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Case 10: Urinary System > Medical Microbiology: UTI > Flashcards

Medical Microbiology: UTI Flashcards

1
Q

What forms part of the upper UT

A

Kidneys & ureters

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2
Q

What forms part of the lower UT

A

Bladder & urethra

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3
Q

What is the cause of cystitis

A

STI & UTI

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4
Q

What is the appearance of cystitis

A

Inflammation of bladder mucosa & urethra

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5
Q

What is the 4 symptoms of cystitis

A

Frequency
Urgency
Dysuria
Suprapubic pain

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6
Q

What is pyelonephritis

A

Acute kidney infection

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7
Q

What is the 6 symptoms of pyelonephritis

A

Fever
Flank pain/tenderness
N/V
Dysuria
Urgency
Frequency

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8
Q

What is uncomplicated UTI

A

Infection w/o comorbidities & structurally & functionally normal UT

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9
Q

What is complicated UTI

A

Predisposing factors to infection like structural or functional abnormalities or comorbidities

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10
Q

What is the 2 routs of infection

A
  1. Ascending route
  2. Haematogenous route
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11
Q

What is the pathogenesis of ascending route infection

A
  1. Bacteria of GIT colonize in peri-urethral area & disseminate to bladder
  2. Bacteria colonize & invade the bladder w/ pili & adherents (in catheter fibrinogen accumulation)
  3. Neutrophils infiltrate
  4. Some bacteria evade immune system & form biofilms
  5. Bacteria secrets toxins, enzymes & proteins that damage epithelial cells & ascend to kidneys causing pyelonephritis
  6. Colonize in kidney & bacteria release damaging substances
  7. If crooks tubular epithelium it can cause bacteraemia
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12
Q

What is the haematogenous route

A

Blood borne organisms can infect the renal parenchyma

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13
Q

What is the 4 micro-organism causing haematogeous infection

A

S. Aureus
Candida
MTB
Salmonella Typhi

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14
Q

What is the 4 bacteria virulence factors

A
  1. Adhesins: for adherence & colonize in UT
  2. Capsule: protect from phagocytosis
  3. Flagella: motility & ascension in ureters
  4. Bacterial enzymes, toxins & protein:
    Hemolysins, cytotoxic & proteases damage host cells
    Aerobactin bind to iron
    Urease breaks down urea & increase pH causing crystal & stone formation
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15
Q

What is the 5 populations predisposed to UTI & why

A
  1. Female due to short urethra & close to GIT
  2. Increased number of pathogens due to poor hygiene & sexual intercourse
  3. Obstruction due to physical or neurological deficits
  4. Co-morbidities like DM & immunocompromised
  5. Foreign bodies & instrumentation like catheter or surgery
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16
Q

What is the 2 natural host defense mechanisms & functions

A
  1. Physical
    Presence of vesicles-urethral valve
    Peristalsis of ureters
    Urine flow
  2. Chemical
    Acidic pH due to high urea content
    Secretion of bactericidal peptides like defensins & IgA
    Inflammatory response to bacteria
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17
Q

What is the correct urine to take as urine samples

A

Mid stream urine

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18
Q

What is the procedure to take urine

A
  1. Clean peri-urethral area & perineum from front to back w/ soap & then wipe w/ sterile gauze
  2. Hold labia apart, void & dischard the first 2-5 ml
  3. Continue w/ urination & remove before last bit of urine
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19
Q

What extra part must be cleaned w/ male when taking a urine sample

A

Urethral meatus

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20
Q

What is the 4 things looked at in a urine dipstick analysis

A
  1. Nitrite
  2. Leukocytes
  3. Protein
  4. Blood
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21
Q

What does the presence of nitrites indicate in urine & how to test

A

Bacteria infections & needs to be in urine for 4 hours otherwise a false negative
False + if testing of sample delayed

22
Q

What does the presence of leucocytes in the urine indicate

A

Presence of white blood cells

23
Q

When is leucocytes present in urine

A

Due to UTI or trauma like a renal stone or catheter

24
Q

How to take urine sample for lab testing

A

Before antimicrobial therapy & refrigerate if not tested w/i 2 hrs

25
Q

Who is the 4 patients in which U-MCS is done in

A
  1. Complicated/recurrent UTI
  2. Hospitalized patients
  3. Pregnant women w/ UTI symptoms or abnormal dipstick
  4. Undergoing urological instrumentation/surgery
26
Q

