Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RGU Exam 3 > Bacterial Pathogens of the Urinary Tract > Flashcards

Bacterial Pathogens of the Urinary Tract Flashcards

1
Q

Bacteriuria

A
  • Bacteria in the urine
  • Can be symptomatic or asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pyuria

A
  • WBCs in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sterile Pyuria

A
  • Neg. urine culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complicated vs. Uncomplicated UTI

A
  • Most episodes of cystitis and pyelonephritis are generally considered to be uncomplicated in otherwise healthy nonpregnant adults. A complicated urinary tract infection, whether localized to the lower or upper tract, is associated with an underlying condition that increases the risk of failing therapy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complicated UTI treatment

A
  • UTI when it occurs in men, pregnant women, is anatomic, warrants 10-14 day tx. course
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Uncomplicated UTI treatment

A
  • 3 day tx course
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UTI Lifetime Risk

A
  • >50% of all women
  • 12% of all men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UTI Epidemiology by Age

A
  • First 3 months: male - female ratio 3:1

*circumcision reduces UTI rates by 90%

  • School children: male - female ratio 1:3
  • Women

*prevalence = 3.5%

*increases 1%/decade

*10% of women >70

  • Men

*increases w/ BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UTI Genetic Risk Factors

A
  • Immune receptor polymorphisms
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

UTI Biologic Risk Factors

A
  • Urinary calculi
  • Urinary stasis/obstruction
  • Congenital anomalies of the lower urinary tract, microbiologic change (atrophic vaginitis)
  • Diabetes/ Neurologic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UTI Behavioral Risk Factors

A
  • Sexual intercourse
  • Birth control practices (spermacide/diaphragm use)
  • Antimicrobial use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common UTI pathogen in women of reproductive age

A
  • Staphylococcus saprophyticus (10-20%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common UTI Pathogens

A

- Uropathogenic Escherichia coli (85%)

- Staphylococcus saprophyticus (10-20% mainly in reproductive age women)

  • Klebsiella species
  • Enterococcus species
  • Group B streptococcus
  • Proteus mirabilis
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

General Women UTI Risk Factors

A
  • Lewis blood group non-secretor phenotype
  • Urothelial receptor density
  • Vaginal factors

*alkalization of pH (normal pH is acidic)

*antibiotic-induced alterations of normal flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recurrent UTI

A
  • Defined as 3 UTIs within 12 months, or 2 within 6 months
  • Identify the source
  • Management

*suppressive therapy

*self-start therapy

*post-coital therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post-menopausal Women Risk Factors

A
  • Low estrogen; causes colonization
  • Incomplete bladder emptying
  • Incontinence
  • Prolapse
  • Diabets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

UTIs During Pregnancy

A
  • Complicated by defintion
  • Affect 17-20% of pregnancies
  • Asymptomatic bacteriuria occurs in 2-10% w/ 2-4% developing pyelonephritis
  • One of the only instances where you would treat someone w/ asymptomatic bacteriuria due to ascending infection risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

UTIs During Pregnacy Risks

A
  • PROM
  • Preterm labor
  • Chorioamnionitis
  • Postpartum fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Pyelonephritis Risks

A
  • Increased risk during pregnancy
  • Maternal risks: septic shock, respiratory and renal insufficiency, fluid balance disorders and even death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Antibiotics During Pregnancy

A
  • Penicillin (Amoxicillin) - Class B
  • Cephalosporin (Keflex) - Class B
  • Nitrofurantoin - Class B (hemolytic anemia)
  • Fosfomycin - Class B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Antibiotics to avoid during pregnancy

A
  • Fluoroquinolones

*cartilage development

  • Chloramphenicol

*“gray baby syndrome”

  • Trimethoprim

*folate antagonism: anemia/malformations

  • Erythromycin

*maternal cholestatic jaundice

  • Tetracyclines

*fetal bones/teeth, maternal liver

22
Q

Pyelonephritis during pregnancy treatment

A
  • 1 episode of pyelonephritis or 2 episodes of a UTI during pregnancy is indicator for suppressive antibiotics
  • Pyelonephritis ⇒ hospitalize + IV antibiotics ⇒ no improvement in 72hr ⇒ re-eval
23
Q

UTI Diagnosis in Men

A

<50

  • Exlude STIs: gonorrhea and chlamydia
  • Evaluate for anatomic abnormalities

>50

  • Atypical or absent symptoms of a UTI
  • Ask for recent hospitalization/instrumentation
  • Consider multi-drug resistant organisms in complex cases
  • Surgical management may be necessary for pts. w/ an assoc. abscess, emphysematous pyelonephritis or ureteral obstruction
24
Q

UTI in Spinal Cord Injury (SCI) Patients

A
  • High risk for UTIs: bladder dysfunction and indwelling catheters
  • Resistant polymicrobial UTIs

- Treatment for asymptomatic bacteriuria in SCI pts. is not recommended

  • Evaluations: fluoroscopic urodynamic, imaging and cystoscopy
25
Q

Catheter assoc. UTI (CAUTI)

A
  • Occurs after a catheter has been left in place for 48hrs
  • Biofilm formation
  • Bacteriuria: treat if symptomatic
  • Requires removal and replacement of indwelling catheter
  • Less catheterization = less UTIs and bacteriuria
26
Q

