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Micro 3010 > Unit 13 - UTI's > Flashcards

Unit 13 - UTI's Flashcards

1
Q

UTI’s are a very common type of ______ infection

A

bacterial

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2
Q

What gender is at greater risk?

A

women > men

  • pregnancy increases risk
  • sexual activity
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3
Q

Does age pose a risk?

A

yes - elderly more likely to get UTI’s

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4
Q

Who else is at risk of getting a UTI?

A

Patients with:

  • co-morbid conditions (diabetes)
  • spinal cord injuries (can’t empty bladder as frequently and smoothly)
  • catheters (substrate for bacteria to grow on, and a passage for bacteria)
  • GU tract abnormalities
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5
Q

There are 2 types that a UTI can occur: Describe them

A

1) Ascending route (up urinary tract)

2) Hematogenous spread (gets into blood then into kidneys and urinary tract)

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6
Q

_____ is a common cause because antibiotics suppress normal microflora

A

candida

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7
Q

More gram _____ in hospitals because they are intrinsically resistant to antibiotics which allows them to grow in hospital.

A

negative

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8
Q

Bacteriuria

A

bacteria in urine

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9
Q

Bacteriuria can be _______ or _________

A

symptomatic or asymptomatic

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10
Q

asymptomatic bacteriuria (ASB) is if person is healthy and resolves it by itself but treatment is recommended for certain individuals: which individuals?

A

during pregnancy, prostate resection, immunosuppression

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11
Q

Relapse

A

an infection when the same agent causes infection after 2 weeks without symptoms

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12
Q

Reinfection

A
  • brand new infection
  • needs to be 1 month between 2 infections
  • could be same organism or new organisms
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13
Q

Describe uncomplicated UTI’s

A
  • usually happen in healthy females (50% of all females will have UTI at least once)
  • readily treated with antibiotics
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14
Q

Describe complicated UTI’s

A
  • either gender
  • more difficult to treat
  • Key risk factors:
    • underlying diseases
    • kidney stones
    • urinary tract abnormalities
    • indwelling urinary catheters
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15
Q

Contributing factors?

A
  • length of urethra
  • sexual activity (females)
  • uncircumcised male infants
  • blockage
  • catheterization (3-10% increased risk/day of catheterization)
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16
Q

Bacterial attributes to UTI’s

A
  • capsular antigens
  • haemolysins
  • urease
  • adhesion to uroepithelium
  • introital colonization
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17
Q

Host factors to UTI’s

A
  • renal calculi
  • ureteric reflux
  • tumours in and adjacent to urinary tract
  • pregnancy, bladder stones
  • neurologic problems (incomplete bladder emptying, large volume of residual urine, loss of sphincter control)
  • prostatic hypertrophy
  • short urethra in women
  • catheterization
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18
Q

List types of UTI’s

A
  • Asymptomatic bacteriuria
  • Urethritis
  • Cystitis
  • Acute urethral syndrome
  • Pyelonephritis
  • Prostatitis
  • Cervicitis
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19
Q

Describe the type:

Asymptomatic bacteriuria

A

is if person is healthy and resolves it by itself but treatment is recommended for certain individuals (during pregnancy, prostate resection, immunosuppression)

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20
Q

Describe the type:

Urethritis

A
  • infection of the urethra

- symptoms include dysuria (pain or discomfort when urinating) & frequency

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21
Q

Describe the type:

Cystitis

A
  • bladder infection
  • symptoms include dysuria (pain or discomfort when urinating), frequency, urgency, pain over bladder area
  • signs include bloody urine, cloudy urine, bad odour
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22
Q

Describe the type:

Acute urethral syndrome

A
  • same symptoms as cystitis but lower CFU/mL than cystitis

- pyuria (pus in the urine from a bacterial infection)

23
Q

Describe the type:

Pyelonephritis

A

infection of kidney & renal pelvis

24
Q

Describe the type:

Prostatitis

A

infection involving prostate

25
Q

Describe the type:

Cervicitis

A

inflammation of cervix

26
Q

Epidemiology of UTIs in pediatrics

A
  • high morbidity
  • impaired renal function
  • hypertension
  • end-stage renal disease
  • complications during pregnancy as adult
27
Q

Epidemiology of UTIs in adults < 65 years old

A

incidence in women > incidence in men

28
Q

Epidemiology of UTIs in geriatrics

A
  • incidence in both men and women increases but ratio changes
  • prostate enlargement leads to poorer bladder emptying which leads to increased UTI incidence
29
Q

