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SM Renal > Microbiology of Urinary Tract Infection > Flashcards

Microbiology of Urinary Tract Infection Flashcards

1
Q

What part of the renal tract is colonised by bacteria

A

The distal end of the urethra

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2
Q

What type of bacteria is found in the distal end of the urethra

A

Coliforms and enterococci from the large bowel

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3
Q

What is the definition of a UTI

A

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

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4
Q

What is cystitis

A

Inflammation of the bladder that ay or may not be caused by an infection

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5
Q

What is a lower UTI

A

an infection that is confined to the bladder (cystitis)

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6
Q

What is an upper UTI

A

An infection involving the ureters +/ the kidneys (pyelonephritis)

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7
Q

Why is it important to determine whether the infection is upper or lower

A

Different antibiotics are used to treat different levels of the urinary tract

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8
Q

What is a complicated UTI

A

A UTI complicated by systemic sepsis or a urinary structural abnormality or stones

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9
Q

What patients are more likely to have bacteria in their urinary tract but not necessarily an infection

A

Patients with catheters or elderly patients

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10
Q

What is meant by bacteriuria

A

The presence of bacteria in the urine

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11
Q

Give 3 reasons that make women more susceptible to UTI than men

A

Short wide urethra
proximity of urehtra to anus is shorter
increased risk with sexual activity,
pregnancy (uterus presses down on the bladder resulting in incomplete emptying)

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12
Q

Ascending infection is more common. Describe how it occurs

A

Bowel organisms colonise the perineal skin. they travel to the lower end of the urethra, into the bladder, ureters and then kidneys

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13
Q

Describe how infection occurs from the blood

A

The patient has bacteraemia/ septicaemia from another focus of infection –> bacteria in blood –> seeded into kidney –> multiple small abscesses –> bacteria in urine

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14
Q

What organism is responsible for 70% of UTI

A

E Coli

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15
Q

What are almost all causal organisms

A

Gram negative bacilli

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16
Q

What are some other causal organisms

A

Coliforms
Klebstelle sp.
Enterobacter sp.
Proteus sp.

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17
Q

What is protest sp. associated with

A

the formation of stones (calculi)
They produce urease which changes urinary pH which causes precipitation of salts and this can result in the formation of stones

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18
Q

there are 2 common forms of Enterococcus spp.
Name them
What is more difficult to treat and why

A

Enterococcus faecalis and enterococcus faecium

Faecium is more difficult to treat as it is more resistant to antibiotics

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19
Q

What organism usually affects women of child bearing age

A

Staphylococcus saphrophyticus

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20
Q

What is pseudomonas aeruginosa associated with

A

UT instrumentation or catheters

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21
Q

What is the antibiotic that seems to be sensitive to pseudomonas aeruginosa.

What is the disadvantage of using it

A

Ciprofloxacin

Associated with C diff infection

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22
Q

How does pseudomonas aeroginosa behave differently to other coliforms

A

It grows aerobically

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23
Q

What are the signs and symptoms of a UTI

A

dysuria
frequency of urination
nocturia
haematuria

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24
Q

What are some signs of an upper urinary tract infection

A

fever
loin pain
rigors

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25
Q

How is the best specimen collected

A

Wash perineum / urethral meatus with sterile saline (not antiseptic)
Allow patient to pass first part in toilet. Collect second part which should have less organisms and not just urethral organisms
Pass last urine in toilet

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26
Q

Why should antiseptic not be used to wash the perineum

A

It can inhibit bacteria growth which may affect lab results

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27
Q

What is the difficulty with bag urine collection

A

It is often contaminated with bowel flora

A negative culture result is more useful than a positive as it can exclude infection from the differential

28
Q

What might a clinician do lift he bag urine is positive

A

Suprapubic aspirate of urine

29
Q

How is urine collected from a catheter for culture

A

Take from a collection port - not the bag

30
Q

What is the best container to collect urine for sending to the lab

A 
Boricon container (red top) 
It contains the preservativeve boric acid which will stop bacteria multiplying for 24 hours
31
Q

When might LEU be raised on dipstick

A

Catheterised patients

32
Q

What organism does not give a positive nitrite test

A

Enterococci

33
Q

If a patients urinalysis shows LEU, when should you send a sample

A

Only if they have signs and symptoms as well

34
Q

What should we look for on microscopy of urine

A

Not done routinely but when we do we look for: presence of polymorphs (pus cells), bacteria +/- RBCs

