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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
etiologies of sterile pyruia
non-infectious: trauma, glomerulonephritis, neoplasms, other inflammatory conditions, stones, etc. infectious: stuff that needs special culture medium (standard culture negative)
26
general guidelines for UTI diagnosis
clinical context and exclusion of STIs and noninfectious causes urinalysis + culture imaging in case of treatment failure or predisposing factors
27
how is a urinalysis collected and performed
collection: clean catch midstream, urethral catheter, or suprapubic aspirate dipstick test for RBCs, WBCs, and bacteria
28
what amt of bacteria is diagnostic in a UA
>100,000/ml
29
general guidelines for UTI therapy
antibiotics that are secreted in therapeutic concentrations in urine antimicrobial sensitivity dictates change length depends on infection severity
30
uncomplicated UTI treatment
nitrofurantoin | Bactrim (trimethoprim + sulfamethoxazole)
31
complicated UTI treatment
1-2 weeks of oral ciprofloxacin, fluoroquinolone, Bactrim (not for pseudomonas or enterococcus) initial IV dose of ceftriaxone, aminoglycoside, fluoroquinolone
32
treatment of abscesses
add appropriate drainage
33
treatment of epididymitis or prostatitis
longer treatment (3-12 weeks) to reach therapeutic tissue levels
34
treatment of re-infection or relapsing infection
test of cure | urologic investigation
35
UPEC virulence factors
``` flagella pili/fimbrae adhesins afimbrial adhesins proinflammatory toxins siderophores LPS ```
36
specific UPEC adhesins
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
UPEC proinflammatory toxins
hemolysin | cytotoxic necrotizing factor
38
type 1 fimbriae overview
FimA subunits FimF and FimG adapters FimH: adhesion and invasion, binds to uroplakins expressed by urothelial umbrella cells
39
process of exfoliation of infected cells
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
discuss the process of neutrophil infiltration in UTIs
- 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
what is asymptomatic bacteriuria
occurs in 2-5% of women higher in diabetics and cystocele patients linked to less virulent strains
42
when do you treat asymptomatic bacteriuria
pregnant women before GU procedure renal transplant patients
43
UPEC/UTI prevention
hydration | voiding after sexual intercourse
44
DOCs for UPEC
nitrofurantoin or Bactrim (95% effective) | fosfomycin
45
how can d-mannose prevent UTIs
bind to type 1 pili to prevent them from interacting with mannose receptors on the bladder wall
46
what are siderophore vaccines
immunization of mice with aerobactin conjugated to cationized BSA has shown some effects in mice
47
description of staph saprophyticus infection
gram +, coagulase -, novobiocin (R) cells adhere to urinary tract epithelium via hemagglutinin pyuria and large numbers of staph in urine
48
DOC for staph sapro
Bactrim | B lactams
49
description of proteus infection
gram -, lactose -, urease + swarming motility urease generated ammonia and CO2, raises pH, and leads to soluble ion precipitate and formation of renal stones
50
DOC for proteus
need sensitivities before treatment
51
description of klebsiella infection
gram -, lactose + | non motile, prominent capsule
52
DOC for klebsiella
aminoglycosides + B lactam
53
description of enterobacter infection
gram -, motile, capsule
54
DOC for enterobacter
need sensitivities before treatment
55
description of pseudomonas infection
gram - rod, oxidase +, non fermenter fruity odor blue green pigment (pyocyanin)
56
DOC for pseudomonas
MDR piperacillin, ticarcillin need sensitivities
57
description of enterococcus infection
gram +, variable hemolysis | salt tolerant
58
DOC for enterococcus
need sensitivities before treatment
59
pathogenesis of bacterial vaginosis
due to displacement of normal flora (lactobacilli) not a single etiologic agent fishy odor (Whiff test) clue cells: coccobacilli adhering to epithelial cells
60
DOC for bacterial vaginosis
metronidazole
61
differentiating between urethritis and cystitis
cystitis has more hematuria, more abrupt onset, more severe, suprapubic pain
62
presentation of acute bacterial prostatitis
lower UTI symptoms lower abdominal/suprapubic discomfort obstruction from edema of infected prostate toxicity and high fever
63
finding in acute bacterial prostatitis
bacteremia may be spontaneous or after vigorous rectal exam pyuria positive urine culture
64
etiology of acute bacterial prostatitis
> 35: enterobacteriaceae | < 35: bacterial STIs
65
complications of acute bacterial prostatitis
bacteremia prostatic abscess, prostatic infarction, prostatitis recurrent UTI of same organism
66
complications of asymptomatic bacteriuria
pyelonephritis in 20-40% if untreated | low birth weight babies
67
treatment for asymptomatic bacteriuria
only treat pregnant women adjust based on culture avoid fluoroquinolones (teratogens) no sulfa in 3rd trimester (cholestasis)
68
describe catheter related UTIs
almost certain low density bacteriuria common high density bacteriuria 10-25% become symptomatic 1-2% become bacteremia
69
treatment of catheter related UTIs
prior urinalysis, urine, and blood cultures | catheter removal and exchange
70
high risk groups for catheter related UTIs
infections w highly bacteremia organisms neutropenic, immunosuppressed, organ transplant patients pregnant women urologic procedure

GIR Test 4 (20 decks)

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