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CRRAB II > Bacterial UTI (Diebel) - W3 > Flashcards

Bacterial UTI (Diebel) - W3 Flashcards

1
Q

What are first line antibiotics for UTI for WOMEN

A
  • nitrofurantoin and TMP-SMX
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2
Q

What are first line antibiotics for UTI in men?

A
  • fluoroquinolone
  • TMP-SMX
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3
Q

What is the “gold standard” for detecting bacteria in urine?

A

detection of bacteria in a urine culture

  • may also see white cells and inflammatory cytokines
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4
Q

How much more common are UTIs in women than men in adults aged 20-50 years?

A

50x more common

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5
Q

What are the underlying factors that predispose an individual to an ascending bacterial infection?

A
  • presence of urinary instrument (catheter)
  • anatomic abnormalities
  • obstruction of urine flow
  • poor bladder emptying
    • caliculi, tumors, pregnancy, neurogenic disorders, porstate enlargement, uterine prolapse, cystocele
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6
Q

What are risk factors for women in getting UTIs?

A
  • sexual intercourse
  • diaphragm use
  • spermacide use
  • antibiotic use
  • hx of recurrent UTIs
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7
Q

What are risks for young men getting UTIs?

A
  • unportected anal intercourse
  • uncirmucised penis
  • unportected intercourse w/woman whose vagina is colonized w/urinary pathogens
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8
Q

What are the common pathogens for uncomplicated UTIs?

A
  • E. coli - 75%
  • Staphylococcus saprophyticus - 5-15%
  • Other enteric bacteria - 5-10%
    • kelbsiella
    • proteus
    • enteroccus
    • citrobacter
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9
Q

What are the common pathogens involved in complicated UTIs?

A
  • E. coli - still most predominant
  • other anaerobes, gram negative
    • kelbseilla
    • proteus
    • citrobacter
    • acinetobacter
    • morganella
    • pseudomonas
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10
Q

What are the factors of the ENVIRONMENT that lead to a UTI?

A
  • colonization of vaginal introitus and periurethral area w/intestinal flora
  • condition that allows for urinary stasis
  • stones
  • urinary catheters
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11
Q

HOST factors that lead to increaed risk for UTI

A
  • increased ability of E coli to colonize through better attachment to epithelial cell surface or decreased immune response to colonization
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12
Q

What does E. coli contain that allow them to cause invasive symtpoms w/UTIs in otherwise normal hosts?

A
  • surface adhesions
    • ​facilitate binding to epithelial cells to initiate colonization
  • P. fimbrae
    • important for pyelonephritis and blood stream invasion
  • type 1 pilus (fimbria)
    • key for bladder infection
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13
Q

What E. coli virulence factor faciliates blood stream invasition & pyelonephritis, and interacts w/specific receptor on renal epithelial cells

A

P. fimbriae

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14
Q

What are type I pili (fimbria)

faciliate what?

do all strains have?

what does it bind to?

A
  • initiates E. coli bladder infection
  • all possess genetically but not all express
    • gene on chromosome but protein not always present
  • mediate binding to uroplakins on luminal surface of bladder uroepithelial cells
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15
Q

What are the major defenses of the urinary system?

A
  1. Urine pH, lysozyme and lactoferrin
  2. Flow
  3. IgA - adaptive immune response that goes through epithelial lining
  4. changing surface proteins on epithelial cells
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16
Q

What are the major threats to the urinary system?

A
  • micro-organisms of GI
  • hematogenous spread from other areas
  • blocked or decreased urine flow
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17
Q

For each of the following, say if they’re complicated or uncomplicated UTIs.

Parkinson’s disaease

Renal transplant

Infection in men

pregannt women

children

hospitalized patients

A
  • ALL are complicated cases
  • any neurologic disease could predispose to voiding issues
  • obstruction, catheteres, immunosuppression could also be added.
  • organisms are more likely to be resistant
  • men - complicated since get infection of prostate w/the bladder
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18
Q

What is the overall UTI incidence in women and what is the reoccurence rate?

A
  • .5-.7 episodes per year
  • recur in 25-30%
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19
Q

Presents with high fever, flank pain, dysuria, nausea, and vomitting

A

Pyelonephritis

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20
Q

What is an infection due to acute complication of pyelonephritis

A
  • Papillary necrosis
    • normally occurs w/ DM, UT obstruction, sickle cell disease or analgesic abuse
    • necrotic renal papillae may slough and cause obstruction
    • intrarenal abscess may result from bacteremia or be complication of severe pyeloneprhtitis
    • perinephric abscesses occur when micro-organisms from renal parenchyma or blood are deposited in soft tissues surrounding kidneys
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21
Q

What are the signs of chronic pyelonephritis?

A
  • one or both kidneys contain gross scars
    • not equal damage
  • uneven scarring
  • parenchyma shows interstitial fibrosis w/inflammatory infiltrate of lymphocytes and neutrophils
  • contracted or dilated tubules
  • colloid casts in the tubules
  • concentric fibrosis about parietal layer
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22
Q

What do you SEE in the kidney with papillary necrosis?

