Chapter 99 - Urosepsis

Question 1

risk factors for urosepsis

Answer 1

anatomic abnormality, UT obstruction, nephrolithiasis, prior UT disease, renal failure, neurologic disease, DM, hyperA, immunosuppression

Question 2

definition of urosepsis

Answer 2

sepsis, + UTI + risk factor(s)

Question 3

definition of complicated UTI

Answer 3

UTI + risk factor(s) (anatomic abnormality, UT obstruction, nephrolithiasis, prior UT disease, renal failure, neurologic disease, DM, hyperA, immunosuppression)
additionally pregnant or intact dogs/cats

Question 4

most common sources of urosepsis

Answer 4

pyometra > prostatic abscessation/suppuration > testicular abscessation, renal abscessation (> vaginal abscessation)

Question 5

Common uropathogens in urosepsis

Answer 5

E. coli (up to 50% of urine isolates), gram- positive cocci such as Staph, Strep, Enterococci (up to 1/3rd), less commonly Pseuomonas, Klebsiella, pasteurella, Corynebacterium, Mycoplama

Question 6

which phylogenetic groups do uropathogenic E. coli most commonly belong to

Answer 6

B2, less commonly D

Question 7

common serogroups of urovirulent E. coli in humans

Answer 7

O, K, H

Question 8

list 4 virulence properties of uropathogenic E. coli

Answer 8

presence of pilus to mediate attachment to uroepithelium
presence of hemolysin and aerobactin
resistance to bactericidal action of serum
rapid replication time in urine

Question 9

host defences against ascending UTI

Answer 9

normal micturition
extensive renal blood supply
normal UT anatomy (high pressure zones in urethra, long urethral length)
urethral and ureteral peristalsis
mucosal defence barriers
antimicrobial properties of urine
systemic immunocompetence

Question 10

additional host defence against prostatic infection

Answer 10

prostatic fluid contains zinc-associated antibacterial factor

Question 11

T/F canine E. coli isolates resistant to fluoroquinolones have lower prevalence for virulence genes

Answer 11

T

Question 12

T/F canine E. coli isolates resistant to fluoroquinolones are less likely to be from phylogenetic groups A and B1 and more likely to be from phylogenetic group B2

Answer 12

F, the opposite is true

Question 13

Pyelonephritis is usually via a) ascending infection or b) hematogenous spread

Answer 13

a) ascending infection

Question 14

how does renal trauma or the presence of urinary tract obstruction increase incidence of hematogenous spread of infection to the urinary tract?

Answer 14

via interference with urinary circulation

Question 15

list ultrasonographic signs of chronic pyelonephritis

Answer 15

mild-mod renal pelvic dilation and ureteral dilation
renal cortex and surrounding retroperitoneum hyperechoic
poor corticomedullary definition
distortion of the renal collecting system
irregular renal shape
decreased kidney size

Question 16

recommended antimicrobial therapy length for pyelonephritis

Answer 16

4-8 weeks

Question 17

total nephrectomy should be considered under while conditions

Answer 17

unilateral advanced pyelonephritis, pyonephrosis, presence of renal abscess

Question 18

treatment other than nephrectomy for pyonephrosis

Answer 18

temporary placement of a ureteral stent to allow continuous drainage

Question 19

common causes of urinary tract rupture (most common first)

Answer 19

blunt trauma > penetrating trauma, aggressive catheterization, prolonged urethral obstruction, excessive force during bladder expression

Question 20

mechanism of hindlimb edema in prostatic infection

Answer 20

altered vascular permeability from sepsis

interference with normal lymphatic and venous drainage from peripheral LNs

Question 21

What is the most frequently diagnosed uropathogen in urosepsis?

Answer 21

E.coli

Question 22

Principle source of infection in urosepsis?

Answer 22

rectum, genital, perineal area

Question 23

How they explained the process result in septick shock in urosepsis?

Answer 23

Septic peritonitis associated with urinary tract disorder, visceral and parietal peritoneum provide a large surface area for absorption of bacteria and endotoxins in septic shock

Question 24

Pyelonephritis: which one is more commonly affected, ascending infecton VS hematogenous infection

Answer 24

kidneys and ureters are affected most commonly by ascending bacteria rather than via hematogenous infection

Question 25

AUS findings in acute and chronic pyelonephritis

Answer 25

acute: renal enlargement
chronic: poor corticomedullary definition, distortion of renal collecting system, irregular renal shape, reduced kidney size

Question 26

How they explained the mechanism of developing hindlimb edema in patient with prostatic infection

Answer 26

1) altered vascular permeability

2) presence of an abscess interfering with normal lymphatic and venous drainage from peripheral lymph node

Question 27

Pyometra happens in what stage of the estrus cycle

Answer 27

Luteal stage

Question 28

Incidence of UTI in dogs and cats with closed catheter system

Answer 28

both studies suggest that risk of infection increased with duration of catheterization and that antimicrobial therapy was associated with increasingly resistant gram-negative organisms

Question 29

Most common location for bacteria for enter the system

Answer 29

catheter-collecting tube junction or at the drainage bag portal

Question 30

Why prophylactic use of antimicrobial is not recommended?

Answer 30

1) longer duration of catheterization has been associated with antimicrobial resistant bacteria
2) duration of catheterization is unpredictable