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Renal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Define a lower UTI

A

Infection confined to the bladder (cystitis)

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2
Q

Define cystitis

A

Inflammation of the bladder not always due to infection

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3
Q

Define upper UTI

A

Infection involving ureters/kidneys (pyelonephritis)

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4
Q

Describe the physiological bacteria in the urinary tract

A

Normally the lower end of the urethra is colonised by bacteria - coliform and enterococci but the rest is sterile

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5
Q

What is a complicated UTI?

A

Systemic sepsis
Structural abnormality
Stones

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6
Q

Define bacteriuria

A

Presence of bacteria in the urine - not always infectious (elderly and catheterised patients)

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7
Q

State the risk factors for UTI

A

Women>Men (short wide urethra, proximity of urethra to anus, sexual activity, pregnancy)
Catheterisation (colonised bacteria can easily enter bladder)
Abnormalities of the urinary tract

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8
Q

Name the two key routes of infection

A

Ascending - from bowel to perineal skin to lower urethra to urinary tract
Blood stream - seeded into kidneys from blood leading to multiple small abscesses and bacteria in the urine

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9
Q

What are the most common organisms in a UTI?

A

Coliforms - e.coli, klebsiella, enterobacter, proteus

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10
Q

What is proteus associated with?

A

Calculi - foul smelling due to urease breaking down to ammonia increasing pH and causes salt precipitation

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11
Q

Name the other organisms apart from coliform that cause UTIs

A

Enterococcus faecilus and faecium
Staphylococcus saphrophyticus (young child bearing age)
Staph aureus
Pseudomonas

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12
Q

What are pseudomonas associated with?

A

Catheters and instrumentation - resistant to most antibiotics except ciprofloxacin

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13
Q

How does ciprofloxacin work? What is the risk of using it?

A

Inhibits DNA gyrate to prevent supercoiling - not used in children/pregnant women risk of c.diff

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14
Q

What are the symptoms of a UTI?

A 
Dysuria
Frequency of urination 
Nocturia
Haematuria 
Fever 
Loin pain 
Rigors
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15
Q

State the different methods of collecting urine for sample

A

Mid-stream specimen of urine
Clean catch (nurse catches sample)
Bag urine (used in babies but can be contaminated with bowel flora)
Supra-pubic aspirate (babies and young kids)
Catheter specimen of urine (aspirate from catheter)

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16
Q

What is the best container for the urine to go to the lab in?

A

Boron container (red top) contains boric acid which stops bacteria multiplying

17
Q

What does a dipstick often show in a patient with a UTI?

A

Leukocyte esterase (WBC)
Nitrites (bacteria converts nitrates to nitrites)
Protein
Blood

18
Q

State the test used in urgent cases

A

Microscopy will only show WBC, red cells and bacteria

19
Q

On culture what volume of organism indicates infection

A

<10^3 organisms/ml - not significant
10^4 organisms/ml - doubtful
>10^5 organisms/ml - significant

20
Q

How is an uncomplicated LUTI in women treated?

A

Nitrofurantoin/trimethoprim 3 days

21
Q

How is an uncatheterised LUIT in men treated?

A

Nitrofurantoin/trimethoprim 7 days

22
Q

In primary care how is complicated UTI/pyelonephritis treated?

A

Co-amoxiclav (co-trimoxazole if allergic)

23
Q

In secondary care how is complicated UTI/pyelonephritis treated?

A

Amoxicillin and gentamicin

Step down to oral co-trimoxazole

24
Q

Describe gentamicin

A

Given IV it has a narrow therapeutic index 7mg/kg for 3 days only - avoid in pregnancy

25
Q

How does trimethoprim work and when is it avoided?

A

Inhibits folic acid synthesis
Avoid in 1st trimester of pregnancy
Can cause steven johnstone syndrome

26
Q

What can trimethoprim be mixed with to form a more potent antibiotic?

A

Sulfamethoxazole to form cotrimoxazole

27
Q

Why can nitrofurantoin only be used in lower UTIs?

A

It only reaches effective concentrations in the bladder

28
Q

When should nitrofurantoin be avoided?

A

Late pregnancy and children <3months

29
Q

Why does amoxicillin often not work?

A

50% e.coli are resistant

30
Q

What antibiotic is used if amoxicillin and trimethoprim resistant?

A

Cefalexin - broad spec but safe to use

31
Q

What antibiotic has activity against ESBL?

A

Pivmecillinam

32
Q

What antibiotic can be used is renal function is too poor for gentamicin?

A

Temocillin

33
Q

Name the antibiotic used as last resort

A

Meropenem

34
Q

What are the side effects of gentamicin?

A

CN VIII

Nephrotoxic

Renal (20 decks)

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