UTI in kidney transplant patients risk factors

A
  • Cadaveric graft
  • Diabetes
  • Prolonged hemodialysis prior to transplant
  • 2 episodes of asymptomatic bacteriuria

*treatment of asymptomatic bacteriuria in renal transplant pts is controversial

  • Female
27
Q

UTIs in HIV Patients

A
  • CD4 count <200 cells/mm3 are at higher risk for:

*atypical fungal, mycobacterial and viral infections

  • Higher rates of Acinetobacter and salmonella
  • TMP-SMX prophylaxis decreases the risk of UTI
28
Q

Pathogens w/ a higher rate of urinary tract infections in immunocompromised individuals (eg HIV)

A
  • Acinetobacter
  • Salmonella
29
Q

HIV UTI Prophylaxis

A
  • TMP-SMX
30
Q

Pyelonephritis

A
  • Ascending GU tract infection
  • UTI symptoms plus flank pain (“stabbing”)
  • Treatment duration = 7-14 days
  • Sepsis needs broad-spectrum antibiotics
  • If not getting batter acquire imaging for perinephric absscess or structural abnormality (renal stones)
31
Q

Emphysematous Pyelonephritis

A
  • Urologic emergency
  • Necrotizing infection of the kidneys w/ the formation of gas
  • E. coli, K. pneumoniae, and proteus mirabilis
  • Dry version treated by nephrectomy
  • Abscess version treated by drainage
32
Q

Xanthogranulomatous Pyelonephritis

A
  • Unknown etiology; usually due to stone disease and obstruction
  • Often asymptomatic
  • Infections result in scarring causing obstruction
  • UTI symptoms, weight loss and pyuria
  • Diffuse disease requires nephrectomy
  • Focal or segmanetal disease requires antibiotics
33
Q

Epididymitis/Orchitis Causes

A
  • <35 think chlamydia trachomatis infection
  • >35 think E. coli
  • History, exam and testicular US
34
Q

Asymptomatic Bacteriuria Treatment

A
  • No treatment except in:

*pregnant women

*pts. scheduled for GU instrumentation

35
Q

Genitourinary Tuberculosis

A
  • 3rd most common presentation of extrapulmonary TB
  • Reactivation of the granulomas (cortex) results in papillary necrosis or progression down the ureters, bladder and testes
  • Sterile pyuria, proteinuria or hematuria
36
Q

Sterile Pyuria Diagnosis

A
  • Urine which contains white blood cells while appearing sterile by standard culturing techniques
  • Urine acid-fast bacilli w/ culture
  • Chest x-ray and imaging of the GU system
37
Q

Sterile Pyuria Treatment

A
  • 2 months for a 4-drug regimen followed by 7 months of isoniazid + rifampin
  • Can be caused by TB so can be treated w/ TB drugs
38
Q

Schistosomiasis

A
  • Caused by schistosoma haemotobium
  • Vector = snails
  • Causes granulomas in bladder, hematuria, painful micturition
  • Untreated can go on to form squamous cell cancers of the bladder
  • Diagnosed by ELISA
  • Treated w/ Praziquantel
39
Q

Schistosomiasis Diagnosis

A
  • Diagnosed by ELISA`
40
Q

Schistosomiasis Treatment

A
  • Praziquantel
41
Q

Parasites that can cause UTIs

A
  • Schisosoma haemotobium
  • Tichomonas vaginalis

*motile organism on wet mount

  • Plasmodium falciparum
42
Q

Trichomonas vaginalis symptoms

A
  • Inflammation around the urethra and vagina
43
Q

Plasmodium falciparum Symptoms

A
  • Blackwater fever

*recent travel history?

44
Q

Trichomonas vaginalis treatment

A
  • Flagyl for 7 days
45
Q

Cephalosporins

A
  • Inhibit bacterial cell wall synthesis
  • 4 Generations

*1st - cefazolin, cephalexin

*2nd- cefoxitin

*3rd- ceftriaxone

*4th- cefepime

46
Q

Trimethoprim/Sulfamethoxazole

A
  • Inhibit bacterial folate metabolism
  • Less risk of C. Diff
  • Spectrum

*strep, staph

*G (-) rods

*does not treat pseudomonas

  • Interacts w/ coumadin by increasing PT
47
Q

Fluoroquinolones

A
  • Inhibit bacterial DNA gyrase
  • Spectrum

*most Gm (-) rods

*pseudomonas

  • Side effects

*tendon rupture

*lower seizure threshold

*supratherapeutic INR in coumadin pts.

48
Q

Aminoglycosides

A
  • Inhibit ribosomal protein synthesis
  • Spectrum

*most G (-) rods

*pseudomonas

  • Side effects

*ototoxicity

*renal toxicity

*neuromuscular blockade

49
Q

UTI Prevention

A
  • Probiotics
  • Cranberry (PACs, ⇒ Ellura OTC)
  • Sexual practices
  • Fluids
  • Timed voiding
  • Eliminating stasis (TURP, CIC, reconstruction)
  • Eliminating source (stone, foreign body)
50
Q

Antibiotic for UTIs that is safe during pregnancy

A
  • Nitrofurantoin

RGU Exam 3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions