Diebel: UTI Flashcards
What is the difference between an upper and lower UTI?
Upper- kidneys
Lower- bladder, urethra, prostate
What type of bacteria cause most UTIs?
Enteric
What are the most common sxs of UTIs?
- asymptomatic (ABU)
- increased freq/urgency
- dysuria
- lower abdominal pain
- flank pain
When are systemic sxs and sepsis possible when related to a UTI?
Kidney infection
How do you dx UTI?
UA
Urine culture
How are UTI and ABU diagnostically defined?
Presence of bacteria in the urine accompanied by WBC/inflammatory cytokines
What is the difference between ABU and UTI?
Absence of sx
UTI symptomatic and warrantes antimicrobial therapy
What is the gold standard of detection of UTI? how long does it take?
Bacteria in the urine
24 hrs to obtain results
additional 24 for specific organism
What is used to tx UTI in women?
- nitrofurantoin
2. TMP-SMX
What is used to tx UTI in men?
- fluoroquinolone
2. TMP-SMX
What natural mechanisms help to prevent UTI in the body?
- acidity of the urine
- act of urinating
- immunological/physical barriers to infection (mucosal lining of urinary tract and urethral sphincter)
What causes 90% of UTIs?
Bacteria ascend the urethra to the bladder
What causes a complicated UTI?
Underlying factors that predispose an individual to a UTI
- catheter
- obstruction of flow
- poor bladder emptying (calculi, tumors, neurogenic disorder, pregnancy, prostatic enlargement, uterine prolapse, cystocele)
What causes an uncomplicated UTI?
No underlying sx or impairment to flow
Men: unprotected sex, uncircumcised penis
Women: sex, diaphgram/spermacide use, antibiotic use, hx of recurrent UTIs
Why does antibiotic and spermacide use increase your chance of getting a UTI?
Alters vaginal flora and can lead to an overgrowth of e. coli
What causes most bacterial infections?
Commensal enteric gram - aerobic/facultative bacteria
What are common causes of uncomplicated UTI?
e. coli (75%)
s. saprophyticus (5-15%)
other enteric organisms (5-10%)
What cause copmlicated UTI?
E. coli and a WIDE variety of other organisms
What are the three major contributing factors to UTI?
- environment- any condition taht cuases urinary stasis (stones/catheters)
- host- familial disposition (women with recurrent UTI are more likely to have it before age 15 and have a maternal hx- e. coli can attach easier or decreased immune response)
- microorganism- strains of e. coli that cause symptomatic UTI have certain VFs
What are the most important VFs related to E. coli?
Surface adhesions (facilitate binding to epithelial cells to initiate colonization)
What is the p fimbriae? What pathogenesis does p fimbriae play a critical role in?
An adhesion that is a hair like protein structure that interacts with a specific receptor on RENAL epithelial cells.
Particularly important in pathogenesis of pyelonephritis and subsequent blood stream invasion of kidney.
What is a type 1 pilus important for establishing bladder infection? Is it always expressed?
Play a key role in initiating e. coli bladder infection- mediate binding to uroplakins on luminal surface of BLADDER uroepithelial cells.
adhesion with all e coli strains possess genetically but not all e coli strains express.
