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MICBI - Clinical MICBI > L30 UTI > Flashcards

L30 UTI Flashcards

1
Q

Prevalence of UTI in male VS female?

Reason?

A

< 3 months old: Male > female because they are uncircumcised, the greater probability of accumulating bacteria in skin folds

> 3 months old: Female > Male because of the shorter urethra (urethra flora easier to ascend)

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2
Q

The urinary tract is basically sterile, except?

A

distal 1/3 portion of urethra, (urine in urinary bladder is sterile)

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3
Q

Significant Bacteriuria is diagnosed by?

A 
Quantitative culture (10^5 bacteria CFU/mL in MSU) //
Any growth at supra-pubic aspiration is considered significant (using JJ stent), because it should be sterile
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4
Q

Examples of Lower UTI?

A
  1. Urethritis (urethral)
  2. Cystitis (inflammation of bladder epithelium)
  3. Prostatitis
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5
Q

Symptoms of urethritis?

A
  • Dysuria
  • urethral discharge
  • Urgency
  • Frequency
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6
Q

Symptoms of cystitis? (inflammation of the bladder epithelium)

A
  • Dysuria
  • Urgency
  • Frequency
  • Suprapubic pain
  • Haematuria
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7
Q

Symptoms of prostatitis?

A 
- Same as cystitis +
Bladder outlet obstructive symptoms:
Hesitancy, poor stream, post-micturition dribbling 
- perineal/low-back pain
- complicated by epididymitis
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8
Q

Example of upper UTI?

Symptoms?

A

Pyelonephritis - inflammation of the renal parenchyma
- fever, loin pain tender renal angle
- bacteraemia if sepsis (chills, rigors 發冷)
(kidney as a vascular organ: easy for bacteria to migrate)

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9
Q

How can we classify UTI other than upper/lower? What are the main differences?

A
  1. Uncomplicated
    - adult, non-pregnant demale, without structural/neurological dysfunction
    - Good prognosis
  2. Complicated
    - male
    - pregnant female
    - requires durther investigations: lower cure rate, higher recurrence
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10
Q

UTI in paediatrics is more common in M/F?

Symptoms?

A

M;

- prolonged fever of unknown origin, febrile convulsion, failure to thrive (growth curve)

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11
Q

Suggest routes of infection of UTI. (5)

A

Ascending

  1. Shorter urethra in female
  2. Indwelling catheters (damaged urothelial epithelium)
  3. Vesicoureteric reflux (urine flows from bladder to ureters)

Descending (hematogenous)

  1. Staph. aureus, Mycobacterium tuberculosis
  2. Pyelonephritis, renal abcess
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12
Q

Many species can cause UTI. Which is the MC microbial species to cause UTI? (1)
Mechanism of pathology? (2)

A

E.coli
(Uropathogenic E.coli = UPEC)

  • production of K antigen (capsular polysaccharide) [protect from being engulfed by macrophages]
  • adherance to uroepithelial cells by fimbriae
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13
Q

Host factors - Urinary tract is normally resistant to colonisation (except distal 1/3) Why ? (4)

A
  1. Regular mechanical flushing via micturition
  2. Phagocytosis by polymorphs
  3. Humoral antibodies - IgA (at lining of uroepithelium)
  4. Urine per se- hyperosmolar, high urea, low pH (difficult to survive there)
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14
Q

Give exmaples of at risk hosts? (who are more susceptible to UTI?)

A
  1. Incomplete emptying (extraluminal, intraluminal, luminal)
  2. Vesicoureteric - reflux, in children
  3. Catheterization
  4. DM (increased glucose in urine and blood, good culture medium, inactivate immune cells)
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15
Q

Other than the MC causative organism, list some G- and G+ bacteria that causes UTI. (7)

A

MC: E.coli

G-:

  1. Klebsiella
  2. Proteus: stone-forming (increase pH by splitting urea into CO2 + NH4+ by urease)
  3. Pseudomonas: catheterized patients

G+ :

  1. S. aureus: endocarditis, bacteremia
  2. Coagulase negative staphylococcus (CoNS): elderly man with outflow obstruction e.g. BPH
  3. S. saprophyticus: sexually active young women
  4. Enterococcus (DO U <3 TREES)
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16
Q

Which of the following are correct?
A. Candida can cause UTI esp if the patient is catheterized
B. Anaerobes, mycobacteria can be causes of UTI
C. STD by Neisseria gonorrhoeae and Chlamydia can cause UTI
D. Adenovirus and polyomavirus can cause UTI in immunocompromised patients
E. Schistosoma haematobium can cause UTI

A

All of the above
C: urethritis in males
E: bladder, parasite

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17
Q

Why is first pass urine removed in taking specimens?

A

Remove skin/urethral flora

except suspected gonococcal/Chlamydia urethritis

18
Q

Mid-stream urine is collected for specimen after careful cleansing of labia/glans.
This indicates urine from?
What does it mean by significant bacteriuria?

A

Mainly from bladder

  • significant bacteriuria:
    > 10^5 CFU/ml

(colony forming units)

if contamination: <10^5 CFU/ml

19
Q

Terminal urine is urine from? Take it if suspect?

A
  • Prostate

- Suspect prostatitis

20
Q

Catheterized urine (CSU) is collected from?