35
Q

When is a plate insignificant of a urine infection

A

10^3

36
Q

When is a plate of urine definitive for UTI

A

10^5 organisms or more but usually only 1 organism shows huge numbers (not huge numbers of various organisms)

37
Q

When might a urine plate be contaminated or show signs of an early UTI

A

10^4 organisms

Test should be repeated

38
Q

What is the problem of using Kass’s Criteria

A

It only applies to women of child bearing age

39
Q

What is ESBL

A

Extended spectrum beta lactamase - this is an enzyme that breaks down the beta lactic rings in almost all cephalosporins and penicillins

40
Q

Where is ESBL carried

A

on a plasmid

41
Q

What are some antibiotics that may be useful for treating ESBL-producing bacteria

A 
Nitrofurantoin - oral
Pivemecillinam - oral
Fosfomycin - oral 
Tmocillin-IV
Meeropenem - IV
Ertapenem -IV
42
Q

What is though to be one of the causes for the increasing incidence of ESBL producing bacteria

A

Imported chickens - they contain antibiotic strains

43
Q

What are carbapenemase- producing enterobacteriaceae (CPE)

A 
Gram negative (coliform) bacilli that are resistant to meropenem --> basically resistant to all antibiotics  
This is the last choice antibiotic
44
Q

Why did CPE become resistant

A

A lot of organisms are found in Asia. Uncontrolled use of antibiotics there

45
Q

What are 4 ideal components of an antibiotic

A

Excreted in urine in high concentration
Oral
Inexpensive
Few side effects

46
Q

Why is trimethoprim the first line AB in women

A

It inhibits bacterial folic acid synthesis - a range of organisms can be treated

47
Q

Why is trimethoprim contraindicated in the 1st trimester of pregnancy

A

It inhibits folate synthesis –> spinabifida is associated with low levels of folic acid in pregnancy

48
Q

How can trimethorprim be given

A

As co-trimoxaxole (IV or oral)

49
Q

When would nitrofurantoin be given

A

In lower uncomplicated UTI -

50
Q

When should nitrofurantoin be avoided

A

Late pregnancy

Breastfeeding

51
Q

Why can Nitrofurantoin only be used for uncomplicated lower UTI

A

It is only activated in the urine

52
Q

Why should gentamicin be avoided in pregnancy

A

Risk of hearing problems and kidney problem in the fetus

VIIIth nerve damage - deafness and balance problems

53
Q

How long should gentamicin be prescribed for

A

3 days only - not 3 doses

54
Q

What is the main advantages of using pivmecillinam

A

Very beta-lactamase stable - high activity against very antibiotic-resistant coliforms that produce extended spectrum beta-lactamases (ESBLs)
Less of a risk of C diff

55
Q

When would Temocillin be used

A

It is useful for patients whose renal function is too poor for gentamicin but is not as effective

56
Q

When is Cefalexin used

A

During pregnancy

57
Q

What is co-amoxiclav made up of

A

amoxicillin and clavulanic acid

58
Q

What does Ciprofloxacin do

A

Inhibit bacterial DNA gyros which prevents supercoiling of bacterial DNA

59
Q

Who should not receive ciprofloxacin

A

Pregnant women or young children

60
Q

What is the antibiotic of choice for a female lower UTI

A

Trimethoprim or nitrofurantoin
oral
3 days

61
Q

What is the antibiotic of choice for an uncatheterised male UTI

A

Trimethoprim or nitrofurantoin orally

7 days

62
Q

What is the antibiotic used for a complicated UTI or pyelonephritis (GP)

A

Co-amoxiclav or co-trimoxazole

14 days

63
Q

What is the antibiotic used for a complicated UTI or pyelonephritis (hospital)

A

Amoxicillin and gentamicin IV for 3 days
Co-trimoxazole and gentamicin if penicillin allergic
Stepdown as guided by antibiotic sensitivities

64
Q

Why are pregnant women treated for asymptomatic bacteriuria but other patients are not

A

If pregnant women are left untreated, 20-30% progress to pyelonephritis
This may lead to intra-uterine growth retardation or premature labour

65
Q

What might help symptoms of bacterial cystitis / urethral syndrome

A

Alkalinising the urine may help

SM Renal (23 decks)

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