B5-080 Renal Infections Flashcards
- gradual onset of internal dysuria
- sexually active patient with new partner
- no hematuria
clamydia
UTI in men, pregnant women, and children is usually considered
complicated
causes 80% of UTIs
E. coli (UPEC)
2nd most common UTI in sexually active young women
Staph. sapro
causes renal and urinary stones
proteus mirabilis
UTI pathogen associated with catheterized patients
klebsiella pneumoniae
UTI pathogens associated with immunocompromised patients
2
enterobacter
enterococcus faecalis
cause renal stones, chronic prostatitis, and more common in catherized patients
pseudomonas aeruginosa
gram negative bacilli, lactose fermentors
3
E coli
Klebsiella
Enterobacter
gram negative bacilli, lactose negative, glucose fermentor
1 that we talked about
proteus
gram negative bacilli, does not ferment glucose
1 that we talked about
pseudomonas
gram positive cocci
clusters
catalase +
staphylococcus
common culture contaminants
- lactobacilli
- a-hemolytic strep
nitrate production on dipstick indicates
gram negative bacteria
greater than 10 WBC/hpf
pyuria
greater than 100,000/hpf is diagnostic of
bacterial infection
treatment for uncomplicated UTI
nitrofuratoin or Bactrim
treatment of complicated UTI
- 1-2 weeks of oral antibiotic and possibly..
- IV initial dose of ceftriaxone, aminoglycoside or fluroquinolone
epididymitits, acute/chronic prostitis should be treated for […] weeks
3-12
why is designing a vaccine for UTI based on pilli very difficult?
pili undergo phase variation in response to environment
FimH binds to
uroplakins (glycoproteins)
adhesin and invasin
exfoliation of infected cells is largely triggered by
LPS
innate immune response
- critical for clearance of bacteria
- presence in urine is a hallmark of UTI
neutrophils
what populations should be treated for asymptomatic bacteriuria?
- pregnant women
- before GU procedure
- renal transplant patients for first 6 months
prevention of EPEC UTI
- hydration
- voiding after SI
DOC for EPEC UTI
- nitrofurantoin or bactrim
- fosfomycin
does cranberry juice help prevent UTIs?
no
does D-mannose help prevent UTIs?
yes, some evidence preventing recurrent UTIs
novel treatment: D-mannose antagonists
aerobactin conjugated to cationized BSA
siderophore vaccine
protect mice against EPEC, but no antibodies
novel vaccine treatment
gram +
coagulase -
novobiocin resistant
S. sapro
adhere to UT epithelium via hemagglutinin
S. sapro
DOC S. sapro
bactrim, b lactams
gram -
lactose -
urease +
proteus mirabilis
“swarming motility” on agar
proteus mirabilis
plate looks kind of like a target
treatment of proteus, enterobacter, pseudomonas, and enterococcus requires
antibiotic sensitivity testing
gram -
lactose +
non- motile
prominent capsule
klebsiella pneumoniae
forms large mucoid colonies
klebsiella pneumoniae
gram -
motile
capsule
moist colonies
enterobacter
DOC klebsiella
aminoglycoside + b lactam
gram -
rod
oxidase +
non-fermenter
fruity odor
blue-green pigment
pseudomonas
DOC for pseudomonas
piperacillin, ticarcillin
MDR: need sensitivity testing
gram +
variable hemolysis
salt-tolerant (6.5% NaCl)
enterococcus faecalis
due to displacement of normal vaginal flora
bacterial vaginosis
fishy odor of discharge
whiff test
clue cells
BV
DOC for BV
metronidazole
free living spirochetes
leptospira
rodents, dogs, and farm animals can carry […] asymptomatically in kidneys
leptospria
occupation exposures
cause meningitis, hepatitis, nephritis, hemorrhage
damage of small vessels
leptospira
- cases spike in warmer months
- can be spread through contaminated water
lepto
gold standard for diagnosis of lepto
aggultination test
novel: IgM assay
DOC leptospirosis
IV penicillin
doxy can be preventative
causative pathogen of acute bacterial prostitis in >35 year olds
enterobacteriacea
less than 35: bacterial STDs
what antibiotics should be avoided in the treatment of asymptomatic bacteriuria in pregnancy?
- fluoroquinolones
- sulfa drugs in 3rd trimester
most important treatment in CAUTI
remove catheter
a urine sample that contains leukocytes and bacteria that are not cultivable using standard urinary tract culture media
sterile pyuria
the presence of enzyme leukesterase indicates
pyuria
presence of nitrates indicates
gram- bacteria
is nitrofurantoin ok in pregnancy?
yes until 36 weeks
are cultures diagnositic of BV?
no
Whiff test and clue cells
what is used to diagnose BV?
- Whiff test
- clue cells
urease positive bacteria that raise pH of urine
2
- klebsiella
- proteus
supplemental D-mannose is thought to disrupt
adhesion via pili
anti-LPS antibodies can be used to serotype
leptospira
top two infectious agent in uncomplicated UTIs in sexually active young women
E coli
S sapro