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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
2nd line antibiotics for UTI?
``` Pivmecillinam Temocillin Cefalexin Co-amoxiclav Ciprofloxacin ```
26
Is amoxicillin safe in pregnancy?
Yes
27
Antibiotic that could treat Enterococcus faecalis and some coliforms?
Amoxicillin
28
How does trimethoprim work?
Inhibits folic acid synthesis
29
Trimethoprim is usually given oral, how would you give it IV?
Co-trimoxazole
30
Risk of what from sulphonamide?
Stevens-Johnson syndrome
31
What is Stevens-Johnson syndrome?
Its a form of toxic epidermal necrolysis
32
Range of organisms treated by trimethoprim?
Most coliforms, including staph aureus but not psuedomonas
33
Which type of UTI is Nitrofurantoin used in?
Nitrofurantoin only useful in lower uncomplicated UTIs as only reaches effective concentrations in bladder urine
34
When should you avoid Nitrofurantoin in pregnancy?
Avoid in late pregnancy (can cause neonatal haemolysis), breast feeding and children <3 months old
35
Why should you avoid nitrofurantoin in late pregnancy?
Can cause neonatal jaundice
36
How many days can you prescribe gentamicin for?
Can only prescribe for 3 days
37
Gentamicin and pregnancy?
AVOID!
38
Gentamicin will not treat what?
Enterococcus
39
Dosage and measuring gentamicin?
Given once daily – 7mg/kg (ideal body weight) then measure a blood level 6-14 hours later.
40
Side effects of gentamicin?
Renal and VIIIth nerve damage
41
Pivemecillinam uses and pregnancy
Good for ESBL bacteria | Not recommended in pregnancy
42
When might you use Temocillin?
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
Is cefalexin safe in pregnancy?
Yes
44
Why might you not give cefalexin?
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
Inhibits bacterial DNA gyrase, which prevents "supercoiling" of bacteria
Ciprofloxacin
46
Only oral antibiotic used to treat Pseudomonas?
Ciprofloxacin
47
Empirical treatment for Female lower UTI
Trimethoprim or nitrofurantoin orally (3 days)
48
Empirical treatment for Uncatheterised male UTI
Trimethoprim or nitrofurantoin orally (7 days)
49
Empirical treatment for Complicated UTI or pyelonephritis (GP)
Co-amoxiclav or co-trimoxazole (14 days)
50
Empirical treatment for Complicated UTI or pyelonephritis (Hospital)
Amoxicillin and gentamicin IV for 3 days (cotrimoxazole and gentamicin if penicillin allergy), stepdown as guided by antibiotic sensitivities
51
Asymptomatic bacteruria in pregnancy?
- 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
Pregnancy risks associated with asymptomatic bacteruria?
20-30% progress to pyelonephritis | May lead to intra-uterine growth retardation (IUGR) or premature labour
53
Abacterial cystitis/urethral syndrome?
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
Gram negative bacillus but not a coliform Associated with catheters and UT instrumentation resistant to most oral antibiotics except ciprofloxacin
Psuedomonas aeruginosa
55
Staphylococcus saphrophyticus is associated with who?
Women of child bearing age | Its a type of coagulase negative staph
56
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
Proteus

Renal (44 decks)

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