Microbial Virulence Factors

A
  • Adherence (bacterial adhesions)
  • Calculi formation
  • Toxin & enzyme production (hemolysins, lipopolysaccharides)
  • Capsular polysaccharide
  • Biofilms
30
Q

Host defences

A
  • Flushing action of urinary flow
  • Growth inhibitory properties of urine (low pH, osmolarity, high urea, organic acid concentrations)
  • Mucopolysaccharides
  • Preventing reflux
31
Q

Resident normal microflora of the urethra varies with age & health status:
Describe newborns

A

sterile

32
Q

Resident normal microflora of the urethra varies with age & health status:
Describe 1-3 days

A

Staph, enterococci, diptheroids

33
Q

Resident normal microflora of the urethra varies with age & health status:
Describe 3 days - weeks

A

lactobacillus acidophilus

34
Q

Resident normal microflora of the urethra varies with age & health status:
Describe prepubertal

A

micrococci, streptococci, coliform, diptheroids

35
Q

Resident normal microflora of the urethra varies with age & health status:
Describe adult

A

L. acidophilus, staphylococcus epidermis, streptococci (alpha & non-hemolytic), E. coli, diphtheroids, yeasts

36
Q

Resident normal microflora of the urethra varies with age & health status:
Describe pregnancy

A

increase L. acidophilus, yeasts, S. epidermidis

37
Q

Resident normal microflora of the urethra varies with age & health status:
Describe postmenopausal

A

similar to prepubertal flora:

micrococci, streptococci, coliform, diptheroids

38
Q

Gram-negative bacilli

A

Enterobacteriaceae

  • fecal E. coli, uncomplicated UTIs
  • MDR (multi-drug resistant) enterobacteriaceae, hospital-acquired
  • duration of hospitalization and catheterization
    • Increased pseudomonas, proteus, klebsiella, acinetobacter, and enterobacter
    • decreased E. coli
39
Q

Gram-positive cocci

A

Enterococci
-older men, urinary tract manipulation, instrumentation

Staphylococcus saprophyticus
-symptomatic sexually active women <40 yrs

40
Q

Gram positive bacilli

A

Diphtheroids, mycobacteria and Listeria monocytogenes

-Bacillus

41
Q

Fungi

A

Candiduria, hospitalized patients

42
Q

Lower UTI affects ??

A

bladder and urethra

43
Q

Lower UTI includes ____

A

cystitis

44
Q

Describe cystitis

A
  • dysuria (burning pain during urination)
  • urgency
  • increased frequency
    • E. coli, Klebsiella spp, other enterobacteriaceae, enterococci, CoNS
45
Q

Upper UTIs include ??

A
  • Acute pyelonephritis

- Subclinical pyelonephritis

46
Q

Describe acute pyelonephritis

A
  • fever
  • lower UTI symptoms (dysuria, urgency, increased frequency)
  • enterobacteriaceae, staphylococcus aureus
47
Q

Describe subclinical pyelonephritis

A

-CoNS, candida spp, mycobacterium spp, mycoplasma hominis
Important:
-pregnant women and young children
-patients undergoing instrumentation in UT
-elderly and diabetics

48
Q

Laboratory diagnosis determine ______ vs ______

A

infection vs colonization

49
Q

Laboratory diagnosis collects _________ urine

A

midstream

MSU = midstream urine

50
Q

Describe the microscopic examination

A

rapid

preliminary report

51
Q

Describe suprapubic aspiration of bladder urine and when it would be useful

A

Urine samples are collected directly from the bladder by insertion of a needle.
This method is useful in young children from whom it is difficult to obtain an uncontaminated midstream urine specimens

52
Q

Describe the interpretation of results

A
  • Collection
  • Storage (cultured within 1 hour of collection, stored at 4 degrees celsius for not > 18 hours)
  • Antibiotic treatment (take into thought resistance, and if the number is significant ??)
  • Fluid intake (influence on quantitation)
  • Kind of specimen (MSU vs catheter/suprapubic aspiration)

*MSU = midstream urine

53
Q

What is the treatment for an uncomplicated UTI - cystitis?

A
  • may resolve spontaneously within 4 weeks (up to 40% patients)
  • antibiotics administered to reduce symptoms & ensure complete eradication
  • followup recommended at the end of the treatment
  • drink lots of fluids to facilitate flushing action
54
Q

What is the treatment for a complicated UTI - pyelonephritis?

A
  • systemic IV treatment until symptoms subside
  • oral therapy afterwards
  • > 10 days to sterilize kidney

Micro 3010 (20 decks)

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