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Microbiology Midterm 2 > Lecture 14: UTIs > Flashcards

Lecture 14: UTIs Flashcards

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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
Q

What is prostatitis

A

inflammation/inflammation of the prostate gland

may be acute or chronic

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26
Q

What is infrarenal abscess

A

Collection of pus in the kidney or in the soft tissue surrounding the kidney

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27
Q

What is another name for infrarenal abscesses

A

perinephric abscesses

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28
Q

Who is most likely to get an uncomplicated UTI

A

young non-pregnant women with normal genitourinary tract

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29
Q

Who is most likely to get a complicated UTI

A

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)

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30
Q

What is a complicated infection in UTIs

A

Underlying abnormality that predisposes patient to UTI or makes UTI more difficult to treat effectively

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31
Q

What are the two types of recurrent UTI infections

A

Relapse

Re-infection

32
Q

Relapse in UTI

A

Recurrent of infection by the SAME organism after discontinuation of treatment

33
Q

Re-infection in UTI

A

Recurrent of infection by a DIFFERENT organism after discontinuation of treatment

34
Q

Why is it important to know if a patient is having a relapse or re-infection with UTIs

A

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
Q

What is a pathogenesis

A

UTI usually due to patients own intestinal flora

Ascending (increasing) route of infection

36
Q

How does pathogenesis occur

A

Its a type of UTI
Organisms enter the urniary tract in a retrograded (swim up) fashion via the urethra

37
Q

What are complicated factors in pathogenesis

A

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
Q

How does aging affect UTIs

A

Agging increases the likelihood of getting a UTI because..

Increased diabetes mellitus
Increased risk or urinary stasis
Impaired immune response
Incontienence

38
Q

How does aging affect UTIs

A

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
Q

Why are female likely to get UTIs

A

short urethra

Sexual intercourse

Contraceptives that alter the normal bacteria flora

Pregnancy (alters anatomy)

40
Q

What type of Urinary tract obstructions make you more likely to get an UTI

A

tumor or calculi (kidney stones)

Strictures (narrowing in the intestines)

41
Q

Why are males likely to get UTIs

A

prostatic hypertrophy (enlargement of the prostate gland) and anal intercourse

42
Q

What the risk factors associated with UTIs

A

Aging

Female

Male

Urinary tract obstruction

Impaired bladder innervation

Hematogenous spread (through blood)

43
Q

The majority of UTIs are ____microbial

A

mono

due to a single pathogen

44
Q

What bacteria is responsible for 90% of UTIs

A

Enterobacteriaceae (family)

with Escherichia coli (E coli) being in this family and being the most commonly isolated pathogen in all UTIs

45
Q

What is the structure of enterobacteriaceae

A

Gram negative bacilli
Facultatively anaerobia
Common intestinal flora

46
Q

What are uro-pathgens

A

Basically the same as virulence factors that allow them to colonize and infect the urinary tract

47
Q

What is the most important uro-pathogen in E. coli and how does it work

A

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
Q

What are uro-pathogens in E. coli

A

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
Q

What are the classical UTI pathogens

A

Proteus

Morganella

Providencia

50
Q

What is important about classical UTIs

A

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
Q

What are biofilms

A

Highly motile, producing fimbria for attachment

Making it hard for antibiotics to penetrate biofilms and

52
Q

What is staphylococcus saprophytic in UTIs

A

it is coagulate -ve

typically associated with younger, sexually active females, but most common is still E. coli

1-5% of cystitis

53
Q

How did staphylococcus saprophytic in UTIs used to be detected

A

using resistance to novobiocin

54
Q

What is the effect of nosocomial UTIs

A

Health care associated infection, especially due to catheters, decreased the amount of E. coli but still is most prevalent bacteria

55
Q

How is a UTI tested rapidly in office

A

urinalysis by dipstick testing

56
Q

How does a urinalysis by dipstick testing work

A

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
Q

Red blood cells in a urinalysis by dipstick testing

A

Red blood cell detection is not sensitive or specific

58
Q

What is a semi-quantitative culture

A

Urine culture

59
Q

What is a significant bacteriuria defined as

A

105 bacteria/mL (10^8 / L)

60
Q

What are the two types of agar used for urine cultures

A

SBA/ MacConkey agar / Chromongenic agars

61
Q

When might there be lower numbers in urine cultures

A

in children and in catheter collected specimens which may either be significant or due to contamination

62
Q

What is the most common type of specimen collection of urine/UTI

A

Clean catch mid stream specimens

63
Q

How does the clean catch mid stream specimens method of urine collection work

A

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
Q

Who are collection bags most commonly used for

A

Children that lack bladder control

But are often contaminated, so most meaningful result is a negative culture

65
Q

What are indewlling catheters used for

A

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
Q

What is supriapubic aspiration/straight catheters used

A

Urine collection method

It is quite invasive as the specimen is obtained directly from the bladder

Risk of contamination

67
Q

How is urine transported

A

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
Q

Urine specimens not received by the lab in ____ hours must ____

A

1-2

be refrigerated

69
Q

Urine not received within _____ or not _____ will be rejected by the lab due to ____

unless transported in a ___

A

24 hours

refrigerated

Contaminated bacteria can grow and lead to false positives

Boric acid tube

70
Q

Should all patients with a suspected UTI be cultured

A

no

71
Q

What is empiric therapy for UTIs

A

based on most probable pathogens

Lower vs upper tract infection

Local rates of resistance

Acute infection vs relapse/re-infection

72
Q

What treatment is used for uncomplicated cystitis typically

A

Nitrofurantoin
Fosfomycin

73
Q

What is used to treat pyelonephritis

A

b-lactam + aminoglycoside or ciprofloxacin/levofloxain

74
Q

What other type of treatment is used for complicated infections

A

parenteral therapy and longer course of therapy up to 6 weeks

Microbiology Midterm 2 (15 decks)

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