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1. Renal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is a lower UTI?

A

infection confined to the bladder

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2
Q

What is an upper UTI?

A

infection involving the ureters and kidney - pylonephritis

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3
Q

Which parts of the urinary tract are normally sterile?

A

bladder, ureters and kidneys

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4
Q

Which parts of the urinary tract are not normally sterile?

A

urethra - colonised by coliforms and enterococci due to proximity to the large bowel

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5
Q

What is a complicated UTI?

A

UTI complicated by systemic symptoms or abnormal structure

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6
Q

What is bacteriuria?

A

bacteria is present in the urine but does not always indicate infection e.g. catheter or elderly patient

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7
Q

What are the risk factors for UTIs?

A

female>male due to shorter, wider urethra, close to anus
increased risk with sexual activity or pregnancy
catheterised patients
structural abnormalities

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8
Q

What are the two routes of infection for UTI?

A

Ascending

Bloodstream

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9
Q

Describe ascending UTIs?

A

most common
bladder -> ureter -> kidney
often E.coli as they have fimbrae that can climb up the ureters
bacteria from bowel

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10
Q

Describe bloodstream UTIs?

A

less common
often septicaemia or bacteriaemia
multiple small abcesses seeded into the kidneys

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11
Q

What are the investigations done for a UTI?

A

specimen to lab for:
dipstick - nitrites and leucocytes
culture
microscopy - not routine

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12
Q

What must the urine specimen be transferred in?

A

must be sent in either a boricon container - contains boric acid which stops the bacteria from multiplying for around 24hours
OR
in a sterile universal container - must reach the lab within 2 hours

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13
Q

What type of urine sample is needed?

A

mid stream sample - urine passed from the urethra will initially get contaminated with bacteria from the peritoneum or lower urethra

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14
Q

What is the presentation of a UTI (mainly lower)?

A

dysuria - pain passing urine
frequency of urination
change in nocturne
haematuria

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15
Q

What are the signs of an upper UTI?

A

loin pain
fevers
rigors

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16
Q

What are the main pathogens that cause UTIs?

A 
E.coli 
Proteus
Kleibsella
Enterbacter
Serratia
Citrobacter
Maganella
Providericia
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17
Q

What is the gram stain and classification of pathogens that cause UTIs?

A

gram negative coliforms

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18
Q

What is the one organism that is not a coliform that can cause a UTI?

A

psuedomonas - it is a gram negative bacillus

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19
Q

How does a UTI caused by proteus present?

A

STAG HORN CALCULI
produces urase which breaks down urea to form ammonia which increases urinary pH and precipitation of salts
foul smelling, burnt chocolate

20
Q

What is the only oral antibiotic that treats pseudomonas?

A

ciprofloxacin

21
Q

What gram positive organisms can cause UTIs?

A

enterococcus faecalis and fasecium - most commonly aquired in hospital not in normal healthy people
staph saphrophyticus - coagulase negative staph, usually affects women of child bearing age
stay aureus - in bacteraemia

22
Q

What is the diagnostic criteria for UTIs?

A

Kass Criteria
>10^5 organisms/ml = significant/probable UTI
10^4 organisms/ml = repeat - may be contaminated may be infection
<10^3 organisms/ml = not significant

23
Q

What is a genuine UTI normally due to?

A

just one organism - if more than 2 its probably not significant

24
Q

What is the action of ciprofloxacin?

A

inhibits bacterial DNA gyrase - not used in pregnant women or young children

25
Q

What is antibacterial cystitis/urethral syndrome?

A

patient has symptoms of UTI, there are pus cells present in the urine but no bacterial growth on culture
may be due to urethral trauma, urethritis caused by STI, or just early phase of UTI

26
Q

What is honeymoon cystitis?

A

urethral trauma due to sexual activity - presents with same symptoms as a UTI

27
Q

What can help honeymoon and antibacterial cystitis and urethral syndrome?

A

alkalising the urine

28
Q

What is asymptomatic bacteriuria?

A

bacteriuria >10^5 but the patient is asymptomatic so is detected incidentally - no treatment is needed

29
Q

When is treatment needed for asymptomatic bacteriuria?

A

in prengancy

30
Q

When are pregnant women screened for aysymptomatic bacteriuria?

A

1st antenatal unit appointment

31
Q

What are the risks of not treating asymptomatic bacteriuria in pregnant women?

A

can progress to pylonephritis

and cause intra uterine growth retardation or premature labour

32
Q

When shoud catheratised patients be given antibiotics for bacteriuria?

A

IF THEY HAVE SYMPTOMS

33
Q

What is the treatment of a complicated UTI/pylonephritis/urosepsis in hospital?

A

amoxicillin and gentamicin IV - 3 days
step down: co trimoxazole PO
cotrimoxazole if pen allergic

34
Q

What is the treatment of a complicated UTI/pylonephritis/urosepsis in primary care?

A

coamoxiclav PO - 14 days

cotrimoxazole if pen allergic

35
Q

What is the treatment of a female lower UTI?

A

Nitrofuratoin or Trimethoprim PO - 3 days

36
Q

What is the treatment of a male lower UTI?

A

Nitrofuratoin or Trimethoprim PO - 7 days

37
Q

What are the characteristics of gentamicin?

A 
IV only 
avoid in pregnancy
narrow therapeutic index 
gram -ve cover
only to be given for 3 days
38
Q

What are the characteristics of Trimethoprim?

A

NOT FOR 1ST TRIMESTER
inhibits folic acid synthesis
(part of cotrimoxazole)
oral

39
Q

What are the characteristics of Nitrofurantoin?

A 
NOT FOR 2ND OR 3RD TRIMESTER - can cause neonatal haemolysis
AVOID IN BREAST FEEDING AND CHILDREN < 3
oral
only used in lower, uncomplicated UTIs
doesnt treat proteus or pseudomonas
40
Q

What are the characteristics of co-amoxiclav?

A

combo of amoxicillin and clauvulanic acid (beta lactamase inhibitor)

41
Q

What are the characteristics of Pivmecillinam?

A

oral
treats lower, uncomplicated UTIs
has activtiy against ESBLs
NOT FOR PREGNANCY

42
Q

What are the characteristics of Temocillin?

A

IV
has activity against ESBLs
useful for complicated UTIs/urosepsis - patients whose renal function is too poor for gentamicin

43
Q

What are the characteristics of Cefalexin?

A

oral
only used when amoxicillin and trimethoprim are resistnat
1st generation cephalosporin

44
Q

Name some antibiotics that might treat ESBLs?

A 
nitrofurantoin
pivmecillinam
fosfomycin
temocillin
meropenem
entrapenem
45
Q

What are carbapenem producing enterobactams?

A

gram -ve coliform/bacilli that are resistant to meropenem - resistance is plasma mediated

46
Q

How is ESBLs resistnace carried?

A

on a plasmid

1. Renal (28 decks)

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