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Renal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is an UTI

A

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

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2
Q

What is the definition of a lower UTI

A

Infection confined to the bladder

Also involves cystitis - bladder inflammation

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3
Q

What is the definition of an upper UTI

A

Infection involving the ureters +/- the kidneys

Also called pyelonephritis (in kidney)

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4
Q

Urine in the bladder is normally sterile - true or false

A

True

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5
Q

What is a bacteriuria

A

Bacteria present in the urine

Doesn’t always mean there is symptoms

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6
Q

List risk factors for UTI

A

Being female - shorter urethra
Catheterisation
Abnormalities of the urinary tract

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7
Q

How do bacteria get to the urinary tract

A

Ascending infection - common
The bacteria travel from the rectum or perineal skin up into the tract

Rarely bacteria from the bloodstream can seed in the kidneys

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8
Q

What is the best type of urine sample

A

Mid stream urine sample
First urine passed into toilet, without interruption collect next part in a bowl, finish in toilet
Transfer from bowl to container

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9
Q

Are urine dipsticks useful for UTI

A

They are in young patients
Look for nitrites and leukocytes
May see protein or blood
NEVER use in elderly or catheters

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10
Q

What are the main causative organisms of UTI

A

Gram –v bacilli are the biggest cause
E.coli in particular
Klebseilla, Enterobacter etc
Pseudomonas

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11
Q

What does a proteus UTI cause

A

Struvite stones - large ones that take shape of calyx (look like antlers)
Creates them by breaking down urea to ammonia - causes precipitation of salts

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12
Q

How does proteus appear when plated

A

Foul smelling - burnt chocolate

Looks like tree rings - swarming

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13
Q

What is a pseudomonas UTI associated with

A

Catheters and instrumentation

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14
Q

How do you treat a pseudomonas infection

A

Ciprofloxacin is the only oral one that works

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15
Q

Which gram positives can cause UTI

A

Enterococcus - from GI, common in hospital
Staph saprophyticus
Aureus rarely from bacteraemia

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16
Q

What are the symptoms of UTI

A

Dysuria
Increased frequency
Nocturia
Haematuria

If upper tract involved - fever, loin pain, rigors

17
Q

Describe the different types of urine container

A

Sterile universal container - white lid, must reach lab within 2 hours
Boricon container - red lid, contains boric acid to stop bacteria multiplying, works for 24hrs

18
Q

What is considered a significant result on urine culture

A

More than 10 to the 5 organisms per ml

Probably a UTI

19
Q

Which antibiotic is used for uncomplicated lower UTI

A

1st line - Nitrofurantoin
2nd line - Trimethoprim

3 days in women and 7 days in men

20
Q

If you get pus cells in a urine sample but no significant bacteria on culture, what could be the cause

A

Could be early phase of UTI
Honeymoon cystitis - urethral trauma
May be an STI
Abacterial cystitis

21
Q

How do you treat abacterial cystitis

A

Alkalinising the urine may help (symptomatic relief)

22
Q

What is an asymptomatic bacteruria and how would you manage it

A

Significant bacteriuria (>105 orgs/mL)
Patient is asymptomatic (incidental finding)
No pus cells in urine

DO NOT give antibiotics

23
Q

How does treatment for asymptomatic bacteruria differ in pregnancy

A

You would treat with antibiotics
All women are screened at 1st antenatal visit
Can lead to pyelonephritis or IUGR or premature labour

24
Q

When would you treat a catheter patient with a bacteriuria

A

ONLY if they have symptoms

Catheter samples will always grow bacteria

25
Q

How do you treat complicated UTI or pyelonephritis in the community

A

Co-amoxiclav or co-trimoxazole (14 days)

26
Q

How do you treat complicated UTI or pyelonephritis in hospital

A

Amoxicillin and gentamicin IV for 3 days

27
Q

How do you give gentamicin

A

7mg/kg - refer to guidance
NOT in pregnancy
Take bloods 6-14 hours later to check it has cleared from system
Only prescribe for 3 days

28
Q

If bacteria produced ESBL, how does it affect treatment

A

It will be resistant to all cephalosporins and almost all penicillin
May use nitrofuratinin, meropenem etc

29
Q

Is trimethoprim safe in pregnancy

A

Yes but not in the 1st trimester

Renal (18 decks)

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