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ABBEY MSII Unit 5 > Micro UTI > Flashcards

Micro UTI Flashcards

1
Q

e coli bacteriology

A

gram - rod, facultative, lactose fermenter, indole positive, H2S negative, urease negative

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2
Q

MCC uncomplicated UTI

A

uropathogenic e coli (autoinoculates from GI)

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3
Q

how do e coli become pathogenic

A

virulence factors on plasmids (normal GI flora otherwise)

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4
Q

what do uropathogenic strains of e coli have?

A

P fimbriae aka type 1 fimbriae virulence factor

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5
Q

leading cause of nosocomial bacteremia?

A

e coli

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6
Q

diagnosis of e coli UTI

A

urinalysis: dipstick (+ nitrates because bacteria are reducing nitrates, + leukocyte esterase because PMNs are present)
microscopy: RBC = hematuria; WBC = pyuria, WBC casts = upper tract infection

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7
Q

e coli treatment

A

cystitis: trimethoprim-sulfamethoxazole or fluoroquinolone

polynephritis or sepsis: fluoroquinolone, third generation cephalosporin for longer course

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8
Q

e coli prevention

A

nosocomial: prompt removal/switching of catheters
recurring: cranberry juice (tannins reduce fimbrae binding)

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9
Q

how is a UTI defined?

A

dysuria, frequency, and urgency with >10^5 organisms/mL by semiquantitative urine culture (use a loop)

> 50,000 for pediatric

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10
Q

list the bacteria that cause UTIs

A 
e coli (MC)
klebsiella/enterobacter/serratia
proteus, providencia, morganella
enterococcus species
STIs
pseudomonas aeruginosa
staph saprophyticus
strep B
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11
Q

klebsiella/enterobacter/serratia bacteriology

A

enterobacteriaceae (less pathogenic than e coli)

  • gram -
  • normal flora
  • men, neonates, elderly highest risk
  • Ab resistance a major problem
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12
Q

which bacteria is MC in people with urinary tract procedures/catherization UTI

A

klebsiella/enterobacter/serratia

e coli MC in previously-healthy

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13
Q

when is klebsiella pneumoniae most likely to cause UTI

A

usually with predisposing condition like old, chronic respiratory disease, diabetes, alcoholism

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14
Q

klebsiella pneumoniae virulence factor

A

1- large polysaccharide capsule defends against phagocytosis, complement
2- adhesins adhere to gut cells
3- siderophores chelate iron

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15
Q

MC nosocomial outbreak bacteria

A
  1. e coli

2. klebsiella pneumonia

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16
Q

when is enterobacter most likely to cause UTI

A

nosocomial, ICU bugs

-opportunistic, rarely causes disease in previously healthy

17
Q

enterobacter virulence factor

A

exotoxin (cytolysin)

18
Q

serratia marcenscens most likely to cause infections

A

opportunistic nosocomial pathogen

-endocarditis and osteomyelitis in IV drug users

19
Q

klebsiella/enterobacter/serratia diagnosis

A

culture and gram stain

  • k. pneumoniae polysaccharide capsule gives mucoid appearance
  • s. marcescens forms red-pigmented colonies
20
Q

treatment for klebsiella/enterobacter/serratia

A

begin with sensitivity testing - NO cephalosporin for enterobacter
-usually begin with aminoglycoside then cephalosporin

21
Q

Proteus/Providencia/Morganella bacteriology

A
  • enterobacteriaceae
  • gram -
  • produce PHENYALANINE DEAMINASE and UREASE
  • NOT lactose fermenters
  • produce H2S
  • proteus “swarm”
22
Q

when does Proteus/Providencia/Morganella cause infection

A

opportunistic nosocomial infections - all normal flora gone bad

23
Q

Proteus/Providencia/Morganella virulence factors

A
  • fimbriae attachment
  • urease production raises pH or urine leading to struvite (ammonium magnesium phosphate) stones which then cause abrasion/inflammation and harbor more bacteria
24
Q

Proteus/Providencia/Morganella differences

A
  • morganella: rarest and causes lots of other things
  • proteus: can also cause pneumonia or wound infection
  • providencia: may cause gastroenteritis
25
Q

Proteus/Providencia/Morganella diagnosis

A
  • UTI, flank pain with
  • history of recent beta-lactam Ab therapy (enriches body for this group)
  • general and semiquantitative urine culture
26
Q

Proteus/Providencia/Morganella treatment

A

most sensitive to aminoglycosides

-make sure to change catheters

27
Q

enterococcus bacteriology

A
  • facultative anaerobes
  • grow in high salt
  • catalase -
  • gram +
  • normal GI flora
  • NOT enterobacteriaceae
28
Q

how is enterococcus differentiated from strep?

A

resistance to penicillin

29
Q

enterococcus diagnosis

A
  • physical signs specific to site
  • echo for endocarditis
  • abdominal CT or US for abscess or bowel injury
  • samples before empiric antibiotics
30
Q

enterococcus treatment

A

antibiotic treatment may NOT be necessary

-switch out IVs, cathetics, replacement of prosthetics, drain abscesses

31
Q

pediatric UTI

A

tnederness in lower abdomen with inadequate urine flow

32
Q

difference between enterobacteriaceae and enterococcus

A

enterobacteriaceae: gram - rods that are promiscuous to incorporating foreign DNA (virulence factors and antibiotic resistance)
enterococcus: gram +
- BOTH: facltative anaerobes

33
Q

what are the enterobacteriaceae?

A 
e coli
shigella
salmonella
klebsiella/enterobacter/serratia
proteus/providencia/morganella
34
Q

Klebsiella/enterobacter/serratia differences

A

klebsiella: hemorrhagic pneumonia in alcoholic men
enterobacter: panresistance
serratia: endocarditis in heroin addicts

35
Q

cystitis vs polynephritis

A

cystitis: uncomplicated UTI - treat with sulfa or fluoroquinolone
polynephritis: kidney infection - third generation or combined drugs and antibiotic sensitivity testing

36
Q

when should home remedies be use?

A

recurrent infection - patient can tell when one is coming, use home remedy before antibiotics would be indicated - always present to MD if symptoms worsen

ABBEY MSII Unit 5 (8 decks)

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