What is the 2 types of catheter specimen of urine

A
  1. Collected from catheter in patient w/ catheter
  2. In & out catheter for urine collection
27
Q

What is the risk w/ in & out catheter

A

Possibility of introducing bacteria of urethra into bladder causing infection
But should be aseptic procedure

28
Q

What is suprapubic aspiration

A

Use needle & syringe directly into abdominal wall

29
Q

What is a urine bag specimen

A

Used in infants
Place plastic bags stuck to perineum after area is washed

30
Q

Why is a urine bag specimen not ideal

A

Contaminated w/ perineal & GIT flora

31
Q

What is a cystoscope/nephrostomy specimen

A

Done by urologist for patient w/ abnormal drainage systems in theater

32
Q

What 3 things are looked for in the microscope w/ urine

A
  1. Epithelial cells
  2. Leucocytes
  3. Blood
33
Q

What does the presence of epithelial cells in urine sample indicate

A

Poor sample as epithelial cells of distal urethra or external genitalia is present
Complicating interpretation as bacteria binds to cells

34
Q

What does the presence of leucocytes indicate

A

Inflammatory response

35
Q

What is sterile pyuria

A

Presence of leucocytes but culture - due to antibiotic use before sample taken

36
Q

How is blood observed in the urine

A

Microscopic & macroscopic

37
Q

What is 3 causes of haematuria

A

UTI
Stones
Neoplasms

38
Q

How is urine culture taken

A

Inoculated onto culture plates, incubated & examined after 24-48hrs

39
Q

What is the 2 types of growth in urine culture

A
  1. Pure growth presence of 1 organism
  2. Mixed growth presence of more than 1 organism
40
Q

What is asymptomatic bacteriuria

A

Significant amount of bacteria in urine w/o signs or symptoms of UTI

41
Q

When is urine test done in children

A

Part of sepsis work up & results are correlated w/ symptoms & treated appropriately

42
Q

Who undergoes screening of urine

A
  1. Pregnancy as it increases risk of adverse pregnancy outcomes & pyelonephritis
  2. Undergo invasive procedures or surgery
43
Q

What is the 2 management categories of UTI

A
  1. General hydration, manage comorbidities, obstruction or structural abnormalities treated, removal or replacement of urine catheters
  2. Antibiotics empirical or directed (narrowest spectrum)
44
Q

What is the 3 categories that determine choice & duration of antibiotics

A
  1. Cystitis vs pyelonephritis
  2. Complicated vs uncomplicated
  3. CA vs HA infection
45
Q

What is the treatment for HA infections

A

Broad spectrum antibiotics

46
Q

What is the 3 treatments for uncomplicated community acquired cystitis

A
  1. Gentamicin 5mg/kg IM single dose (not in pregnancy or kidney disease)
  2. Nitrofurantoin 100mg PO 6 hourly for 5-7 days
  3. Fosfomycin 3g PO single dose
47
Q

What is the 2 treatments for complicated community acquired cystitis

A

Adults: Ciprofloxacin 500 mg PO 12 hourly for 7 days
Children: Amoxicillin clavulanic acid 15-25mg/kg/dose of amoxicillin component 8 hourly for 7 days

48
Q

What is the 2 treatments for community acquired acute pyelonephritis

A
  1. General measures
  2. Antibiotics
49
Q

What is the type of antibiotic used in community acquired acute pyelonephritis

A

Systemic antibiotics (IV) the oral when tolerated for 7-14 days

50
Q

What is the 3 empiric antibiotics given for community acquired acute pyelonephritis

A
  1. Ceftriaxone 1g daily for 10-14days
  2. Ciprofloxacin 500mg 12 holy for 7-10 days
  3. Gentamicin 6mg/kg/day for 10-14 days
51
Q

What is the treatment for children w/ community acquired acute pyelonephritis

A

Ceftriaxone or cefotaxime

52
Q

What is the treatment for children w/ community acquired acute pyelonephritis

A

Ceftriaxone or cefotaxime

Case 10: Urinary System (9 decks)

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