Chapter 99 - Urosepsis Flashcards
risk factors for urosepsis
anatomic abnormality, UT obstruction, nephrolithiasis, prior UT disease, renal failure, neurologic disease, DM, hyperA, immunosuppression
definition of urosepsis
sepsis, + UTI + risk factor(s)
definition of complicated UTI
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
most common sources of urosepsis
pyometra > prostatic abscessation/suppuration > testicular abscessation, renal abscessation (> vaginal abscessation)
Common uropathogens in urosepsis
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
which phylogenetic groups do uropathogenic E. coli most commonly belong to
B2, less commonly D
common serogroups of urovirulent E. coli in humans
O, K, H
list 4 virulence properties of uropathogenic E. coli
presence of pilus to mediate attachment to uroepithelium
presence of hemolysin and aerobactin
resistance to bactericidal action of serum
rapid replication time in urine
host defences against ascending UTI
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
additional host defence against prostatic infection
prostatic fluid contains zinc-associated antibacterial factor
T/F canine E. coli isolates resistant to fluoroquinolones have lower prevalence for virulence genes
T
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
F, the opposite is true
Pyelonephritis is usually via a) ascending infection or b) hematogenous spread
a) ascending infection
how does renal trauma or the presence of urinary tract obstruction increase incidence of hematogenous spread of infection to the urinary tract?
via interference with urinary circulation
list ultrasonographic signs of chronic pyelonephritis
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
recommended antimicrobial therapy length for pyelonephritis
4-8 weeks
total nephrectomy should be considered under while conditions
unilateral advanced pyelonephritis, pyonephrosis, presence of renal abscess
treatment other than nephrectomy for pyonephrosis
temporary placement of a ureteral stent to allow continuous drainage
common causes of urinary tract rupture (most common first)
blunt trauma > penetrating trauma, aggressive catheterization, prolonged urethral obstruction, excessive force during bladder expression
mechanism of hindlimb edema in prostatic infection
altered vascular permeability from sepsis
interference with normal lymphatic and venous drainage from peripheral LNs
What is the most frequently diagnosed uropathogen in urosepsis?
E.coli
Principle source of infection in urosepsis?
rectum, genital, perineal area
How they explained the process result in septick shock in urosepsis?
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
Pyelonephritis: which one is more commonly affected, ascending infecton VS hematogenous infection
kidneys and ureters are affected most commonly by ascending bacteria rather than via hematogenous infection
AUS findings in acute and chronic pyelonephritis
acute: renal enlargement
chronic: poor corticomedullary definition, distortion of renal collecting system, irregular renal shape, reduced kidney size
How they explained the mechanism of developing hindlimb edema in patient with prostatic infection
1) altered vascular permeability
2) presence of an abscess interfering with normal lymphatic and venous drainage from peripheral lymph node
Pyometra happens in what stage of the estrus cycle
Luteal stage
Incidence of UTI in dogs and cats with closed catheter system
both studies suggest that risk of infection increased with duration of catheterization and that antimicrobial therapy was associated with increasingly resistant gram-negative organisms
Most common location for bacteria for enter the system
catheter-collecting tube junction or at the drainage bag portal
Why prophylactic use of antimicrobial is not recommended?
1) longer duration of catheterization has been associated with antimicrobial resistant bacteria
2) duration of catheterization is unpredictable
