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GIR Test 4 > B5.080 UTIs > Flashcards

B5.080 UTIs Flashcards

1
Q

epidemiology of UTIs

A

1% of all outpatient visits in US

20% of women will get one in her lifetime

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2
Q

risk groups for UTIs

A

sexually active women (20x more in women than men)
nosocomial infections: catheters
elderly, diabetics: changes in immune system
pregnancy

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3
Q

urethritis symptoms

A

dysuria

mucopurulent drainage

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4
Q

cystitis symptoms

A 
dysuria
urgency
frequency
hematuria
bactiuria
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5
Q

prostatitis symptoms

A

same as cystitis + high fever, perineal back pain, urethral obstruction

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6
Q

pyelonephritis symptoms

A 
flank pain
costovertebral tenderness
fever, chills, nausea, vomiting
SEPSIS MAY DEVELOP
RENAL FAILURE!
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7
Q

natural mechanisms for maintenance of UT sterility

A
  • flushing via flow of urine and micturition
  • exfoliation of infected bladder tissues
  • low pH and osmolarity of urine inhibit growth
  • scavenging of iron by lactoferrin
  • anti-adherence factors
  • additional immune mechanisms
  • intact normal flora of adjacent environments (vaginal lactobacilli)
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8
Q

immune cell mechanisms for UT sterility

A

innate TLR driven responses followed by adaptive immune response
IgG and IgA production in kidney

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9
Q

onset of UTI symptoms

A

sudden

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10
Q

what % of patients have asymptomatic upper UTI involvement with a lower UTI

A

30%

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11
Q

differential for chlamydial STI

A

gradual onset of internal dysuria
sexually active with recent new partner
no hematuria

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12
Q

classification of uncomplicated UTI

A

structurally and neurologically normal urinary tract

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13
Q

classification of complicated UTI

A

structural or functional abnormalities

infection in men, pregnant women, or children

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14
Q

overview of UTI pathogens

A

opportunistic infections of endogenous origin
95% are single infections
organisms: UPEC (80%), staph saprophyticus, proteus, klebsiella, enterobacter, enterococcus, pseudomonas

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15
Q

staph saprophyticus

A

2nd most common UTI in sexually active young women

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16
Q

proteus infection associations

A

renal and urinary stones

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17
Q

klebsiella infection associations

A

catheterized patients

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18
Q

enterobacter and enterococcus infection associations

A

immunocompromised

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19
Q

pseudomonas infection associations

A

renal stones
chronic prostatitis
catheterized pts

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20
Q

gram - identification

A

lactose + : e.coli, kleb, enterobacter
lactose - , glucose +: proteus
lactose -, glucose -: pseudomonas

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21
Q

gram + identification

A

catalase + cocci: staph

catalase -, non-hemolytic: enterococcus

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22
Q

major uncomplicated UTI pathogens

A

E.coli

staph

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23
Q

complicated UTI pathogens

A

much more of a mix

most potential pathogens discussed have similar incidence

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24
Q

what is sterile pyuria

A

WBCs in urine without initial bacterial evidence

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25
Q

etiologies of sterile pyruia

A

non-infectious: trauma, glomerulonephritis, neoplasms, other inflammatory conditions, stones, etc.
infectious: stuff that needs special culture medium (standard culture negative)

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26
Q

general guidelines for UTI diagnosis

A

clinical context and exclusion of STIs and noninfectious causes
urinalysis + culture
imaging in case of treatment failure or predisposing factors

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27
Q

how is a urinalysis collected and performed

A

collection: clean catch midstream, urethral catheter, or suprapubic aspirate
dipstick test for RBCs, WBCs, and bacteria

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28
Q

what amt of bacteria is diagnostic in a UA

A

> 100,000/ml

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29
Q

general guidelines for UTI therapy

A

antibiotics that are secreted in therapeutic concentrations in urine
antimicrobial sensitivity dictates change
length depends on infection severity

30
Q

uncomplicated UTI treatment

A

nitrofurantoin

Bactrim (trimethoprim + sulfamethoxazole)

31
Q

complicated UTI treatment

A

1-2 weeks of oral ciprofloxacin, fluoroquinolone, Bactrim (not for pseudomonas or enterococcus)
initial IV dose of ceftriaxone, aminoglycoside, fluoroquinolone

32
Q

treatment of abscesses

A

add appropriate drainage

33
Q

treatment of epididymitis or prostatitis

A

longer treatment (3-12 weeks) to reach therapeutic tissue levels

34
Q

treatment of re-infection or relapsing infection

A

test of cure

urologic investigation

35
Q

UPEC virulence factors

A 
flagella
pili/fimbrae adhesins
afimbrial adhesins
proinflammatory toxins
siderophores
LPS
36
Q

specific UPEC adhesins

A

bind to cells lining bladder and upper UT
Type 1, S, Dr, P
undergo phase variation so bacteria can shut down their expression…vaccines cannot be developed against them

