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microbiology 2 > urinary tract infections > Flashcards

urinary tract infections Flashcards

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1
Q

cystitis

A

infection of the bladder mucosa

low urinary tract infection

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2
Q

pyelonephritis

A

infection of the parenchyma and collecting system of the kidney (upper urinary tract infection

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3
Q

asymptomatic bacteriuria

A

significant bacteriuria present in the urine with no symptoms
bacteria present in the urine in significant numbers without signs or symptoms of UTI
presence of the same organism in counts of >10^8/L in two consecutive samples

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4
Q

cytistis and pyelonephritis may

A

coexist
may need cystitis before getting pyelonephritis
may also have sunclinical pylonephritis

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5
Q

asymptomatic bacteriuria usually seen in

A

children, pregnant and the elderly

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6
Q

asymptomatic bacteriuria defined by

A

presence of the same organism in counts of >10^8 /L in two consecutive samples

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7
Q

uncomplicated urinary tract infection

A

infection of bladder or kidney occurring in a normal host without structural or functional abnormality of the urinary tract

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8
Q

complicated urinary tract infection

A

infection associated with factors increasing colonisation and decreasing efficacy of therapy
- anatomic or functional abnormality of urinary tract
- immunocompromised host
- multi-drug resistant bacteria
more severe, is diffucult to treat and recurrent

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9
Q

burden of UTI

A 
common 
common HAI
most are catheter related 
more hospitalisations in 
- remote areas 
- lower socioeconomic standing 
- aboriginal and Torres straight islanders
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10
Q

UTI risk factors

A
  • very young or very elderly
  • female
  • pregnancy
  • sexual activity
  • spermicides
  • menopause
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11
Q

UTI in children

A

associated with a high incidence of urinary tract abnormalities

  • vesoci-uriteric reflux
  • ureteral duplication
  • trabeculated bladder
  • hydrometer
  • uretopelvic junction obstruction
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12
Q

vesico-ureteric reflux

A

abnormalities in the way that the ureter inserts into the bladder
when the bladder contracts some urine flows backward into the ureter and toward the kidney

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13
Q

consequences of vesico-ureteric reflux

A

reflux nephropathy

leads to renal scarring which causes hypertension and renal failure

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14
Q

consequences of UTI

A

also result in hypertension and renal failure

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15
Q

UTI and vesicle-ureteric reflux

A

severely increased likelihood of reflux nephropathy and renal scarring leading to hypertension and renal failure

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16
Q

treatment of VUR

A

urinary tract abnormalities such as VUR may require surgical correction
children experiencing urinary tract infection should have their urinary tract evaluated by radiological imaging

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17
Q

UTi in pregancy

A 
asymptomatic bacteriuria (especially recurrent) is more common in pregnancy - making cystitis more likely and pyelonephritis 
pyelonephritis has adverse pregnancy outcomes incr]luing maternal morbidity and preterm birth
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18
Q

adverse pregnancy outcomes in asymptomatic bacteriuria

A

preterm birth
low birth weight
perinatal mortality

19
Q

screening for ASB

A

pregnant women should be screening for ASB at least once in pregnancy
treatment with antibiotics

20
Q

most UTIs result from

A

ascending infection

21
Q

other cause of UTI

A

haematogenous seeding of the kidneys may occur when a patient is bacteraemic with organisms such as S aureus and candida - rare with gram negative enteric bacteria

22
Q

most bacteria causing UTIs originate in

A 
the bowel 
colonise the lower vagina and periurethral mucosa 
colonise the distal urethra 
ascend the urethra into the bladder 
up the ureters into the renal parenchyma
23
Q

causative bacteria of UTI

A

most UTIs caused by a few serotypes of E coli - uropathogenic clones
selected from the colonic flora by virulence factors that enhance adhesion and invasion of the urinary tract
vary according to clinical and epidemiological setting
most are due to bacteria originating from the host’s colonic flora

