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Mechanisms of Microbial Disease > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

Who is at risk for bacterial urinary tract infections?

A

Women (pregnancy and sexual activity increases risk)
Elderly (improper emptying of bladder)
Patients with comorbid conditions (diabetes), spinal cord injuries (improper emptying of bladder), catheters, genitaurinal tract abnormalities (tumor, stone)

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2
Q

What are the two different routes for pathogens to cause a UTI?

A

Ascending route up the urinary tract from the outside. E. coli
Heamatogenous from the blood to the kidney

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3
Q

What is bacteriuria?

A

The presence of bacteria in the urine (normally sterile), can be symptomatic (cloudy) or asymptomatic (only found by screening in lab)

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4
Q

When is treatment recommended fro asymptomatic bacteriuria (ASB)?

A

During pregnancy and prostate resection

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5
Q

What is the proper procedure when taking a urine sample?

A

Pee a little bit. Stop. Then pee in the cup to avoid getting skin contamination or tract flushing.

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6
Q

What are the two subtypes of a recurrent UTI?

A

Relapse is when you become infected by the same organism and same strain.
Reinfection is a 2nd subsequent infection from a different organism.

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7
Q

What does it mean to have an uncomplicated UTI?

A

Occuring in healthy, non-pregnant females

Readily treated with antibiotics

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8
Q

What does it mean to have a complicated UTI?

A

Occurring in either gender but is more difficult to treat due to underlying diseases, kidney stones, UT abnormalities or indwelling urinary catheters

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9
Q

What are some contributing factors to UTIs?

A

Length of urethra, sexual activity (females), uncircumcised male infants, blockage and catheterization (each day risk goes up 10%, allows bacteria to avoid urine, biofilm is more resistant)

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10
Q

What is urethritis? What are the symptoms?

A

Infection of the urethra

Symptoms are dysuria (burning pain on passing urine) and frequency

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11
Q

What is cystitis? What are the signs and symptoms?

A

Bladder infection, lower UTI
Symptoms: Dysuria, frequency, urgency, pain over bladder area
Signs: Bloody, cloudy urine and bad odour

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12
Q

What is acute urethral syndrome?

A

Same symptoms as cystitis but less CFU/ml

Pyuria (8 leukocytes/mm3 of uncentrifuged urine)

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13
Q

What is polynephritis? What are the two subtypes?

What are the symptoms?

A

The infection of the kidney and renal pelvis (acute and subclinical)
Fever, lower UTI symptoms

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14
Q

What is prostatitis?

A

Infection involving the prostate

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15
Q

What is cervicitis?

A

Inflammation of the cervix

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16
Q

What is the epidemiology of UTIs in pediatrics?

A

High morbidity
More likely to develop impaired renal function, hypertension, end-stage renal disease and complications during pregnancy as an adult

17
Q

What is the epidemiology of UTIs in geriatrics?

A

Incidence in both men and women increases but more common in men (prostate enlargement, poorer bladder emptying)

18
Q

What are the microbial virulence factors for pathogens in UTIs?

A

Adherence (bacterial adhesins), calculi formation, toxin and enzyme production (hemolysins, lipopolysaccharides), capsular polysaccharide, biofilms

19
Q

How does the urinary tract prevent infection?

A

Flushing action of urinary flow, growth inhibitory properties of urine (low pH, osmolarity, high urea, organic acid concentrations), mucopolysaccharides, preventing reflux

20
Q

How does the normal microflora of the urethra change with growing up?
Newborn to pre-pubertal

A

Newborns: Sterile
1-3 days: Staph aureus, enterococci, diptheroids
3 days-weeks: Lactobacillus acidophilius
Pre-pubertal: Micrococci, streptococci, coliforms, diphtheroids

21
Q

What does the normal microflora of the urethra look like in pregnancy and post menopausal?

A

Similar to prepubertal microflora

Micrococci, streptococci, coliforms, diphtheroids

22
Q

What does the normal microflora of the urethra look like in adulthood?

A

L. acidophilus, staph epidermidis, streptococci (alpha, non-hemolytic), E.coli, diphtheroids, yeasts

23
Q

What are the gram negative bacilli that cause UTIs?

A

Enterobacteriaceae
Fecal E.coli (uncomplicated)
MDR Enterobacteriaceae (hospital acquired)

24
Q

How does duration of hospitalization and catheterization change the likely causative agents of a UTI?

A

Increased pseudomonas, proteus, klebsiella, acinetobacter and enterobacter
Decreased E. coli

25
Q

What are the gram positive cocci that cause UTIs?

A 
Enterococci (older men, UT manipulation, instrumentation)
Staph saprophyticus (symptomatic sexually active women
26
Q

What are the gram positive bacilli that cause UTIs?

A

Diphtheroids, mycobacteria, Listeria monocytogenes

Bacillus (most likely contamination if in sample)

27
Q

What are the fungi that cause UTIs?

A

Candiduria in hospitalized patients

28
Q

What are the causative agents of cystitis?

A

E.coli, Klebsiella spp, other enterobacteriaceae, enterococci, CoNS

29
Q

What are the causative agents of acute polynephritis?

A

Enterobacteriaceae, staphylococcus aureus

30
Q

What are the causative agents of subclinical polynephritis?

A

CoNS, Candida spp, Mycobacterium spp, Mycoplasma hominis

Must be treated in pregnancy, young children, instrumentation, elderly and diabetics

31
Q

How can a UTI be diagnosed?

A

From a midstream urine sample or right from bladder (avoids contamination, used to find anaerobic) and then microscopic examination

32
Q

How can you tell if bacteria in urine is from infection or colonization when collected midstream?

A

1000 CFU/ml is infection

33
Q

What could change the results of a urine sample?

A

If collected right from bladder, should have 0 CFU/ml
If on antibiotics, finding some CFU, could be a sign of resistant organisms
Drinking lots of water prior could dilute sample

34
Q

How should a urine sample be stored?

A

Cultured within 1 hour of collection and stored at 4 degree for not more than 18 hours

35
Q

How do we treat uncomplicated UTI (cystitis)?

A

May resolve spontaneously within 4 weeks
Antibiotics to reduce symptoms and ensure complete eradication, followup at end
Drink lots of fluids to facilitate flushing

36
Q

How do we treat complicated UTI (pyelonephritis)?

A

Systemic IV treatment until symptoms subside with oral therapy afterwards
Should be >10 days to sterilize the kidney

Mechanisms of Microbial Disease (17 decks)

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