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Renal > Urinary tract infection > Flashcards

Urinary tract infection Flashcards

1
Q

Risk of UTI - facotrs

A
  • host defences

- bacterial virulence

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2
Q

How does an ascending infection start?

A
  • colonisation of perineum and external genitalia
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3
Q

What are the commonest bacterial isolates?

A
  • E.coli > Staphs > Proteus > Klebsiella > Others
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4
Q

Which spp are prone to UTI?

A
  • cats more resistant to UTIs than dogs
  • horses and cattle have similar bacteria spp but also get Corynebacterium
  • cattle more prone to pyelonephritis
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5
Q

List normal host defence mechanisms

A
  • normal micturition
  • anatomical and physiological factors
  • mucosal defence barriers
  • AM effects of urine
  • renal defence mechanisms
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6
Q

Describe normal voiding

A
  • frequent
  • complete
  • adequate flow
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7
Q

Causes - voiding abnormalities

A
  • urethral obstruction
  • spinal dz
  • bladder atony
  • poor husbandry
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8
Q

Protective urinary physiology

A
  • urethral high pressure zone
  • surface characteristics of urethral urothelium
  • urethral peristalsis
  • prostatic antibacterial fraction (bacteriostatic)
  • longer urethral length: males
  • ureterovesical valves and ureteral peristalsis
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9
Q

Conditions associated with increased UTI risk

A
  • ectopic ureters
  • urethral sphincter mechanism incompetence
  • anatomical abnormalities following sx (e.g. perineal urethrostomy)
  • urethral trauma (e.g. catherisation)
  • disease (neoplasia)
  • chemical irritants (cyclophosphamide)
  • older cats (urine changes) > younger cats
  • DM (glucosuria)
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10
Q

Protective factors - mucosal barrier

A
  • AB production
  • surface GAG layer
  • intrinsic mucosal AM properties
  • bacterial interference
  • cell exfoliation
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11
Q

How is urine protective against UTI?

A
  • extreme pH (low or high)
  • hyperosmolality
  • high (urea)
  • organic acids
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12
Q

Pathogenicity of bacteria causing UTI (UPEC)

A
  • avoid flushing action of urine (P- and S-fimbriae)
  • complement-resistant –> organophagocytosis-resistant
  • haemolysin production and iron-chelating activity
  • motility?
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13
Q

Define UPEC

A

Uropathogenic E. coli

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14
Q

Dx - UTI

A
  • direct urine culture by swab is inappropriate (contaminants –> false positive, requires bacterial account)
  • sample: rapid delivery, hold at 4 degrees, boric acid preservative
  • blood agar and MacConkey
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15
Q

How does a bacterial count show a UTI?

A
  • > 100,000 CFU/ml = UTI
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16
Q

Define recrudescence/ relapse

A

= same strain (indicating tx failure)

17
Q

Define recurrence or reinfection

A

= new strain (indicating susceptibility of the animal)

18
Q

Incidence of UTIs in cats/dogs

A
  • variable, about 14% dogs get bacterial UTI during life
  • bitches > dogs
  • older > younger cats
  • usually bacterial
  • fungal rare
  • viral implicated as causal factor in cats with FLUTD but incidence unknown
19
Q

Define UTI

A

= adherence, multiplication and persistence of an infectious agent in the uro(genital) system

20
Q

Define mircoburia

A

presence of microbes in urine

21
Q

Define bacturia

A

presence of bacteria in urina:

  • INFECTION: >10^5/ml
  • SUGGESTIVE OF INFECTION: >10^3 (depends on collection methods)
  • CONTAMINATION:
22
Q

Define funguria

A

presence of fungi in urine

23
Q

Define pyuria

A

increased #s WBCs in urine (>5hpf)

  • significance depends on method of collection
  • cystocentesis >3-5/hpf
  • catheter/free catch >5-10 /hpf
  • increased WBCs indicate inflammation which may or may not be associated with infection
24
Q

What do CS depend on?

A
  • predominant site (UUT vs LRT)

- presence of predisposing conditions (cacluli, DM, neoplasia)

25
Q

CS - UUT (kidneys/ureters)

A
  • renal/lumbar ain
  • haematuria
  • septicaemia
26
Q

CS - LUT

A
  • pollakiuria
  • stranguria
  • dysuria
  • inappropriate urination
27
Q

DX - UTI

A
  • quantitative urine culture

- other tests may suggest but not diagnose a UTI: urinalysis and urine sediment exam, gross appearance and smell

28
Q

Outline urine sample collection

A
  • best done aseptically to prevent contamination*
  • cystocentesis best
  • catheterised sample good alternative provided done carefully
  • free catch not ideal
  • culture (bladder biopsy or urolith) may be useful
  • animal shouldn’t have received ABs 5-7d prior to sample
29
Q

Outline urine sample transport

A
  • sealed sterilised container
  • refridgerated
  • send asap
  • boric acid (bacteriostatic, sometimes used, may not be appropriate)
  • follow courrier regulation
  • avoid sending on friday
  • remember costs and hidden costs
30
Q

Tx principles - UTI

A
  • ABs (mainstay)
  • ideally based on C+S
  • may be used empirically (first occurrence, pending results of C+S)
31
Q

Principles - choosing an AB for UTI

A
  • based on C+S
  • bacteriocidal
  • excreted in urine –> high concentrations
  • no/low risk of toxicity
  • easy to administer
  • cheap
  • good penetration into other related tissue if required (prostate)
  • within cascade
  • avoid abuse of new/BS ABs
32
Q

Outline empiric AB use

A
  • appropriate 1st incidence where no underlying cause
  • short course (5-7d) of AB predicted to ‘hit’ the most likely bacteria (E.coli, Staph)
  • drugs most appropriate (Ampicillin, potentiated amoxicillin, cefalexin, trimethoprim sulphonamide = TMS - latter now less popular)
  • use top end of dose range
33
Q

What to do if UTI signs recur after empiric AB tx?

A

urine sample + consider further investigation

34
Q

Indications - therapeutic culture

A
  • UTI associated with high risk morbidity/mortality (prostatitis, pyelonephritis, immunosuppression)
  • toxic AB (gentamicin, amikacin)
  • signs not improving after 3-5 d after starting tx
  • before discontinuing ABs
35
Q

Indications - surveillance culture

A

AFTER ABs GIVEN:

  • ensure tx success
  • if signs recur (same or different organism?)
  • concerns about underlying condition which increases UTI risk (FLUTD, urinary incontinence, recessed vulva)
36
Q

Causes - tx failure - UTI

A
  • infection NOT the cause
  • inadequate AB delivery (client factors, animal factors, ineffective drug/delivery)
  • AB resistance (intrinsic, acquired)
  • undiagnosed/untreated predisposing factors –> superinfection
37
Q

Actions - poor clinical response to AB for UTI (but you are sure of infection)

A

Define if culture –>

  • no bacterial growth
  • growth of same bacteria susceptible to current AB
  • growth of same bacteria not susceptible to current AB
  • culture of new spp

Renal (30 decks)

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