24
Q

community acquired UTI

A
  • e coli most common

- staph saprophiticus is common in young adult females

25
Q

less common causes of community acquired urinary tract infection

A 
proteus 
klebsiella 
enterbacter
serratia
morganella
citrobacter 
pseudomonas auruginosa 
enterococcus
26
Q

hospital acquired

A

rapid colonisation of the resident microflora
debilitated host
urinary tract intramentalisation - catheterisation
indwelling urinary catheters universally become colonised by bacteria
hospital bacteria generally quite resistant to antibiotics

27
Q

clinical features of cystitis

A

dysuria - painful passage of urine
frequency - passing urine more often
urgency - need to pass urine, although bladder may be empty
suprapubic heaviness or tenderness
urine Is turbos and may be bloody, may smell offensive
fever usually absent, if lower UTI only

28
Q

acute pyelonephritis

A

flank or back pain
fever, chills, riggers suggest bacteraemia
headache, nausea, vomititng, prostration
often with dysuria, freuqnecu, urgency

29
Q

atypical presentations of UTI

A

infants, children - fever, nausea, vomiting, abdominal pain
elderly - bacteraemia and shock
sublcinctal pyelonephritis - seen in some women, dysuria, bacteria, with minimal or no symptoms of pyelonephritis, yet upper tract infection is present

30
Q

types of urine specimens

A
  • MSU - midstream urine
  • suprapubic aspirate - unlikely to be contaminated - needle goes into the full bladder
  • CSU - sample collected through catheter
  • bag urine - very easily contaminated
31
Q

CSU urine specimens

A

in-out - don’t get colonised by bacteria

indwelling catheters - get colonised always, sample collected from this is meaningless

32
Q

urine microscopy

A
  • cells and other components of the urine are assessed by the lab
  • white cells (<10/ul)
  • red cells
  • squamous epithelial cells
    elevated WCC in urine = pyuria
33
Q

red cell count in urine

A

red cells got into the urine from sources of bleeding in the urinary tract - calculi, inflammation, tumours, infection) or from being extruded through damaged glomeruli

extruded red cells have bizarre morphologies which can be recognised using phase contract microscopy
reported glomerular red cells, presence indicated further investigations of the kidney are indicated

34
Q

squamous epithelial cells

A

originate outside the urinary tract
presence indicates contamination
may be expressed semiquantitatively , or quantitatively

35
Q

other things reported on microscopies

A
  • crystals
  • casts - have been formed within a glomerulus and take on the shape of the golmerulus, protenacioous or cellular, may indicate glomerular nephritis
  • bacteria
  • yeasts, usually indicate contamination from vagina
36
Q

qualitative culture

A

specimen processed in such a way that the number of bacterial colonised growing on the agar medium can be extrapolated back to indicate the number of bacteria per unit volume of original specimen
expressed on the report as per ml or per microlitre

37
Q

kass criterion

A

studies done determined that significant bacteriuria was defined by the presence of a single species of bacterium in the urine at a concentration of >10^2/ml in females
>10^3/ml in males

38
Q

when more that one microorganisms is cultured from urine, it is more likely to indicate

A

contamination

39
Q

antibiotic treatment of UTI

A
  • amoxycillin
  • augmentin
  • cephalexin
  • nitrofurantoin
  • trimethoprim
  • norfloxacin
40
Q

lab testing is important if

A
  • recent overseas travel
  • recent antibiotic use
  • aged care facility
41
Q

measures to prevent UTIs

A
  • extra fluid intake
  • frequent bladder emptying
  • bladder emptying after intercourse
  • wipe front to back
  • oestrogen cream for elderly women
  • shower rather than bath
  • prophylactic antibiotics
42
Q

problems with prophylactic antibiotics

A

selection of resistant bacteria

antibiotic side effects

43
Q

cranberry juice

A

some adhesion factors that uroeethogenic e coli use can be inhibited by components of cranberry juice

44
Q

probiotics

A

not well studied for prevention of UTIs

microbiology 2 (26 decks)

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