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Renal > Lec 28 UTIs > Flashcards

Lec 28 UTIs Flashcards

1
Q

What are 4 mechs of UTI infection?

A

ascending from urethra = most common
hematogenous: from bacteremia
lymphatic [rare]
direct extension from IBD/PID

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2
Q

What is the most common UTI pathogen?

A

E Coli = 85% of community acquired; 50% of nosocomial

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3
Q

What are risk factors for UTI?

A

past history, sexual intercourse, diabetes, lack of circumcision, AIDS

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4
Q

What virulence factors are involved in E Coli UTI?

A

bacterial fimbrae/pili allow higher degree of adherence

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5
Q

What are some host protective factors from UTI?

A
  • efficient emptying of bladder w/ void to decrease colony count
  • glycosaminoglycan layer = interferes with bacterial adherence
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6
Q

What makes women particularly suscpetible to UTIs?

A
  • have short urethra = facilitates ascent into bladder
  • those with recurrent UTI may have more adhesion receptors for pathogen binding
  • women whose mucosal secretions lack fucosyl transferase may be prone
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7
Q

What are male-specific factors that increase risk of UTI?

A
  • uncircumcised = higher incidence of UTI

- lower zinc secretion from prostate [usually acts as an antibacterial]

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8
Q

What is an uncomplicated UTI?

A

infection in patient with structurally and functionally normal urinary tract [includes isolated or recurrent bacterial cystitis and acute pyelonephritis]

eradicated with short course of oral antibiotics

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9
Q

What is a complicated UTI?

A

infection with structural or functional impairment that reduces efficacy of antibiotics; seen commonly in older men with prostate problems

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10
Q

What is treatment of complicated UTI?

A

prolonged course of antibiotics; may need urologic evaluation and treatment

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11
Q

What is asymptomatic bacteriuria?

A

absence of symptoms and no pyuria on UA BUT urine culture demonstrates bacterial growth

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12
Q

How do you treat asymptomatic bacteriuria?

A

no treatment needed unless obstruction, pregnant, or diabetic

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13
Q

What is cystitis? presentation?

A

lower UTI –> dysuria, frequency, urgency, suprapubic pain/fullness

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14
Q

What are major pathogens that cause cystitis?

A

E coli 70-80%
Enterobacter 20%
S. saprophyticus 10-20%

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15
Q

What is treatment for cystitis?

A

3 day course or single dose of antibiotics

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16
Q

What is presentation of acute pyelonephritis?

A

infection of renal parenchyma = dysuria and increased frequency, fever, chills, flank pain

17
Q

What is treatment of acute pyelonephritis?

A

usually treat with IV antibiotics at least until symptoms improve

18
Q

What is treatment of a perinephric abscess?

A

can be a complication of pyelonephritis –> requires percutaneous or open drainage and empiric antibiotics

mortality up to 50%; may need nephrectomy

19
Q

What is infected in acute vs chronic pyelonephritis?

A 
acute = infection of renal parenchyma
chronic = diffuse interstitial inflammation of kidney
20
Q

What is infected in cystitis?

A

superficial mucosal infection of bladder

21
Q

What is infected in urethritis?

A

inflammation of urethra usually due to sexually transmitted infection

22
Q

What is definition of pyuria

A

10 or greater leukocytes / high power field; leukocyte esterase test on dip stick urine = rapid screen

23
Q

What is standard technique for urinalysis?

A

clean catch mid stream urine

24
Q

What is the threshold for significant urine culture? what about if symptomatic man/woman?

A

standard = 100,000 or more organisms/ml of urine
symptomatic women: 100 cfu/ml
symptomatic men: 1000 cfu/ml

25
Q

What type of pathogens associated with catheter related UTI?

A

up to 95% are polymicrobial –> often E Coli, pseudomonas, Proteus, providentia, morganella morgani

26
Q

What is the pathophysiology of UTI in pregnancy?

A

dilation of ureters and renal pelvis in pregnancy + markedly decreased ureteral peristalsis

27
Q

What drugs used to treat UTI in pregnancy?

A

amoxicillin, cephalexin, nitrofurantoin, sulfonamides [except in 3rd trimester]

28
Q

What is the recommendation for detecting UTI in pregnancy?

A

do urine analysis and culture in initial visit and again at 28 wks

29
Q

What does TMP/SMX treat?

A

most uropathogens except enterococcus and pseudomonas

30
Q

WHat does nitrofurantoin treat?

A

most uropathogens including enterobacteriacea; not effective against proteus and pseudomonas

rapidly excreted so not good for complicated UTI

31
Q

What are the first drugs of choice for febrile UTI?

A

TMP/SMX or ampicillin AND aminoglycoside

32
Q

What drug should you use to treat UTI in patient with penicillin allergy?

A

aztreonam

Renal (26 decks)

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