37
Q

UPEC proinflammatory toxins

A

hemolysin

cytotoxic necrotizing factor

38
Q

type 1 fimbriae overview

A

FimA subunits
FimF and FimG adapters
FimH: adhesion and invasion, binds to uroplakins expressed by urothelial umbrella cells

39
Q

process of exfoliation of infected cells

A
  1. infected multinucleated facet cells visible
  2. apoptosis like mechanism triggered by LPS exposes underlying epithelial cells
  3. subsequent shedding of cells and bacteria
40
Q

discuss the process of neutrophil infiltration in UTIs

A
  • infected bladder and kidney epithelial cells are a major source of IL-6 and IL-8
  • ICAM-1 molecule is upregulated by bacterial infection and interacts with neutrophil receptors
  • critical for clearance of bacteria
  • presence of PMNs in urine = UTI hallmark
41
Q

what is asymptomatic bacteriuria

A

occurs in 2-5% of women
higher in diabetics and cystocele patients
linked to less virulent strains

42
Q

when do you treat asymptomatic bacteriuria

A

pregnant women
before GU procedure
renal transplant patients

43
Q

UPEC/UTI prevention

A

hydration

voiding after sexual intercourse

44
Q

DOCs for UPEC

A

nitrofurantoin or Bactrim (95% effective)

fosfomycin

45
Q

how can d-mannose prevent UTIs

A

bind to type 1 pili to prevent them from interacting with mannose receptors on the bladder wall

46
Q

what are siderophore vaccines

A

immunization of mice with aerobactin conjugated to cationized BSA
has shown some effects in mice

47
Q

description of staph saprophyticus infection

A

gram +, coagulase -, novobiocin (R)
cells adhere to urinary tract epithelium via hemagglutinin
pyuria and large numbers of staph in urine

48
Q

DOC for staph sapro

A

Bactrim

B lactams

49
Q

description of proteus infection

A

gram -, lactose -, urease +
swarming motility
urease generated ammonia and CO2, raises pH, and leads to soluble ion precipitate and formation of renal stones

50
Q

DOC for proteus

A

need sensitivities before treatment

51
Q

description of klebsiella infection

A

gram -, lactose +

non motile, prominent capsule

52
Q

DOC for klebsiella

A

aminoglycosides + B lactam

53
Q

description of enterobacter infection

A

gram -, motile, capsule

54
Q

DOC for enterobacter

A

need sensitivities before treatment

55
Q

description of pseudomonas infection

A

gram - rod, oxidase +, non fermenter
fruity odor
blue green pigment (pyocyanin)

56
Q

DOC for pseudomonas

A

MDR
piperacillin, ticarcillin
need sensitivities

57
Q

description of enterococcus infection

A

gram +, variable hemolysis

salt tolerant

58
Q

DOC for enterococcus

A

need sensitivities before treatment

59
Q

pathogenesis of bacterial vaginosis

A

due to displacement of normal flora (lactobacilli)
not a single etiologic agent
fishy odor (Whiff test)
clue cells: coccobacilli adhering to epithelial cells

60
Q

DOC for bacterial vaginosis

A

metronidazole

61
Q

differentiating between urethritis and cystitis

A

cystitis has more hematuria, more abrupt onset, more severe, suprapubic pain

62
Q

presentation of acute bacterial prostatitis

A

lower UTI symptoms
lower abdominal/suprapubic discomfort
obstruction from edema of infected prostate
toxicity and high fever

63
Q

finding in acute bacterial prostatitis

A

bacteremia may be spontaneous or after vigorous rectal exam
pyuria
positive urine culture

64
Q

etiology of acute bacterial prostatitis

A

> 35: enterobacteriaceae

< 35: bacterial STIs

65
Q

complications of acute bacterial prostatitis

A

bacteremia
prostatic abscess, prostatic infarction, prostatitis
recurrent UTI of same organism

66
Q

complications of asymptomatic bacteriuria

A

pyelonephritis in 20-40% if untreated

low birth weight babies

67
Q

treatment for asymptomatic bacteriuria

A

only treat pregnant women
adjust based on culture
avoid fluoroquinolones (teratogens)
no sulfa in 3rd trimester (cholestasis)

68
Q

describe catheter related UTIs

A

almost certain low density bacteriuria
common high density bacteriuria
10-25% become symptomatic
1-2% become bacteremia

69
Q

treatment of catheter related UTIs

A

prior urinalysis, urine, and blood cultures

catheter removal and exchange

70
Q

high risk groups for catheter related UTIs

A

infections w highly bacteremia organisms
neutropenic, immunosuppressed, organ transplant patients
pregnant women
urologic procedure

GIR Test 4 (20 decks)

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