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xB10W2 > MICROBIOLOGY OF THE URINARY TRACT > Flashcards

MICROBIOLOGY OF THE URINARY TRACT Flashcards

1
Q

what are the 2 routes of acquisition of UTIs?

A

ascending or haematogenous

note ascending can be from urethra to bladder or from bladder to kidneys

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2
Q

what’s the most common complications of nosocomial infections?

A

UTIs

nosocomial - related to patient management e.g. use of catheters

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3
Q

what are the 3 subcategories for UTIs?

A

urethritis if it involves urethra (lower)
cystitis if it involves bladder (lower)
pyelonephritis if it involves kidneys (upper)

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4
Q

what’s more alarming, lower or upper UTI?

A

upper UTI

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5
Q

what percentage of women will present UTI symptoms to a GP during their lifetime?

A

50%

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6
Q

what are risk factors for UTIs?

A 
women
sexually active
menopause
urinary tract abnormalities
blockages in urinarytract
functional abnormalities e.g. MS or spina bifida
pregnancy 
catheter use
children <5
men >70
lower birth rates and premature delivery
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7
Q

why can pregnancy be a risk factor for UTIs?

A

dilated urethras and incomplete bladder emptying

maybe also gestational glycosuria

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8
Q

why do blockages in the urinary tract pose as a risk factor for UTIs?

A

they cause mucosal damage so bacteri are less abailable to hist defences

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9
Q

why is menopause a risk factor for UTIs?

A

lower oestrogen levels makes it easier for bacteria to grow

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10
Q

why are women more at risk than men for UTIs?

A

they have a shorter urethra and the urethra lies closer to the perineum

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11
Q

what pathogen most commonly causes UTIs? why?

A

E.coli - because they are members of the bacterial flora of the large bowel so can easily spread from urethra to anus

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12
Q

outline the virulence factors that uropathogenic E.coli have?

A

type 1 fimbriae, K antigen and type p fimbriae

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13
Q

what do type 1 fimbriae do?

A

they mediate adhesion to mannose-containing receptors on uroepithelium to promote formation of intracellular bacterial communities

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14
Q

what are some pathogens that can cause UTIs other than E.coli?

A

Klebsiella species, Proteus species, Pseudomonas aeruginosa, and Enterococcus species, mycobacterium tuberculosis

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15
Q

what are the host defences against UTIs?

A
  • urine flow and micturition
  • urine chemistry - osmolality, pH and organic acids
  • secreted factors - secretory IgA and lacteroferrin
  • mucosal defences - mucopolysaccharides and few receptors
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16
Q

what are symptoms of lower UTIs?

A

burning with urination, increased frequency, increased urgency, blood in urine, cloudy urine, brown urine, strong odoured urine, pelvic pain in women and rectal pain in men

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17
Q

what are symptoms of upper UTIs?

A 
same as lower UTI  plus...
pain and tenderness in upper back and sides
chills
fever
nausea and vomiting
18
Q

how are acute urethritis and cystitis differentiated?

A

fever is more common in urethritis
urethral discharge is more suggested of urethritis
bladder-related symptoms like urgency, polyuria and incomplete voids are more consisten in cystsitis

19
Q

whats the diagnostic criteria for symptomatic UTI with no indwelling catheter?

A

ypu must have at least 3 of the following…

new or increased burning pain on urination, frequency, urgency, new flank/suprapubic pain or tenderness

20
Q

how do we use urinanalysis for diagnosis of UTI?

A

to detect proteinuria, haematuria, leukcoyte esterase and nitrites

21
Q

what are we looking for in urine microscopy for diagnosing UTIs?

A

presence of WBC, epithelial cells and RBCs

22
Q

why do urinary catheters cause UTIs so frequently?

A

they bypass the defence mechanisms of the lower urinary tract and act as a foreign body

23
Q

how can you reduce the risk of catheter-induced UTIs?

A

Restricting catheterization to those who clinically require it, limit the duration of catherisation, use aseptic insertion

24
Q

what is a closed drainage system catheter?

A

an aseptic system in which the path from the tip of the catheter inserted into the bladder, to the bag which catches urine, is closed and should not be disconnected.

25
Q

does catheter associated bacteriuria need to be treated?

A

treatment is only needed for symptomatic catheter-associated UTI not asymptomatic bacteriuria (apart from pregnant women)

26
Q

why dont we treat asymptomatic bacteriuria?

A

increasing antimicrobial resistance

27
Q

what is urethral syndrome?

A

symptoms suggestive of a lower urinary tract infection but in the absence of significant bacteriuria.

28
Q

why causes urethral syndrome?

A

low bacteria counts, non-infective inflamamtion and sexually transmitted diseases

29
Q

what is uncomplicated lower UTIs?

A

Infection in a healthy, non-pregnant, pre-menopausal female patient with anatomically and functionally normal urinary tract.

30
Q

whats the treatment for uncomplicated lower UTIs?

A

maintain good hydration, may resolve spontaneously, short course of antimicrobials if needed

31
Q

what is complicated lower UTIs?

A

Infection associated with factors increasing colonization and decreasing efficacy of therapy e.g. catheter use or urinary stones

32
Q

how do we defines recurrent UTIs?

A

3 or more uncomplicated UTIs in 12 months

33
Q

how do we treat recurrent UTIs?

A

prophylactic antibiotics, voiding post intercourse, HRT in post-menopausal women or proanthocyanidins

34
Q

what are proanthocyanidins? give examples?

A

chemical molecules that inhibit the adherence of p-fimbriated E.coli on uroepithelial cells of the bladder, preventing adherence of bacteria to mucosal surface and thereby inhibiting bacterial proliferation.
cranberry, grape seeds and blueberries

35
Q

what are risk factors for children and UTIs?

A

poor urine flow, history of UTI, recurrent fever of unknown origin, renal abnormalities, family history of uterovesical reflux, evidence of spinal lesions, poor growth, high bp

36
Q

what are some common drugs recommended for UTIs?

A 
Trimethoprim 
sulfamethoxazole 
Fosfomycin 
Nitrofurantoin 
Cephalexin 
Ceftriaxone.
37
Q

outline the pathophysiology of UTIs?

A

contamination of the lower urinary tract -> colonisation of urethra and bladder -> inflammatory response with neutrophil infiltration -> bacteria multiply and evade immune system due to virulence factors -> If UTI progresses and was left untreated or if the patient is immunocompromised then bacteria can ascend towards the kidneys and cause an upper UTI

38
Q

what do you do if a urine dipstick doesnt suggest UTi but symptoms do?

A

send for microscopy culture sensitvity

39
Q

whats the treatment of lower UTIs?

A

3-7 days of oral antibiotics e.g. trimethoprim, nitrofurantrion and amoxicillin

40
Q

how do you treat upper UTIs?

A

IV antibiotics until fever has settled and then oral antibiotics - tends to have a longer course of treatment

41
Q

when do you refer to a urologist for a UTI?

A

if it doesnt respond to treatment, if there are recurrent UTIs, men with symptoms of upper UTIs and haematuria

xB10W2 (6 decks)

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