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Microbiology Midterm 2 > Lecture 14: UTIs > Flashcards

Lecture 14: UTIs Flashcards

1
Q

What is one of the most common reasons for visiting a primary care physician

A

A UTI

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2
Q

How many % of women have a UTI by the age of 30

A

50

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3
Q

Who are UTIs most common in

A

Young women (0.5-0.7 UTIs/person/year)

and postmenopausal women (0.07 UTIs/person/year_

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4
Q

How many % of women will experience a second episode within 6 months of their first UTI

A

25%

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5
Q

What is a bacteriuria

A

The presence of bacteria in urine, does not necessarily imply infection

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6
Q

What is an asymptomatic bacteriuria

A

The presence of bacteria in the urninary tract in the absence of symptoms

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7
Q

How is most common to have an asymptomatic bacteriuria

A

Elderly population (but this is also typically ignored and not treated)

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8
Q

When is asymptomatic bacteriuria treated

A

in pregnant women

in patients undergoing invasive procedures of the urinary tract

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9
Q

Is urine sterile, yes or no

A

yes

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10
Q

How is urine sterility maintained

A

Adequate urine volume

Free-flow from kidneys through urinary meatus/opening

Complete bladder emptying

Normal acidity of urine

peristaltic activity/muscle contractions of ureters (connect kidney to the urninary bladder)

Increased intra-vesicular pressure preventing reflux

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11
Q

In males how is urine sterility maintained

A

antibacterial effect of zinc in prostatic fluid

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12
Q

What are the 3 different factors that determine the classifications of UTIs

A

Location

Condition of the urniary tract or the patient

Evolution

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13
Q

What are the different locations that a UTI can happen in

A

Upper tract infection (pyelonephritis) ex. kidney

Lower tract infection (cystitis and urethritis)

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14
Q

What are the different conditions of the urinary tract or the patient for classification of UTIs

A

Uncomplicated and complicated

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15
Q

What are the different types of evolution that are important for the classification of UTIs

A

Acute

Chronic (symptoms persist over time)

Recurring (replace or reinfection)

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16
Q

What is cystitis

A

UTI presumed to be confined to the bladder

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17
Q

What are the 3 most common signs of cystitis

A

dysuria (pain on urination)

Urinary frequency

urinary urgency

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18
Q

What are other signs of cystitis

A

Supra-pubic pain

Hematuria (blood in urine)

Nocturia (peeing at night)

Bladder tenesmus (feeling like you need to poop even though your bladders are empty)

absence of vulvar or vagina discharge or irritation

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19
Q

What is acute urethritis cause by

A

By a sexually transmitter infection

Chlamydia trachomatis

Neisseria gonorrhoeae

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20
Q

What is Vulvitis caused by

A

This is inflammation of the vulva

caused by contact dermatitis, allergic reaction
Candida albicans, HSV infection

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21
Q

What is the most common type of UTI

A

cystitis

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22
Q

What is Vaginitis

A

Inflammation of the vagina

Caused by the bacterial vaginosis

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23
Q

What is pyelonephritis and what is it characterized with

A

clinical diagnosis imposes a more invasive infection

Upper tract infection

Inflammation of the kidney and renal pelvis is assumed to be present when patients have pain or tenderness involving the flank, together with other clinical or laboratory evidence of UTI

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24
Q

What are the systemic findings of Pyelonephritis

A

Fever, flank pain, nausea, chills, malaise headaches, etc

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25
What is prostatitis
inflammation/inflammation of the prostate gland may be acute or chronic
26
What is infrarenal abscess
Collection of pus in the kidney or in the soft tissue surrounding the kidney
27
What is another name for infrarenal abscesses
perinephric abscesses
28
Who is most likely to get an uncomplicated UTI
young non-pregnant women with normal genitourinary tract
29
Who is most likely to get a complicated UTI
Structurally or functionally abnormalities of the genitourinary tract Pregnant women, elderly, men, and children Chronic symptoms Cormorbid illness (ex. diabetes) or immune-compromised Upper tract disease (pyelonephritis)
30
What is a complicated infection in UTIs
Underlying abnormality that predisposes patient to UTI or makes UTI more difficult to treat effectively
31
What are the two types of recurrent UTI infections
Relapse Re-infection
32
Relapse in UTI
Recurrent of infection by the SAME organism after discontinuation of treatment
33
Re-infection in UTI
Recurrent of infection by a DIFFERENT organism after discontinuation of treatment
34
Why is it important to know if a patient is having a relapse or re-infection with UTIs
Release: as this is with the same organism, maybe the patient wasn't treated properly and their treatment needs to be altered Re-infection: Maybe they have a structural abnormality or they are doing something to cause this
35
What is a pathogenesis
UTI usually due to patients own intestinal flora Ascending (increasing) route of infection
36
How does pathogenesis occur
Its a type of UTI Organisms enter the urniary tract in a retrograded (swim up) fashion via the urethra
37
What are complicated factors in pathogenesis
catheters, nephrostomy tubes, surgery, urniary stones, etc. Allow organisms to easily enter and persist in urniary tract Alter the typical spectrum of organisms (broaden the spectrum, typically only one organism) May have multiple aetiologies
38
How does aging affect UTIs
Agging increases the likelihood of getting a UTI because.. Increased diabetes mellitus Increased risk or urinary stasis Impaired immune response Incontienence
38
How does aging affect UTIs
Agging increases the likelihood of getting a UTI because.. Increased diabetes mellitus Increased risk or urinary stasis Impaired immune response Incontinence (leaks urine by mistake)
39
Why are female likely to get UTIs
short urethra Sexual intercourse Contraceptives that alter the normal bacteria flora Pregnancy (alters anatomy)
40
What type of Urinary tract obstructions make you more likely to get an UTI
tumor or calculi (kidney stones) Strictures (narrowing in the intestines)
41
Why are males likely to get UTIs
prostatic hypertrophy (enlargement of the prostate gland) and anal intercourse
42
What the risk factors associated with UTIs
Aging Female Male Urinary tract obstruction Impaired bladder innervation Hematogenous spread (through blood)
43
The majority of UTIs are ____microbial
mono due to a single pathogen
44
What bacteria is responsible for 90% of UTIs
Enterobacteriaceae (family) with Escherichia coli (E coli) being in this family and being the most commonly isolated pathogen in all UTIs
45
What is the structure of enterobacteriaceae
Gram negative bacilli Facultatively anaerobia Common intestinal flora
46
What are uro-pathgens
Basically the same as virulence factors that allow them to colonize and infect the urinary tract
47
What is the most important uro-pathogen in E. coli and how does it work
Adherence P fimbria bind to the P blood group Ag present on uro-epithelal cells of 99% of the population If there was no adherence the pathogen would come out when you pee because it wouldn't be able to stick
48
What are uro-pathogens in E. coli
Adherence Hemolysins, Colicin V: aid in resistance to complement dependent bactericidal effects of serum K Antigen: associated with upper tract Type 1 fimbria: interbacterial binding and biofilm formation
49
What are the classical UTI pathogens
Proteus Morganella Providencia
50
What is important about classical UTIs
The have the enzyme urease that breaks down urea and increased urinary pH which leads to crystal formation/struvite stone formation, this then obstructs flow by providing a matrix (for organisms to form biofilms)
51
What are biofilms
Highly motile, producing fimbria for attachment Making it hard for antibiotics to penetrate biofilms and
52
What is staphylococcus saprophytic in UTIs
it is coagulate -ve typically associated with younger, sexually active females, but most common is still E. coli 1-5% of cystitis
53
How did staphylococcus saprophytic in UTIs used to be detected
using resistance to novobiocin
54
What is the effect of nosocomial UTIs
Health care associated infection, especially due to catheters, decreased the amount of E. coli but still is most prevalent bacteria
55
How is a UTI tested rapidly in office
urinalysis by dipstick testing
56
How does a urinalysis by dipstick testing work
It is primarily interested in the detection of nitrites and leukocytes produced by infection Detection of nitrites is reasonably sensitive for gram-negative bacteria but highly specific (nitrites = gram negative bacteria is present. Nitrate--> Nitrate = gram negative ) Detection of leukocytes (white blood cells) is sensitive but not specific
57
Red blood cells in a urinalysis by dipstick testing
Red blood cell detection is not sensitive or specific
58
What is a semi-quantitative culture
Urine culture
59
What is a significant bacteriuria defined as
105 bacteria/mL (10^8 / L)
60
What are the two types of agar used for urine cultures
SBA/ MacConkey agar / Chromongenic agars
61
When might there be lower numbers in urine cultures
in children and in catheter collected specimens which may either be significant or due to contamination
62
What is the most common type of specimen collection of urine/UTI
Clean catch mid stream specimens
63
How does the clean catch mid stream specimens method of urine collection work
works by cleaning the urethra prior to collection, first void urine allowed to pass urethra to clear urethra of contaminated material as the end of the urethra is not sterile The midstream is collected in sterile container
64
Who are collection bags most commonly used for
Children that lack bladder control But are often contaminated, so most meaningful result is a negative culture
65
What are indewlling catheters used for
As a urine collection method Urine obatined by inserting needle into catheter or through diaphragm Preferable to obtain specimen from new catheter rather than old Cather
66
What is supriapubic aspiration/straight catheters used
Urine collection method It is quite invasive as the specimen is obtained directly from the bladder Risk of contamination
67
How is urine transported
sent and processed by lab as quickly as possible When transnsporting it you need to write the method or collection (because different cut offs) and the time/date of collection
68
Urine specimens not received by the lab in ____ hours must ____
1-2 be refrigerated
69
Urine not received within _____ or not _____ will be rejected by the lab due to ____ unless transported in a ___
24 hours refrigerated Contaminated bacteria can grow and lead to false positives Boric acid tube
70
Should all patients with a suspected UTI be cultured
no
71
What is empiric therapy for UTIs
based on most probable pathogens Lower vs upper tract infection Local rates of resistance Acute infection vs relapse/re-infection
72
What treatment is used for uncomplicated cystitis typically
Nitrofurantoin Fosfomycin
73
What is used to treat pyelonephritis
b-lactam + aminoglycoside or ciprofloxacin/levofloxain
74
What other type of treatment is used for complicated infections
parenteral therapy and longer course of therapy up to 6 weeks

Microbiology Midterm 2 (15 decks)

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