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Renal and urology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Where are bacteria found in the normal urinary tract?

A

Kidneys, ureter and bladder - sterile

Urine colonised at lower urethra

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2
Q

What is the definition of a urinary tract infection?

A

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

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3
Q

What is the definition of a complicated UTI?

A

UTI complicated by systemic sepsis or urinary structural abnormality or stones

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4
Q

What is cystitis?

A

Inflammation of the bladder

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5
Q

What factors increase the risk of developing UTI?

A

Female

Catheterised patient

Patients with abnormalities of the urinary tract

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6
Q

What are the two routes of infection for UTI?

A

Ascending infection (from urethra towards kidneys)

Bloodstream

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7
Q

Which bacteria is associated with UTI and development of stones?

A

Proteus sp. (coliform)

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8
Q

What are the causal organisms of UTI?

A

E. Coli

Klebsiella sp.

Enterobacter sp.

Enterococcus

Proteus sp. and other coliforms

Staphlycoccus

Pseudomonas aueruginosa

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9
Q

Why is proteus sp associated with formation of stones?

A

Produces urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts and foul smelling urine

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10
Q

Which bacteria usually causes UTI in women of child bearing age?

A

Staphylococcus saphrophyticus: a type of coagulase negative staph.

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11
Q

What is the difficulty in prescribing oral antibiotics to treat UTI with pseudomonas aeruginosa?

A

Resistant to most oral antibiotic except ciprofloxacin which can cause C. difficile infection

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12
Q

What bacteria is associated with UTI in catheterized patients and those with UT instrumentation?

A

Pseudomonas aeruginosa

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13
Q

What are the symptoms of UTI?

A

Dysuria

Frequency

Nocturia

Haematuria

Fever

Rigors

Loin pain

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14
Q

Which symptoms imply upper UTI?

A

Loin pain

Fever

Rigors

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15
Q

Why is it important to get a mid stream sample of urine from a patient with suspected UTI?

A

First passed urine will be contaminated with organisms from urethra

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16
Q

What is the advantage of using a red lidded container to transport urine specimen to the lab?

A

Boric acid topped will keep urine sterile for up to 24 hours i.e. will not allow bacterial overgrowth

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17
Q

Which substance indicates the presence of leukocytes/white blood cells in the urine?

A

Leukocyte esterase

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18
Q

What does the presence of nitrites in the urine indicate?

A

Presence of bacteria in the urine

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19
Q

Which bacteria do not test positive for nitrites in urine?

A

Enterococcus spp.

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20
Q

Why might culture of urine be done?

A

To test for significance of bacterial growth in urine

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21
Q

What on urine culture would indicate significant bacterial growth?

A

>300 colonies present

>10^5 organism/ml present

22
Q

Is a mixed growth i.e. two or more organisms with >10^5 organisms per ml significant?

A

Probably not

23
Q

What is the significance of an ESBL-producing bacteria?

A

ESBL = extended spectrum beta-lactamase

Makes bacteria resistant to ALL cephalosporins and to almost all penicillins

24
Q

Which antibiotics may be useful against ESBL-producing bacteria?

A

Nitrofurantoin (oral)

Pivmecillinam (oral)

Fosfomycin (oral)

Temocillin (IV)

Meropenem (IV)

Ertapenem (IV)

25
Q

What is carbapenemase-producing enterobacteriaceae (CPE)?

A

Gram negative (coliform) bacilli that are resistant to meropenem - this usually means that they are effectively resistant to ALL current antibiotics

26
Q

What length of course is usually sufficient to treat an uncomplicated lower UTI in women?

A

3 days

27
Q

What first line antibiotics are used for UTI?

A

Amoxicillin (IV, oral)
Trimethoprim (oral, but can be given IV as cotrimoxazole)
Nitrofurantoin (oral)
Gentamicin (IV)

28
Q

What are the second line antibiotics for UTI?

A

Pivmecillinam (oral)

Temocillin (IV)

Cefalexin (oral)

Co-amoxiclav (IV, oral)

Ciprofloxacin (IV, oral)

29
Q

What UTI organisms does amoxicillin treat?

A

Enterococcus faecalis

Some coliforms, but >50% E. coli now resistant, and many other coliforms also resistant

30
Q

When should use of trimethoprim be avoided?

A

1st trimester of pregnancy

31
Q

What is co-trimoxazole?

A

A combination of sulphamethoxazole and trimethoprim

32
Q

What UTI organisms does trimethoprim have effect against?

A

Most coliforms

Staph aureus incl. MRSA

NOT Pseudomonas sp.

33
Q

Why is nitrofurantoin only useful in uncomplicated lower UTI?

A

Only reaches effective concentrations in bladder urine

34
Q

When should use of nitrofurantoin be avoided and why?

A

Late pregnancy, can cause neonatal haemolysis

Breast feeding

Children <3 months old

35
Q

What organisms does nitrofurantoin have effect against?

A

Most coliforms

Enterococci

Staph aureus incl MRSA

NOT proteus sp and pseudomonas sp

36
Q

What organisms does gentamicin have effect against?

A

Most coliforms

Pseudomonas sp

Staph aureus incl MRSA

NOT enterococci

37
Q

When is gentamicin use in UTI particularly useful?

A

Very effective drug in severe Gram negative (coliform-related) sepsis

38
Q

How long should gentamicin be prescribed for?

A

3 days only

39
Q

When is pevmicillam useful in treating UTI?

A

Useful for treating lower uncomplicated UTI

Very beta-lactamase stable – has activity against very antibiotic-resistant coliforms that produce extended spectrum beta-lactamases (ESBLs)

40
Q

Is pevmicillam use recommended in pregnancy?

A

No

41
Q

When is temocillin useful in treating UTI?

A

Very beta-lactamase stable – has activity against very antibiotic-resistant coliforms that produce extended spectrum beta-lactamases (ESBLs)

Useful for treating complicated UTI/urosepsis in patients whose renal function is too poor for gentamicin, but is NOT as effective as gentamicin clinically

42
Q

What empirical antibiotic treatment is issued for lower UTI in women?

A

Trimethoprim or nitrofurantoin orally (3 days)

43
Q

What empirical antibiotic is useful for treating uncatheterised male UTI?

A

Trimethoprim or nitrofurantoin orally (7 days)

44
Q

What empirical antibiotic in a GP setting is useful for treating complicated UTI or pyelonephritis?

A

Co-amoxiclav or co-trimoxazole (14 days)

45
Q

What empirical antibiotic treatment in a hospital setting is given to treat complicated UTI or pyelonephritis?

A

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

46
Q

When should asymptomatic bacteuria always be treated?

A

Pregnancy

47
Q

What complications may arise from untreated asymptomatic bacteuria in pregnancy?

A

20-30% progress to pyelonephritis

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

48
Q

What may be the cause of abacterial cystitis?

A

May be an early phase of UTI

May be due to urethral trauma - “honeymoon cystitis”

May be due to urethritis caused by chlamydia, gonorrhoea

49
Q

How might symptoms of abacterial cystitis be helped?

A

Alkalanising the urine

50
Q

Why should antibiotics only be given to catheterised patients displaying symptoms of UTI?

A

Giving too many antibiotics will only colonise catheter with increasingly resistant organisms

Renal and urology (11 decks)

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