Refrain from having sex until symptoms stop

Alkalinise urine (symptomatic relief only)

45
Q

What is asymptomatic bacteriuria?

A

> 105 organisms in urine but NO SYMPTOMS OF INFECTION

46
Q

How is asymptomatic bacteriuria treated?

What’s the exception?

A

Supportively i.e no antibiotics

Pregnant women are given antibiotics

47
Q

Why are pregnant women given antibiotics if they have asymptomatic bacteriuria?

A

Complications include:

pyelonephritis

premature labour

growth retardation in child

48
Q

People with catheters are more at risk of UTI.

When would you give antibiotics to someone with bacteriuria and a catheter?

A

> 105 organisms AND symptoms of infection

49
Q

How do you treat an uncomplicated UTI in women?

A

Nitrofurantoin OR Trimethoprim (3 days)

50
Q

How do you treat an uncomplicated UTI in men?

A

Nitrofurantoin OR Trimethoprim (7 days)

51
Q

Which drug could you give to a pregnant women with an uncomplicated lower UTI?

A

Cefalexin

because trimethoprim is teratogenic in the 1st trimester and nitrofurantoin is teratogenic in the 3rd (but generally alright to use)

52
Q

Why are nitrofurantoin or trimethoprim used to treat lower UTIs only?

A

They aren’t effective in the upper urinary tract

53
Q

How do you treat a complicated UTI or pyelonephritis in primary care?

A

Co-amoxiclav (14 days)

54
Q

How do you treat a complicated UTI in primary care in a patient who is allergic to penicillin?

A

Co-trimoxazole (14 days)

55
Q

How do you treat a complicated UTI or pyelonephritis in hospital?

A

Amoxicillin + Gentamicin IV (3 days)

56
Q

If a patient in hospital develops a complicated UTI and you treated them with amoxicillin + gentamicin IV for 3 days, what would you then step down to?

A

Co-trimoxazole PO (4 days)

For a total of 7 days on antibiotics

57
Q

How do you treat a complicated UTI or pyelonephritis, in hospital, in a patient who is allergic to penicillin?

A

Co-trimoxazole + Gentamicin IV (3 days)

then step down to

Co-trimoxazole PO (4 days)

58
Q

Gentamicin can only be used in hospital - why?

A

Has to be given IV

59
Q

Is gentamicin safe in pregnancy?

A

No

60
Q

How is gentamicin dose calculated?

A

Weight

61
Q

What are possible effects of gentamicin toxicity?

A

Nephropathy

CN VIII damage - hearing loss, balance problems

62
Q

If a bacterium has beta lactamase, which antibiotics won’t work on it?

A

Penicillins

Cephalosporins

63
Q

Carbapenemase-resistant bacteria are resistant to which antibiotics?

A

All of them

64
Q

What can be given as an alternative to gentamicin in some patients?

A

Aztreonam IV

65
Q

In which trimesters should

a) trimethoprim
b) nitrofurantoin

be avoided?

Why drug could be given to a pregnant women with a UTI instead?

A

a) 1st trimester

b) 3rd trimester

Cefalexin PO

66
Q

What is the combined form of trimethoprim which can be given to patients with complicated UTIs?

What is a rare side effect of using it?

A

Co-trimoxazole

Stevens-Johnson syndrome (severe blistering disease)

Renal Week 4 2017/18 (4 decks)

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