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Microbiology of UTI Flashcards

1
Q

UTI definition?

A

microorganisms in urinary tract causing clinical infection

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2
Q

where is lower UTI?

A

confined to bladder (cystitis)

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3
Q

where is upper UTI?

A

ureters +/- kidneys (pyelonephritis)

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4
Q

describe distribution of bacteria in urinary tract

A

urine in kidneys and bladder = sterile

lower end of urethra colonised by coliforms and enterococci from large bowel

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5
Q

what is a complicated UTI?

A

UTI complicated by systemic symptoms or urinary structural abnormality/stones

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6
Q

what is bacteriuria?

A

bacteria in urine

not always infection - common in elderly patients or patients with catheters

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7
Q

what must be done for bacteriuria?

A

culture

dipstick not enough

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8
Q

who is UTI most common in?

A

women (urethra is shorter and wider and closer to anus)
catheterised patients
any abnormality in urinary tract

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9
Q

what can cause an ascending infection?

A

bacteria from bowel
perianal skin
lower end of urethra
bladder > ureters > kidneys

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10
Q

two common routes of infection in UTI?

A

ascending (most common)

bloodstream

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11
Q

what can cause bloodstream UTI?

A

septicaemia
seeded into kidneys
multiple small abscesses
bacteria in urine

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12
Q

when should urine sample be taken?

A

mid stream

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13
Q

when is dipstick useful?

A

young people with cystitis

not useful in older people or people with catheters as it doesn’t really tell you much, has lots of false positives

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14
Q

describe coliforms

A

gram -ve bacilli

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15
Q

biggest cause of UTI?

A

coliforms

  • E.coli (mainly)
  • also klebsiella and enterobacter
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16
Q

other non coliform causes of UTI?

A

pseudomonas

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17
Q

describe E. Coli

A

endotoxin in LPS layer

fimbriae (help it to attach)

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18
Q

describe proteus

A

foul smelling (burn chocolate)
produces swarming cultures
causes alkaline urine leading to precipitation of salts

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19
Q

what type of stone does proteus cause?

A 
struite stones (triple phosphate)
- due to alkaline urine
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20
Q

describe pseudomonas

A

gram -ve bacillus
NOT A COLIFORM
associated with catheters and urinary instruments

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21
Q

pseudomonas is resistant to most antibiotics except what?

A

ciprofloxacin

22
Q

describe the action of ciprofloxacin

A

inhibits bacterial DNA gyrase, preventing supercoiling of DNA
not used in children or pregnant women
C. Diff risk
active against pseudomonas, most coliforms, some enterococci but not staph

23
Q

what commonly causes UTI in hospitals?

A

enterococcus
- faecalis (mainly)
- faecium
(types of strep which live in the GI tract)

24
Q

who gets staph saphrophyticus UTI?

A

women of child bearing age

25
who gets staph aureus UTI?
if bacteraemia is present
26
symptoms of UTI?
dysuria frequency nocturia haematuria
27
what 3 features suggest involvement of upper urinary tract and should be taken seriously?
fever rigors loin pain
28
cystitis vs pyelonephritis?
pyelonephritis more common in systemic disease (diabetes, immunosuppression etc) pyelonephritis causes more systemic symptoms (fever, chills, malaise, nausea etc)
29
how is UTI diagnosed?
mid stream specimen collection - can be suprapubic aspiration - straight in/out catheter
30
describe process of collecting mid-stream specimen
wash perineum/urethral meatus with sterile saline (not antiseptic) give patient wide mouth bowl first urine passed into toilet next part of stream collected in bowl without interruption last urine passes into toilet urine transferred into lab container
31
what containers are used for urine specimen?
``` boricon (stops bacteria multiplying to can last 24 hrs) sterile universal (must reach lab within 2 hrs) ```
32
other methods of urine collection?
clean catch (in children or cognitive/physical restriction) bag urine (used in babies - negative finding is more useful to rule out UTI) catheter specimen suprapubic aspiration
33
purpose of dipstick testing?
leukocyte esterase indicates WBCs in urine nitrites indicates bacteria in urine can show protein and blood (not useful for diagnosis) NOT USED IN ELDERLY OR CATHETER SPECIMENS
34
lab diagnosis of UTI?
microscopy not really used, can be used after culture culture usually done - >10x5 per ml = significant
35
Kass criteria for culture diagnosis?
10 to power 5 organisms/ml of urine = probable UTI
36
what is mixed growth?
2 or more organisms on culture | usually not significant if found on culture, even if > 10x5/ml
37
management of uncomplicated UTI?
3 day course of antibiotic in women | anti-inflammatories can be as good as antibiotics in some cystitis patients
38
what is abacterial cystitis/urethral syndrome?
symptoms of UTI and pus cells present in urine but no significant growth on culture can be early phase of UTI, urethral trauma or urethritis due to STI
39
how can abacterial cystitis be managed?
alkalinising the urine can help symptoms
40
what is asymptomatic bacteriuria?
significant bacteriuria (>10x5/ml) no symptoms, codition is detected incidentally no pus cells in urine
41
how is asymptomatic bacteria managed?
no antibiotics needed all pregnant women are screened at 1st antenatal visit antibiotics are given in pregnancy as can progress to pyelonephritis or lead to growth retardation in foetus
42
when should catheterised patients be given antibiotics?
only if >10x5 organisms/ml and supporting evidence of UTI (fever, symptoms etc) common to have colonising bacteria in catheter
43
empirical female lower UTI management?
nitrofurantoin or trimethoprim orally for 3 days
44
uncatheterised male UTI management?
get cultures | nitrofurantoin or trimethoprim orally for 7 days
45
how is complicated UTI or pyelonephritis managed in GP?
co-amoxiclav or co-trimoxazole for 14 days
46
how is complicated UTO or pyelonephritis managed in hospital?
amoxicillin and gentamicin IV for 3 days | - co-trimoxazole + gentamicin if penicillin allergic
47
first line for coliforms?
gentamicin IV
48
first line for enterococcus?
amoxicillin IV
49
1st line UTI antibiotics?
amoxicillin trimethoprim nitrofurantoin gentamicin
50
2nd line UTI antibiotics if resistant?
pivmecillinam co-amoxiclav ciprofloxacin
51
main features of gentamicin?
``` only used in hospital avoid in pregnancy narrow therapeutic index first line for coliforms only give for 3 days ```

Renal (34 decks)

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