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Y2 RENAL > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Urine in the kidneys, ureters and bladder is normally sterile. True/False?

A

True

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2
Q

Which organisms usually colonise the lower end of the urethra?

A

Coliforms
Enterococci
(from large bowel)

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3
Q

Define “UTI”

A

Presence of microorganisms in the urinary tract that are causing clinical infection

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4
Q

Lower UTI denotes infection confined to where?

A

Bladder (cystitis)

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5
Q

Upper UTI denotes infection spreading to where?

A

Ureters +/- kidneys (pyelonephritis)

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6
Q

Bacteriuria (presence of bacteria in urine) always indicates a UTI. True/False?

A

False

Especially in elderly, and those with catheters

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7
Q

Why is UTI more common in women? List other risk factors for UTI

A

Short, wide urethra
Urethra near anus
Pregnancy

Catheterised patients
Abnormality of UT
Diabetes
Immunosuppressed patients e.g HIV/ AIDs

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8
Q

What is the most common route of infection in UTI? Name another route of infection

A

Ascending infection - bacteria from bowel/bladder rises upwards through ureters to the kidneys

Bloodstream (bacteraemia/ septicaemia)

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9
Q

List the main causal organisms of UTI

A

E. coli
Klebsiella
Enterococci
Proteus

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10
Q

Which bacteria is associated with the formation of calculi?

A

Proteus sp.
Produces urease which breaks down urea to form ammonia (increases pH), precipitating salt formation (struvite triple phosphate stones)

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11
Q

Which enterococcus - faecalis or faecium - is quite resistant to antibiotics?

A

Enterococcus faecium

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12
Q

Which particular strain of Staphylococcus is associated with UTI? Who is it usually found in?

A

Staph. saphrophyticus (coag. -ve)

Particularly in women of child-bearing age

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13
Q

Which organism is associated with causing UTI in catheterised patients?

A

Pseudomonas

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14
Q

Which antibiotic is Pseudomonas not resistant to?

A

Ciprofloxacin

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15
Q

List the main symptoms and signs of (lower) UTI

A

CYSTITIS
Dysuria
Frequency/nocturia
Haematuria

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16
Q

What clinical features suggest an upper UTI?

A 
PYELONEPHRITIS
Fever and chills
Loin pain
Rigors
Nausea, vomiting
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17
Q

When taking a urine sample to check for UTI, the first urine passed is assessed. True/False?

A

False

First urine is likely to be contaminated; collect mid-stream sample

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18
Q

List different ways of collecting urine specimens

A 
Midstream bowl by patient
Clean catch by nurse
Bag urine (babies)
Catheter specimen
Suprapubic aspiration
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19
Q

Which container contains preservative that can prevent bacteria multiplying in a urine sample?

A

Boricon (red top) container

Works for 24hrs

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20
Q

If a urine sample is collected in a standard universal (white top) container, how quickly must it reach the lab?

A

Within 2 hours of collection

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21
Q

The presence of nitrites on dipstick suggests what? Which organism does not give a positive nitrite test on dipstick?

A

Bacteriuria
(bacteria reduce nitrate to nitrite)
Enterococcus spp.

22
Q

What substances are looked for on urine dipstick?

A

Leukocytes (WBC)
Nitrites
Protein
Blood

23
Q

What is looked for on urine microscopy?

A

Pus cells +/- red cells

24
Q

Define Kass’s criteria for diagnosing UTI in women of child-bearing age

A

Less than 10^4 organisms/ml - unlikely UTI

10^4 organisms/ml - possible (repeat)

More than 10^5 organisms/ml - probable UTI

25
ESBL-producing bacteria are resistant to which antibiotics? Name an antibiotic that can be used to treat?
Cephalosporins Penicillins Meropenem
26
Which antibiotics may be useful for ESBL-producing bacteria?
``` Nitrofurantoin Pivmecillinam Fosfomycin Temocillin Meropenem Ertapenem ```
27
Carbapenemase-producing enterobacteriaceae (CPE) are resistant to which antibiotics?
All current antibiotics!
28
Some antibiotics are metabolised and excreted by the liver. What is the significance of this?
Not useful for treating UTI
29
How is uncomplicated lower UTI in women treated usually?
3 day course of empirical antibiotic
30
List 1st line antibiotics for UTI
Amoxicillin Trimethoprim Nitrofurantoin Gentamicin
31
List 2nd line antibiotics for resistant UTI
``` Pivmecillinam Temocillin Cefalexxin Co-amoxiclav Ciprofloxacin ```
32
Enterococcus faecalis is sensitive to amoxicillin. True/False?
True
33
Amoxicillin is good for empirical UTI treatment. True/False?
False | Resistant rate too high - only used if know organism is sensitive
34
Which antibiotic is usually used for empirical UTI treatment?
Trimethoprim
35
How does trimethoprim work? What is the significance of this?
Inhibits folic acid synthesis - thus not recommended in early pregnancy
36
Trimethoprim can be given as co-trimoxazole. What is a risk of this drug?
Causes Stevens-Johnson syndrome
37
Nitrofurantoin is only useful in uncomplicated lower UTI. True/False?
True | Only reaches effective concentration in bladder urine
38
Should nitrofurantoin be avoided in pregnancy?
Yes | Can cause neonatal haemolysis
39
By definition, hospitalised UTI is usually treated by gentamicin. True/False?
True | Except in pregnancy; can cause ototoxicity
40
What is the maximum duration of prescription of gentamicin?
3 days
41
Which antibiotics have some activity against ESBL-strains?
Pivmecillinam | Temocillin
42
State empirical antibiotic treatment for female lower UTI
Trimethoprim/nitrofurantoin
43
State empirical antibiotic treatment for uncatheterised male UTI
Trimethoprim/nitrofurantoin
44
State empirical antibiotic treatment for complicated UTI/pyelonephritis in GP
Co-amoxiclav/co-trimoxazole for 14 days
45
State empirical antibiotic treatment for complicated UTI/pyelonephritis in hospital
Amoxicillin + gentamicin | co-trimoxazole if pen-allergic
46
What is the first line investigation when significant bacteriuria is suspected?
Urine culture
47
What are the causes of abacterial cystitis? How should it typically be managed?
Early UTI Urethral trauma 'honeymoon cystitis' Urethritis (chlamydia, gonorrhoea) Alkalise urine, empty bladder after sex, fluids
48
Abacterial cystitis should be managed with antibiotics in what group of patients? What are the consequences of not treating?
Pregnancy | Pyelonephritis, IUGR, premature labour
49
Which antibiotic is used to treat UTI in pregnancy? What is the main side effect to be aware of?
Cephalexin | C.diff infection
50
What is the indication for antibiotics in a catheterised patient with UTI? What is the consequence of unecessary antibiotics?
>10^5 organisms/ ml only if supporting symptoms Colonisation of catheter with resistant organisms Risk of C.diff infection

Y2 RENAL (17 decks)

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