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Renal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

The presence of micro-organisms in the urinary tract that are causing clinical infection

A

UTI

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2
Q

Lower UTI

A

infection confined to the bladder (cystitis)

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3
Q

Upper UTI

A

Kidneys +/- ureters

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4
Q

Complicated UTI

A

UTI complicated by systemic sepsis or urinary structural abnormality or stones

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5
Q

Bacteruria and antibiotics?

A

Doesn’t always require antibiotics

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6
Q

Normal bacteria found in the lower end of the urethra?

A

Coliforms and enterococci

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7
Q

Gram negative bacillus but not a coliform

Associated with catheters and UT instrumentation

A

Pseudomonas aureginose

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8
Q

Antibiotic that can be used to treat pseudomonas aeruginosa?

A

Ciprofloxacin

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9
Q

CSU

A

Catheter specimen urine

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10
Q

Which container should you use for urine?

A

Boricon container

red top and contains boric acid to stop bacteria from multiplying

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11
Q

White top container?

A

Sterile universal container

-must reach lab within 2 hours of collection and so not used that routinely

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12
Q

What does leukocyte esterase indicate?

A

Indicates the presence of leukocytes (WBC) in the urine

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13
Q

Nitrites in the urine?

A

Nitrites indicate the presence of bacteria in the urine

Some bacteria can reduce nitrates to nitrites – mainly coliforms – Enterococcus spp. do NOT give positive test

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14
Q

Which bacteria can reduce nitrites to nitrates and therefore give a negative nitrite test?

A

Mainly coliforms - enterococcus

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15
Q

Significance of ESBL?

A

Extended - spectrum beta-lactamse

-Makes bacteria resistant to ALL cephalopsorins and to almost all penicillins

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16
Q

ESBL makes bacteria resistant to what?

A

All cephalosporins and almost all penicillins

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17
Q

Antibiotics that may be useful ofr antibiotic resistant ESBL-producing bacteria

A

Nitrofurantoin (oral), pivmecillinam (oral) fosfomycin (oral), temocillin (IV), meropenem(IV), ertapenem (IV)

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18
Q

To whom do Kass’s criteria apply to?

A

Women of child bearing age

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19
Q

Where do they think ESBL-producing bacteria might come from?

A

Chickens, lol

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20
Q

CPE

A

Carbapenemase-producing Enterobacteriaceae

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21
Q

Which gram negative (coliform) bacilli are resistant to meopenem?

A

CPE

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22
Q

Some strains are associated with travel to the Indian sub-continent

A

CPE

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23
Q

How many days usually needed to treat uncomplicated lower UTI in women?

A

3 day course

24
Q

1st line antibiotics for UTI?

A

Amoxicillin
Trimethoprim
Nitrofurantoin
Gentamicin

25
Q

2nd line antibiotics for UTI?

A 
Pivmecillinam
Temocillin
Cefalexin
Co-amoxiclav
Ciprofloxacin
26
Q

Is amoxicillin safe in pregnancy?

A

Yes

27
Q

Antibiotic that could treat Enterococcus faecalis and some coliforms?

A

Amoxicillin

28
Q

How does trimethoprim work?

A

Inhibits folic acid synthesis

29
Q

Trimethoprim is usually given oral, how would you give it IV?

A

Co-trimoxazole

30
Q

Risk of what from sulphonamide?

A

Stevens-Johnson syndrome

31
Q

What is Stevens-Johnson syndrome?

A

Its a form of toxic epidermal necrolysis

32
Q

Range of organisms treated by trimethoprim?

A

Most coliforms, including staph aureus but not psuedomonas

33
Q

Which type of UTI is Nitrofurantoin used in?

A

Nitrofurantoin only useful in lower uncomplicated UTIs as only reaches effective concentrations in bladder urine

34
Q

When should you avoid Nitrofurantoin in pregnancy?

A

Avoid in late pregnancy (can cause neonatal haemolysis), breast feeding and children <3 months old

35
Q

Why should you avoid nitrofurantoin in late pregnancy?

A

Can cause neonatal jaundice

36
Q

How many days can you prescribe gentamicin for?

A

Can only prescribe for 3 days

37
Q

Gentamicin and pregnancy?

A

AVOID!

38
Q

Gentamicin will not treat what?

A

Enterococcus

39
Q

Dosage and measuring gentamicin?

A

Given once daily – 7mg/kg (ideal body weight) then measure a blood level 6-14 hours later.

40
Q

Side effects of gentamicin?

A

Renal and VIIIth nerve damage

41
Q

Pivemecillinam uses and pregnancy

A

Good for ESBL bacteria

Not recommended in pregnancy

42
Q

When might you use Temocillin?

A

Useful for treating complicated UTI/urosepsis in patients whose renal function is too poor for gentamicin, but is NOT as effective as gentamicin clinically
NO activity against Staphs/Streps/Enterococci or Pseudomonas sp.

43
Q

Is cefalexin safe in pregnancy?

A

Yes

44
Q

Why might you not give cefalexin?

A

It is a cephalosporin –> risk of C. difficile infection

Cefalexin is a broad spectrum and not really used unless organism is amoxicillin and trimethoprim resistant

45
Q

Inhibits bacterial DNA gyrase, which prevents “supercoiling” of bacteria

A

Ciprofloxacin

46
Q

Only oral antibiotic used to treat Pseudomonas?

A

Ciprofloxacin

47
Q

Empirical treatment for Female lower UTI

A

Trimethoprim or nitrofurantoin orally (3 days)

48
Q

Empirical treatment for Uncatheterised male UTI

A

Trimethoprim or nitrofurantoin orally (7 days)

49
Q

Empirical treatment for Complicated UTI or pyelonephritis (GP)

A

Co-amoxiclav or co-trimoxazole (14 days)

50
Q

Empirical treatment for Complicated UTI or pyelonephritis (Hospital)

A

Amoxicillin and gentamicin IV for 3 days (cotrimoxazole and gentamicin if penicillin allergy), stepdown as guided by antibiotic sensitivities

51
Q

Asymptomatic bacteruria in pregnancy?

A
  • All women screened at 1st antenatal visit
  • Usually treated with antibiotics in pregnancy

(if left untreated:

  • 20-30% progress to pyelonephritis
  • May lead to intra-uterine growth retardation or premature labour)
52
Q

Pregnancy risks associated with asymptomatic bacteruria?

A

20-30% progress to pyelonephritis

May lead to intra-uterine growth retardation (IUGR) or premature labour

53
Q

Abacterial cystitis/urethral syndrome?

A

Patient has symptoms of UTI
Pus cells present in urine, but no significant growth on culture
May be an early phase of UTI
May be due to urethral trauma - “honeymoon cystitis”
May be due to urethritis caused by chlamydia, gonorrhoea
Alkalinising the urine may help (symptomatic relief)

54
Q

Gram negative bacillus but not a coliform
Associated with catheters and UT instrumentation
resistant to most oral antibiotics except ciprofloxacin

A

Psuedomonas aeruginosa

55
Q

Staphylococcus saphrophyticus is associated with who?

A

Women of child bearing age

Its a type of coagulase negative staph

56
Q

Associated with the formation of stones (calculi)
Foul smelling
Produces urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts

A

Proteus

Renal (44 decks)

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