A
  • one or more pyramids, frequently both infected
  • yellow necrotic tissue replaces pyramids
  • portion of papilla can break off - produces recognizable calyceal deformity
  • collecting tubules filled w/bacteria and polymorphonuclear leukcotyes
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23
Q

What is the typical pathogen if the UTI occurs via hematogenous spread?

A
  • Staph aureus
    • frequently form abscesses
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24
Q

What are the common serogroups found in E.coli that cause UTIs?

A
  • O1
  • O2
  • O4
  • O6
  • O7
  • O8
  • O75
  • O150
  • O18ab
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25
Q

When serotyping bacteria, what does the O mean

A

polysacchardie sugars in the outer membrane - part of LPS in outer membrane

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26
Q

What does the K encode when serotyping bacteria?

A

capusle antigen - can secrete capsule

encodes sticky glycoprotein

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27
Q

What does the H serotype mean

A

flagellar antigen - protein repeats put together

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28
Q

4 key virulence factors E. coli have:

A
  1. genes associated with adherence
  2. genes associated to resistance of serum bactericidal activity
  3. increased K antigen production (K1, K5, K12)
    1. with more capsule they have a bigger shell
  4. siderophore receptor (iroN)
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29
Q

What do P. fimbriae bind to?

A
  • epithelial cell receptors containing globoseries glycosphingolipid
    • P in fimbriae attach to the receptors
    • the receptors make up the P blood group antigen complex on RBC and uroepithelial cells
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30
Q

What is special about E. coli with P. fimbriae

A
  • resistant to neutrophil destruction
  • induced increased signaling from TLR4
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31
Q

What do Type I fimbriae bind to? What inhibits their binding?

A
  • mannose containing host epithelial receptors (uroplakin I and II)
  • inhibited in the presence of free mannose
32
Q

Prevention strategies for UTIs:

A
  • vaccines in clinical trial
  • regular urination
  • good hygiene
  • drink cranberry juice
33
Q

What is the last line drug used for CRE - carbapenem resistant Enterobacteriacease

A

polymyxin B

34
Q

What is the last line drug for VRE - vancomycin resistant enterococci

A

linezolid

35
Q

What defines pyuria? Bacteriuria?

A
  • pyuria = 10 more neutrophils
  • bacteriuria = 10 to the 5th colony forming units

colony counts are much lower with complicated UTIs.

36
Q

What is the most important first step in diagnosis of infectious disease?

A

accurate clinical history and physical exam

37
Q

What does catalase differentiate between?

A
  • Staph vs. Strep
  • staph is catalase +
    • ​has enzyme capable of converting hydrogen peroxide to water & oxygen
38
Q

What is the coagulase test used to differentiate between?

A
  • Staph aureus vs. coag neg Staph
    • ​staph aureus is ONLY coagulase +
    • allows staph to breakdown collagen
  • fibrogen clumps on staphylococcal cell
39
Q

How do you distinguish between staph epidermidis and staph saprophyticus?

A
  • use novobiocin sensitivity test
    • S. saprophyticus is RESISTANT to novobiocin
  • novobiocin inhibits DNA gyrase
40
Q

What are the hemolytic properties of staph aureus?

of Staph saprophyticus?

A
  • Staph aureus = beta hemolytic
  • Staph saprophyticus = gamma hemolytic
41
Q

Indole test

What does it look for?

What organisms are positive?

A
  • looks at tryptophan
  • E. coli is positive
  • citrobacter is variable
42
Q

Methyl Red

Looks at?

Which organisms are positive?

A
  • glucose fermentation w/pH
  • E. coli
  • Citrobacter
  • Proteus Mirabilis
  • Klebsiella is variable
43
Q

Voges test

looks at?

positive?

A
  • looks at glucose fermentation w/neutral pH
  • Klebsiella
  • Proteus is variable
44
Q

Citrate test

Used for?

positive organisms?

A
  • determining which organisms use citrate for growth
  • Klebsiella
  • Proteus Mirabilis
45
Q

What organism is indole positive and citrate negative?

A

E. coli

46
Q

When do you use TMP-SMX?

A

When local prevalence is less than or equal to 20%

If not used in the last 3 months for UTI.

47
Q

What is the first line treatment for S. saprophyticus?

A
  • Amoxicillin/Clavulanate
48
Q

When do you use fluoroquinolones for UTI?

A
  • severe allergy to first line
  • TMP-SMX used in last 3 months
  • infection in area w/greater than 20% resistance to TMP-SMX
49
Q

Nitrofurantoin

MOA

Activation

Contraindications?

A
  • inhibits bacterial acetyl-coenzyme A
  • activation dependent on urine acidity
  • contra
    • prengancy last 4 weeks
    • impaired renal function
    • men - doesn’t treat prostate
50
Q

TMP-SMX

MOA?

Side effects

A
  • sequential blockage of tetrahydrofolic acid pathway
  • interacts w/warfarin through CYP450 and CYP2C9 system
51
Q

Quinolone

MOA

Most active against?

