48 - Bacterial UTIs

Question 1

Nephritis

Answer 1

Infection in the kidneys

Question 2

Pyelonephritis

Answer 2

Ascending UTI

Question 3

Cystitis

Answer 3

Bladder infection

Question 4

Urethritis

Answer 4

Urethral infection

Question 5

Prostatitis

Answer 5

Prostate infection

Question 6

Symptoms of urethritis and cystitis

Answer 6

Dysuria
Frequency/urgency

Tender over bladder

Positive urine culture

Question 7

Symptoms of prostatitis

Answer 7

Pain in lower back, perirectal, and testicles
Fever, chills

Positive urine culture

Question 8

Symptoms of pyelonephritis

Answer 8

Pain in flanks of body
Fever

Severe - diarrhea, vomiting, tachycardia

Can cause premature birth

Positive urine culture

Question 9

UTI diagnosis

Answer 9

Symptoms and urine examination
Collection of clean, midstream urine

Pyuria most common (>10 WBC per cubic mm of urine)

Question 10

Increased risks for UTIs

Answer 10

Women (shorter urethra)
Kidney surgery

Catheterization

Question 11

Most common cause of UTIs

Answer 11

Normal fecal flora

Enterics

Question 12

Enterics

Answer 12

Facultative anaerobes

LPS

Question 13

Enterobacteriaceae family

Answer 13

Largest group of Gram-negative rods
Normal fecal flora in most animals

Ferment glucose, reduce nitrite, catalase positive, oxidase negative

Question 14

Enterobacteriaceae virulence factors

Answer 14

Endotoxin
Capsule

K and H Ag variation

T3SS

Growth factors

Resistance to serum killing

Antimicrobial resistance

Question 15

E. coli features

Answer 15

Normal fecal flora
Virulence variability based on acquisition of plasmids

Fimbriae or pili

Ferment lactose

Question 16

E. coli UTI virulence

Answer 16

Adhesins - bind to bladder cells
Hemolysin - induce inflammation

Endotoxin - inflammation

Question 17

Type I pili

Answer 17

Most E. coli express this

Binds to the mannose residues commonly present on epithelial surfaces

Question 18

P pili

Answer 18

Subpopulations of E. coli express this

Binds to sugar residues specifically on uroepithelial cells

Question 19

Staphylococci features

Answer 19

Gram-positive, facultative anaerobe, in clusters
Catalase positive

Non-motile, non-spore forming

Question 20

Two groups of Staphylococci

Answer 20

S. aureus (coagulase positive)

Coagulase negative Staph. (CoNS)

Question 21

CoNS features

Answer 21

Form biofilms to enhance survival
S. epidermidis

S. saprophyticus

Question 22

S. saprophyticus

Answer 22

Normally in GI tract
Causes UTIs

Resistant to novobiocin (unlike other CoNS)

Question 23

S. saprophyticus commonly causes?

Answer 23

Cystitis in young, sexually active women

Question 24

Which causes of UTIs are frequent community acquired?

Answer 24

E. coli

CoNS

Question 25

Which causes of UTIs are frequent hospital acquired?

Answer 25

Proteus, Pseudomonas, Klebsiella

Question 26

Proteus mirabilis features

Answer 26

Gram-negative enteric Common in catheterized patients Produce biofilms

Question 27

Proteus virulence

Answer 27

``` Produce a potent urease Alkalizes urine (converts urea into ammonia) ``` Results in formation of renal calculi (kidney stones)

Question 28

Symptoms of renal calculi

Answer 28

Sudden onset of severe pain

Question 29

Treatment of Proteus species

Answer 29

Trimethoprim- Sulfamethoxazole

Question 30

Pseudomonas aeruginosa features

Answer 30

Gram-negative, aerobic, motile rod Oxidase positive Wide temperature range with minimal nutrition Nosocomial infection Opportunistic pathogen

Question 31

P. aeruginosa UTI cause and treatment

Answer 31

Common in long-term catheterization | Treat with multiple courses of antibiotics against resistant strains

Question 32

Enterococcus features

Answer 32

Gram-positive cocci Catalase negative Group D carbohydrate

Question 33

What other bacteria is enterococcus similar to, and how do you distinguish?

Answer 33

S. pneumoniae | Enterococcus tolerates high salt and bile concentrations, and is not sensitive to optochin

Question 34

Common Enterococcus species that cause UTIs

Answer 34

Enterococcus faecalis | Entercoccus faecium

Question 35

Risk factors for Enterococcus infection

Answer 35

Prolonged hospitalization and treatment with broad-spectrum antibiotics

Question 36

Enterococcus - UTI

Answer 36

Hospitalized patients with long-term catheter receiving broad-spectrum antibiotics

Question 37

Enterococcus - peritonitis

Answer 37

Abdominal swelling/tenderness after abdominal trauma or surgery Bacteremia

Question 38

Enterococcus - endocarditis

Answer 38

Infection of heart endothelium or valves | Associated with persistent bacteremia

Question 39

Asymptomatic bacteriuria diagnosis

Answer 39

Significant bacteriuria on two successive cultures (women) or one (men) Common in elderly

Question 40

Treatment for asymptomatic bacteriuria

Answer 40

Only in pregnant women, prior to urologic surgery, and after renal transplantation

Question 41

Treatment for uncomplicated cystitis

Answer 41

Trimethoprim-sulfamethoxazole

Question 42

Treatment for pyelonephritis

Answer 42

Aggressive antimicrobial treatment Fluoroquinolones for Gram-negatives Amoxicillin for Gram-positives

Question 43

Treatment for asymptomatic bacteriuria

Answer 43

``` No treatment (unless indicated) Amoxicillin, cephalexin, or nitrofurantoin ```