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2MBChB Renal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is UTI?

A

The presence of microorganisms in the urinary tract that are causing clinical infection.

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2
Q

What is a lower UTI?

A

Denotes infection confined to the bladder (cystitis).

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3
Q

What is an upper UTI?

A

Denotes infection involving the ureters +/- the kidneys (pyelonephritis).

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4
Q

What is a complicated UTI?

A

A UTI complicated by systemic symptoms or urinary structural abnormality/stones.

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5
Q

What is bacteriuria?

A

Bacteria are present in the urine.

Does not always mean infection, especially in elderly patients or patients with catheters.

Important to determine if the patient is symptomatic.

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6
Q

What is cystitis?

A

Inflammation of the bladder not always due to infection.

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7
Q

What are the risk factors for UTI?

A

Women have a short wide urethra making them more at risk.

Increased risk with sexual activity, pregnancy (female > male).

The proximity of urethra to the anus (female > male).

Catheterised patients.

Abnormalities of the urinary tract.

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8
Q

What are the routes of ascending infection from UTI?

A

Bacteria from the bowel.

Perineal skin.

Lower end of urethra.

Bladder -> ureters -> kidneys.

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9
Q

What are the routes of bloodstream infection due to UTI?

A

Bacteremia/septicaemia.

Seeded into kidneys.

Multiple small abscesses.

Bacteria in urine.

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10
Q

Which patients should you not dipstick?

A

Elderly people.

Catheterised patients.

They will have bacteriuria commonly.

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11
Q

What bacteria type cause UTI?

A

Gram-negative coliforms.

E. coli.

Klebsiella.

Enterobacter.

Serratia.

Citrobacter.

Morganella.

Proteus.

Providencia.

Pseudomonas (not a coliform).

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12
Q

Which bacteria is likely to be infective in stags horn calculi?

A

Proteus (foul-smelling; burnt chocolate; swarming cultures).

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13
Q

What does proteus produce?

A

Urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts.

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14
Q

What types of UTIs is pseudomonas associated with?

A

UTI in patients with catheters and instrumentation.

Only treatment is ciprofloxacin (quinolones).

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15
Q

How does ciprofloxacin work?

A

Inhibits bacterial DNA gyrase, preventing supercoiling of bacterial DNA.

Not used in young children/pregnant women.

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16
Q

What are the gram-positive bacteria that cause UTI?

A

Enterococcus faecalis - common in HAI.

Enterococcus faecium - common in HAI.

Staph. saphrophyticus - coag neg, usually affects women of child-bearing age.

Staph. aureus - usually in bacteraemia.

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17
Q

What are the symptoms of UTI?

A

Dysuria (pain passing urine).

Frequency of urination - change.

Nocturia.

Haematuria.

Fever - worry about upper tract infection.

Loin pain - worry about upper tract infection.

Rigors - worry about upper tract infection.

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18
Q

What are the differences between cystitis and pyelonephritis?

A
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19
Q

Why is a midstream urine needed for detecting UTI?

A

First urine passed is most likely to be contaminated so midstream specific of urine (MSU).

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20
Q

What does a boricon container contain?

A

Contains boric acid (preservative) to stop bacteria multiplying (works for ~24 hours).

21
Q

When should a sterile universal container reach the lab?

A

Within 2 hours of collection.

22
Q

What are the types of urine specimens?

A

Boricon container.

Sterile universal container.

Clean catch urine - kids.

Bag urine - used on babies.

Catheter specimen of urine.

Suprapubic aspitation

23
Q

What does a raised leukocyte esterase on a dipstick mean?

A

Indicated the presence of leukocytes (WBC) in the urine.

24
Q

What does a raised nitrites on a dipstick mean?

A

Indicate the presence of bacteria in the urine.

Some bacteria can reduce nitrates to nitrites - mainly coliforms.

25
Q

What does a dipstick of blood and protein not suggest?

A

NOT infection diagnosis alone.

26
Q

Who does the Kass’s criteria apply to?

A

Women of childbearing age.