Can’t be taken with?

A
  • inhibits DNA gyrase and topoisomerase IV
  • most active against aerobic gram negative bacilli
  • can’t be taken with ANTACIDS
52
Q

Describe the macConkey agar?

A
  • Selective - only grows gram negative
  • Differential
    • lactose fermetation
53
Q

What does P. Fimbriae allow for (related to cytokines?

A

Allows LPS to engage TLR4 more intensely. Increases downstream effects of IL-1 and TNF.

NF-kappaB and AP-1 are turned on.

54
Q

Good test, besides gram stain, to tell between Saphrophytics and enterococcus.

A

Catalase test - staphrophyticus is catalase positive.

55
Q

Why cant you use nitro in the last 4 weeks of pregnancy?

A

Could end up w/hemolytic anemia if individual has G6P deficiency.

Use 3rd gen cephalosporin.

Or beta lactam.

56
Q

What are things that can make a UTI complicated?

A
  • urinary catheters
  • anatomical anomalies
  • obstruction of urine flow
  • poor bladder emptying
57
Q

What are reasons for poor bladder emptying, that could cause complicated UTI

A
  • caliculi
  • tumors neurogenic disorders
  • pregnancy
  • prostatic enlargement
  • uterine prolapse
  • cystocele
58
Q

Women with recurrent UTIs are more likely to have…

A
  • maternal history of UTI
  • first UTI before age 15
59
Q

What does novobiocin do?

A

inhibits bacterial DNA gyrase in susceptible organisms.

Staph saprophyticus is resisant.

60
Q

Citrobacter

gram + or - & shape

+ tests

Lactose fermenation?

A
  • gram negative ROD
    • for methyl red. Variable for indole.
  • Yes - Slow lactose fermenter.
  • Other
    • use malonate.
    • found in soil, water
    • can accumulate uranium
61
Q

Klebsiella

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Other?

A
  • gram negative ROD
    • voges and citrate. variable methyl red.
  • yes - PINK ON MACCONKEY.
  • Urease +
  • immotile
  • normal part of intestinal flora.
  • 3rd leading cause of UTI
62
Q

Proteus mirabilis

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram NEGATIVE – ROD
    • methyl red & citrate
      • variable voges.
  • NO LACTOSE fermentation.
  • Urease +
  • FISHY ODOR
  • catalase +
  • MOTILE - shows swarming on agars.
63
Q

Staph saprophyticus

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram positive
  • Resistant to novobiocin.
  • Urease +
  • Catalase + (coagulase negative)
  • 2nd leading cause of UTI
  • gamma hemolysis
64
Q

E. coli

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram negative – ROD - encapsulated
  • Indole and methyl red + (citrate negative)
  • Catalase +
  • Nitrite +
  • EMB agar - green metallic - fast lactose fermenter.
    • also on MacConkey
65
Q

Pseudomonas aeruginosa

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram NEGATIVE - rod
  • AEROBIC
  • NO LACTOSE
  • catalase +
  • MOTILE
  • fruity odor
  • blue-green pigment
66
Q

Acinetobacter

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram negative - occur in pairs
  • oxidase negative
  • non-motile
  • may grow on MacConkey
  • nitrate negative
  • found in soil
67
Q

Morganella

gram + or - & shape

+ tests

Lactose fermenation?

Urease?

Catalase?

Odor?

Other?

A
  • gram negative
  • Catalase +
  • oxidase negative
  • faculative anaerobe
  • methyl red positive
68
Q

How can you differentiate between staph saprophyticus and enterococcus, since both are gram positive?

A
  • catalase test
    • staph is catalase +
    • enterococcus is catalase negative
69
Q

What antibiotics do you use for UTI w/pregnancy?

A
  • Nitrofurantoin up to last 4 weeks
  • 3rd gen cephalosporin - ceftriaxone
  • beta lactam
70
Q

What is the most common type of nosocomial infection?

A

catheter related UTIs

71
Q

What is an acute complication of pyelonephritis and when does it commonly occur?

A
  • papillary necrosis
  • occurs with:
    • diabetes mellitus
    • UT obstruction
    • sickle cell disease
    • analgesic abuse
72
Q

What are some issues with papillary necrosis?

A
  • sloughing - could lead to uretral obstruction
  • intrarenal abscess
  • perinephric absess - deposited into soft tissues surrounding kidneys
73
Q

What is the pathognomonic feature of acute pyelonephritis?

A
  • suppurative necrosis or abscess formation within the renal substance
74
Q

What is seen with chronic pyelonephritis?

A
  • one or both kidneys w/gross scars
    • uneven scarring
  • parenchyma has interstitial fibrosis with inflammatory infitrate of lymphocytes and neutrophils
  • atrophy of tubular lining
  • colloid casts
  • periglomerular fibrosis
75
Q

What quinolone is used against P. aeruginosa?

A

levofloxacin

CRRAB II (26 decks)

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