A
  • Sampling port of the catheter

- NOT from the drainage bag (heavily contaminated by environmental flora)

21
Q

When is supra-pubic urine taken? (2)
How is it taken? (1)
Diagnosis of significant bacteriuria = ? (1)

A
  • In Paediatrics (infants): bladder is suprapubic and palpable
  • In elderly: those with AROU, bladder with >1L urine and thus palpable
  • Aspiration is performed under aseptic technique, 20 degrees insertion of suprapubic catheter
  • any growth is considered as signigficant bacteria
22
Q

Urine multistix is a useful screening test but cannot differentiate between contamination and infection.

Nitrite test is to detect nitrate reductase from _____________, which converts nitrate to nitrite.

A

Enterobacteriaceae

23
Q

Leukocyte test detects leukocyte esterase from WBC, +ve test suggests?

A

Pyuria (urine containing white cells/pus)

24
Q

Urine per se is a culture meedium, overgrowth will occur if not immediately processed. _________ is used as a bacteriostatic agent that lasts 24-48 hours, in a sterile container.

A

Boric acid

25
Q

Urine microscopy is a wet mount, unstained, for identification of the presence of WBC and bacteria only.
Standard _______ of urine is put in microtitre plate for examination.

A

volume (80 ul)

26
Q

Dip-slide is a culture method that is no longer used now. It has MacConkey on 1 side and CLED (cysteine-lactose-electrolyte-deficient) on the other to support growth of all potential urinary pathogens.
Good and Bad?

A

Good
- can perform immediate inoculation and culture

Bad
- no microscopy can be done

27
Q

Filter paper strip method is when ________________is taken up by filter paper, it is impregnated onto agar plate with CLED medium. > overnight incubation > bacterial colonies

A

standard volume of urine

28
Q

__________ method is to inoculate a standard amount of bacteria onto an agar plate. e.g. 1ul/ 10ul

A

Standard loop

e.g. 1ul/ 10ul per loop

29
Q

What are the possible causes of negative culture?

5

A
  1. Genuine absence of UTI
  2. Prior use of antibiotics
  3. Use of diuretics
  4. Fastidious organisms: STD pathogens: (Chlamyda, Gonnococcus… requiring specific culture medium)
  5. TB infection: sterile pyuria (presence of WBC without significant bacteriuria)
30
Q

What do we do if there is sterile pyuria in TB patient?

A

Repeat using EMU to increase inoculum

31
Q

Disc diffusion test is for testing?

A

Antibiotic susceptibility

32
Q

What are the non-pharmacological treatment for UTI?

A
  1. Increase fluid intake
  2. Good personal hygiene
  3. Treat underlying abnormalities/disease
33
Q

List examples of urinary tract agents (urinary antiseptics) for treating UTI.
- oral/high concentration in urine.

A
  1. Nitrofurantoin

2. Fosfomycin

34
Q

Precautions of using nitrofurantoin?

A
  • highly concentrated in urine
  • only effective for Escherichia coli infection
  • do not use in patients with renal failure (Crcl <30 ml/min) : use Augmentin for it
  • used with caution in elderly patients
35
Q

What antibiotics can be used in UTI? (4)

A
  1. Quinolones (ciprofloxacin? levofloxacin?)
  2. beta-lactam/beta-lactamase inhibitors (Augmentin, tazocin?)
  3. aminoglycosides (Gentamicin, amikacin, streptomycin..?)
  4. Cephalosporins (cefuroxime, ceftriaxone?…)

Nitrofurantoin too?

36
Q

Duration of Abx therapy in UTI?

A
  • 3 days in uncomplicated case
  • otherwise 3-5 days
  • 90% cure rate
37
Q

UTI treatment for cystitis (urothelial epithelium inflammation)

A
  1. E.coli: Nitrofurantoin
  2. S.saprophyticus: Augmentin (amoxicillin-clavulanate)
  3. Septrin (co-trimoxazole)
  4. Fosfomycin
  5. fluroquinolone: with side effects, used only if no other options
38
Q

Acute pyelonephritis usually by which causative organism? (3)
Treatment? (3)

A
  1. Enterobacteriaceae
  2. Enterococcus
  3. Pseudomonas in catheter-related patients

Tx
I.V. Augmentin (amoxicillin-clavulanate) (until afebrile 24-48hs, then complete 14 days course with oral drugs)

alternatives:

  • I.V. piperacillin-tazobactam (if suspect P.aeruginosa) /
  • Carbapenem if severe
39
Q

M. tuberculosis causes hematogenous spread: renal cortex, papilla, caseation > discharge of tubercle bacilli into urine (in frequent and small amount).
> what to order?

A

EMU x3

40
Q

Prognosis of UTI in paediatric population is renal scarring, thus renal failure, Management?

A
  • thorough investigation for structural abnormalities

- consider long-term prophylactic antibiotic treatment

41
Q

Prognosis of pregnant patient with UTI?

A
  1. 25% with pyelonephritis if untreated

2. complicated pregnancy - low birth weight, prematurity, fetal loss, neonatal sepsis

42
Q

Management for pregnant patient with UTI?

A

Compulsory antibiotic treatment even if asymptomatic bacteriuria

MICBI - Clinical MICBI (19 decks)

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