27
Q

What is the ideal antibiotic for an uncomplicated lower UTI?

A

Excreted in urine in high concentration.

Oral.

Inexpensive.

Few side effects.

3 day course for treating uncomplicated lower UTI in women.

28
Q

Why is asymptomatic bacteriuria treated in pregnant women?

A

If left untreated, 20-30% progress to pyelonephritis.

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

29
Q

What is the empirical antibiotic treatment for female lower UTI?

A

Nitrofurantoin or trimethoprim orally - 3 days.

30
Q

What is the empirical antibiotic treatment for uncatheterised male lower UTI?

A

Get cultures!

Nitrofurantoin or trimethoprim orally - 7 days.

31
Q

What is the empirical antibiotic treatment for complicated UTI or pyelonephritis (GP)?

A

Co-amoxiclav or co-trimoxazole (14 days).

32
Q

What is the empirical antibiotic 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.

33
Q

What are the first line antibiotics for UTI?

A

Amoxicillin (IV, oral).

Trimethoprim (oral, but can be given IV as co-trimoxazole).

Nitrofurantoin (oral).

Gentamicin (IV).

34
Q

What are the second line antibiotics for UTI?

A

Pivmecillinam (oral).

Temocillin (IV).

Cefalexin (oral).

Co-amoxiclav = amoxicillin + clavulanic acid (IV, oral).

Ciprofloxacin (IV, oral).

35
Q

What does ESBL do?

A

ESBL = extended spectrum beta-lactamase.

Makes all bacteria resistant to all cephalosporins and to almost all penicillins.

36
Q

Why is E. coli the most common cause of UTI?

A

It is the most common aerobe in the bowel.

37
Q

Name 3 important factors (other than cost) that should be considered when choosing an antibiotic to treat UTI?

A

Likely organisms.

Site of UTI.

Urine excretion of antibiotic.

38
Q

Why is nitrofurantoin a suitable choice for the treatment of cystitis but not for pyelonephritis?

A

It is not effective in the upper urinary tract.

39
Q

What is the antibiotic treatment for pyelonephritis?

A

Amoxicillin and gentamicin.

(If penicillin allergic, co-trimoxazole and gentamicin).

40
Q

Give 2 reasons why erythromycin is not a suitable antibiotic for treating a UTI in a penicillin hypersensitive patient?

A

It is not excreted in the urine.

It is bacteriostatic.

(The likely causative organisms may be resistant to it).

41
Q

Should a urine sample for this patient be sent for culture and sensitivity?

40 year old male with multiple sclerosis who has an indwelling catheter and has pyrexia.

A

Yes.

42
Q

Should a urine sample for this patient be sent for culture and sensitivity?

Asymptomatic 26 year old who is catheterised prior to a minor gynaecological procedure. The urine was obtained when the catheter was passed.

A

No.

43
Q

Should a urine sample for this patient be sent for culture and sensitivity?

80 year old lady admitted to an acute medical ward with pyrexia.

A

Yes.

44
Q

What is the treatment for abacterial cystitis?

A

Recommend emptying the bladder after sex.

45
Q

Name possible adverse effects of prescribing an unnecessary antibiotic for a catheterised patient?

A

Resistant organisms will colonise the catheter.

The patient may develop C. diff.

The patient may develop an antibiotic allergy.

46
Q

What is abacterial cystitis (urethral syndrome)?

A

Patient has the symptoms of UTI.

Pus cells are present in the urine but no significant growth on culture.

May be an early phase of UTI, due to urethral trauma (honeymoon cystitis), due to urethritis caused by chlamydia or gonorrhoea.

47
Q

What is the Tayside formulary choice of antibiotics for coliforms causing UTI?

A

Gentamicin IV.

Amoxicillin (40% resistant).

Trimethoprim (for lower tract UTI).

Co-trimoxazole (IV-oral-switch-therapy if sensitive) - not reliable if bacteraemic.

48
Q

What is the Tayside formulary choice of antibiotics for enterococci causing UTI?

A

Amoxicillin IV.

Cotrimoxazole.

2MBChB Renal (20 decks)

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