(MHD) Lecture 18- UTI

Question 1

Name the (2) key adhesins associated with UTI pathogenesis. What receptors do they bind to? What parts of the urinary tract?

Answer 1

1. Type 1 Fim H: Mannose Sensitive
   
   • Receptor: D-mannose on many epithelial cells
   • Site: Bladder and lower tract
2. PAP-P fimbrae
   
   • Receptor: P Blood group antigens– digalacoside on RBC and urothelium
   • Site: Renal pelvis of kidney

Question 2

Signs/Symptoms of Prostatitis

How often is the prostatitis nonbacterial?

Answer 2

• Perineal/lower back pain
• Tender Prostate
• Mild-Major dysuria

90% is nonbacterial prostatitis

Question 3

In what UTI types are blood cultures positive? (2)

Answer 3

1. Acute Pyelonephritis
2. Prostatitis

Question 4

What are your basic steps when treating acute pyelonephritis?

What is it imperative to always do?

Answer 4

1. Put patient on antibiotic
2. ALWAYS DO UA!!!
3. Adjust therapy based on culture (stronger meds if needed)

Question 5

Acute Cystitis- Typical Presentation:

Antimicrobial regimen? (4)

Answer 5

• Nitrofurantoin- 5 days
• Bactrim (Trimethoprim/sulfamethoxazole)- 3 days
• Fluoroquinolone- 3 days
• Fosfomycin- single dose

Question 6

Treatment of pyelonephritis

uncomplicated?

septic shock?

Answer 6

• Uncomplicated: Fluoro, Cephalosporin or Bactrium
• Septic: Ceftazimide + gentamicine

Question 7

Treatment of complicated UTI:

First time patient with obstruction?

Parplegic patient with catheter?

Answer 7

1. Ceftriaxone/Ciprofloxacin
2. Zosyn + Tobramycin