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Microbiology Flashcards

1
Q

definition of UTI?

A

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

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2
Q

what is meant by lower UTI?

A

denotes infection confined to the bladder (cystitis)

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3
Q

what is meant by upper UTI?

A

denotes infection involving the ureters +/- the kidneys

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4
Q

what is infection of the kidneys referred to as?

A

pyelonephritis

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5
Q

what is meant by a complicated UTI?

A

a UTI which is complicated by systemic sepsis or urinary structural abnormalities or stones

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6
Q

meaning of cystitis?

A

inflammation of the bladder (not always due to infection)

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7
Q

what makes woman more suseptible to UTIs?

A
  • short wide urethra

- proximity of urethra to anus

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8
Q

what else increases the risk of UTI in woman?

A
  • increased sexual activity

- pregnancy

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9
Q

2 routes of infection of the urinary tract?

A
  • ascending infection

- from the bloodstream

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10
Q

what route of infection of the urinary tract is much more common?

A

ascending route

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11
Q

how does infection travel in the ascending route?

A

bacteria from bowel, onto perineal skin, to lower end of urethra, then to bladder then ureters then kidneys

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12
Q

how does infection affect the kidney in the bloodstream route?

A

patient with bacteraemia/septicaemia from another focus of infection, bacteria in blood is seeded into kidneys and gives rise to multiple small abscesses

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13
Q

what organism causes about 70% of UTIs?

A

E.coli

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14
Q

most common causal organisms in UTI?

A
  • E.coli
  • Klebsiella sp
  • Enterobacter sp
  • Proteus sp
  • other coliforms
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15
Q

what is infection with proteus sp associated with?

A

the formation of stones

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16
Q

how does infection with proteus sp increase the ph of the urine?

A

it produces urease which breaks down urea to form ammonia

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17
Q

2 types of enterococcus sp that can cause UTI?

A
  • enterococcus faecalis

- enterococcus faecium

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18
Q

what enterococcus sp tends to be resistent to antibiotics and difficult to treat?

A

enterococcus faecium

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19
Q

what organism is often causative of a UTI in women of child bearing age?

A
  • staphlococcus saphrophyticus
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20
Q

what is pseudomonas auruginosa UTI associated with?

A

catheters and UT instrumentation

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21
Q

pseudomonas aeruginosa causing UTI is resistent to most oral antibiotics except?

A

ciprofloxacin

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22
Q

symptoms and signs of UTI?

A
  • dysuria
  • frequency of urinarion/nocturia
  • haematuria
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23
Q

what symptoms/signs suggest involvement of upper urinary tract?

A
  • fever
  • loin pain
  • rigors
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24
Q

why is it important to get a mid-stream collection of urine for sample?

A

bladder urine is normally sterile but urine passed via urethra will be contaminated with bacteria from the perineum or lower urethra so first urine passed is most likely to be contaminated

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25
Q

what should be done before asking patient to give a urine sample?

A
  • wash perineum/urethral meatus with sterile saline

- give patient sterile foil bowl

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26
Q

what are other forms of urine samples (not MSSU)?

A
  • “clean catch” urine: in children and elderly
  • bag urine (in babies)
  • catheter specimen of urine (CSU)
  • subrapubic aspiration
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27
Q

what type of container is optimum for a urine sample and why?

A
  • a boricon container

- contains boric acid (preservative) to stop bacteria multuplying for about 24 hours

28
Q

if you use a sterile universal container for a urine sample, when must it be given to the lab?

A

within 2 hours of collection

29
Q

why does nitrites in urine indicate infection?

A

some bacteria can reduce nitrates to nitrites - mainly coliforms

30
Q

what organism will not give a postive nitrite test on dipstick?

A

enterococcus spp

31
Q

when is microscopy of urine used?

A

only done on selected urgent cases

32
Q

how is bacteria in the urine routinely diagnosed in the lab?

A

culture of urine

33
Q

According to the Kass’s criteria, what suggests a significant probable UTI?

A

> 10 to the 5 organism/ml

34
Q

according to Kass’s criteria, what would

A

not significant bacteriuria

35
Q

according to Kass’s criteria, what does by 10 to the power 4 organism/ml suggest?

A
  • ?contaminates
  • ?infection
  • repeat specimen
36
Q

what age group does the Kass’s criteria apply to?

A

woman of child bearing age

37
Q

is a mixed growth > 10 to power 5, signififcant?

A

probably not significant, a genuine UTI will usually be a single organism

38
Q

what is ESBL?

A

extended spectrum beta-lactamase

39
Q

what antibiotics does ESBL make bacteria resistant to?

A

all cephalosporins and almost all penicillins

40
Q

what is ESBL carried on?

A

on a plasmid

41
Q

antibiotics that may be useful in UTI with ESBL?

A
  • nitrofurantoin, pivmecillinam, fosfomycin, temocillin, meropenum, ertapenam
42
Q

what last choice antibiotic is carbapenemase producing enterobacteriaceae resistant to?

A

meropenum

43
Q

how long should a course of antibiotics be given for in an uncomplicated UTI in women?

A

3 days

44
Q

what are the first line antibiotics available for treating UTI?

A
  • amoxicillin
  • trimethoprim
  • nitrofuranoin
  • gentamicin
45
Q

what can trimethaprim be given as intra-venously?

A

as cotrimoxazole

46
Q

2nd line options for treating UTI?

A
  • pivmecillinam
  • temocillin
  • cefalexin
  • co-amoxiclav
  • ciprofloxacin
47
Q

why is amoxicillin not really used as empirical treatment for UTI anymore?

A

more than 50% of E.coli are now resistant, along with other coliforms

48
Q

is amoxicillin safe in pregnancy?

A

yes

49
Q

what does trimethoprim inhibit?

A

bacterial folic acid synthesis

50
Q

can trimethoprim be given in pregnancy?

A

avoided in first 3 months

51
Q

what organisms does trimethoprim cover?

A

most coliforms, staph aureus incl MRSA

52
Q

what does trimethoprim not cover?

A

pseudomonas sp

53
Q

when should nitrofurantoin be avoided and why?

A

in late pregnancy, breast feeding and in children under 3. cause cause neonatal haemolysis

54
Q

what does nitrofurantoin not cover?

A

proteus sp and pseudomonas sp.

55
Q

why can gentamicin only be used to treat a UTI in hospital?

A

has to be given IV

56
Q

can gentamicin be used in pregnancy?

A

no

57
Q

what does gentamicin not cover?

A

enterococci

58
Q

how long show gentamincin be prescribed for?

A

for 3 days only

59
Q

what drug can be useful in complicated UTIs in patients whose renal function is too poor for gentamicin?

A

temocillin

60
Q

what is the empirical treatment for a female lower uncomplicated UTI?

A

trimethoprim or nitrofurantoin orally for 3 days

61
Q

empirical treatment for uncatheterised male UTI?

A

trimethoprim or nitrofurantoin orally for 7 days

62
Q

empirical treatment in the community setting of compicated UTI or pyelonephritis?

A
  • co-amoxiclav or co-trimoxazole for 14 days
63
Q

empirical treatment in hospital of a complicated UTI or pyelonephritis?

A

amoxicillin and gentamicin IV for 3 days then stepdown as guided by antibiotic sensitivities

64
Q

what do you give in complicated UTI or pyelonephritis in hospital if patient is penicillin allergic?

A

cotrimoxazole and gentamicin IV fr 3 days then stepdown guided by antibiotic sensitivities

65
Q

when are pregnant woman screened for a UTI?

A

at 1st antenatal visit

66
Q

if a bacteria in the urine is left untreated in pregnancy, what % progress to pyelonephritis?

A

20-30%

Renal (10 decks)

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