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medical microbiology > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q

Urinary Tract Infections (General)

A
  • very common bacterial infection
  • more frequent in women due to anatomic difference
  • can be single, recurrent, uncomplicated or complicated
  • Urinary tract normally resistant to infection due to urine characteristics
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2
Q

Upper UTI’s

A

infection of renal parenchyma or ureters

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3
Q

Lower UTI’s

A

infection of bladder, urethra or prostate (males)

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4
Q

Recurrent UTI’s

A
  • Relapse: re-infection with the same bacteria
  • Reinfection: second UTI infection by different organism
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5
Q

Uncomplicated UTI’s

A

UTI’s in sexually active women with normal GU tracts; no procedures

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6
Q

Complicated UTI’s

A

UTI’s due to one or more structural or functional abnormalities

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7
Q

Urine infection resistance

A
  • extremely high osmolarity to inhibit growth of most organisms
  • low pH
  • dilute urine grows less
  • prostatic fluid (men)
  • flow has washing affect to inhibit adherence
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8
Q

UTI Risk factors

A
  • AGE (kids with long-term medical problems, adults with GU abnormalities, elderly because of catheterization, prostate problems, bladder prolapse)
  • INSTITUTIONALIZE CARE (catheters, asymptomatic bacteruria)
  • PREGNANCY (increased ASB)
  • RENAL TRANSPLANT (leads to septicemia)
  • BLADDER CATHETERIZATION
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9
Q

Route of Infection

A
  • Ascending route: most common route, migration from bladder, acquired UTI’s
  • Descending route: infection via blood, < 5% of UTI’s
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10
Q

UTI’s (Clinical Signs/Symptoms)

A
  • failure to thrive, vomiting, lethargy, fever in kids < 2 y/o
  • dysuria, frequency and abdominal/flank pain in kids
  • dysuria, frequency, urgency, suprapubic pain, hematuria in adults
  • fever, costovertebral angle tenderness, flank pain, chills, vomiting in upper UTI’s
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11
Q

Infections in urine cultures that aren’t UTI’s

A
  • Herpes simplex (HSV)
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
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12
Q

UTI pathogenesis (women)

A
  • infection via ascending route
  • due to shorter ureter
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13
Q

UTI pathogens

A
  • Gram-positives (S. sapro, Enterococcus, S. epi) via ascending route
  • Gram-negatives (E. coli, Pseudomonas, Proteus, Kleb, Acinetobacter, Enterobacter) via ascending route - from catheterization (except E. coli)
  • GPR’s (Bacillus, MAC, Listeria)
  • Chlamydia, N. gonorrhoeae, Mycoplasma, Ureaplasma, Gardnerella, Adenovirus, HSV
  • Bacteremias, endocarditis, , mycobacteria, Candida, fungal infections via hematogenous route
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14
Q

UTI virulence factors

A
  • adherence
  • biofilms
  • calculi formation
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15
Q
  • Gram positive cocci
  • catalase positive, coagulase negative
  • Bacitracin resistant, Novobiocin resistant
A

S. saprophyticus

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16
Q
  • Gram positive cocci
  • catalse -
  • Bile esculin +, growth in 6.5% NaCl, PYR +
A

Enterococcus

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17
Q
  • Gram positive cocci
  • catalase +, coagulase -
  • Bacitracin resistant, Novobiocin susceptible
A

S. epidermidis

18
Q
  • GNR
  • oxidase -, glucose fermenter, nitrate reducer, motile
  • IMVC (++–)
  • H2S -, citrate -, PAD -, A/A
A

E. coli

19
Q
  • blue-green hue on MAC (pyoverdin and pyocyanin)
  • beta hemolytic
  • oxidase +, catalase +, ADH +, citrate +
  • glucose oxidizer
  • grows at 42C
A

P. aeruginosa

20
Q
  • GNR
  • H2S +, swarm, PAD +, urease +
  • vulgaris (indole +, ODC -, A/A)
  • mirabilis (indole -, ODC +, K/A)
A

Proteus

21
Q
  • GNR
  • citrate +, H2S -, PAD -, urease -, IMVC (–++)
  • oxytoca (indole +)
A

Klebsiella

22
Q
  • GNR
  • oxidase -, glucose oxidizer
  • NLF, but purple on MAC
A

Acinetobacter

23
Q
  • GNR
  • oxidase -, IMVC (–++), LDC + (except cloacae), ODC +
  • citrate +, H2S -, PAD -, urease -
A

Enterobacter

24
Q
  • Gram positive bacilli
  • grows at 4C, catalase +
  • umbrella motility at 25C, tumbling motility
  • CAMP positive (block)
A

Listeria

25
Q
  • Gram positive bacilli
  • motile, beta hemolytic
  • catalase positive
A

Bacillus (cereus)

26
Q
  • inactive in most tests
  • heat-stable catalase
  • common Mycobacteria in US
A

M. avium complex (MAC)

27
Q
  • intracellular parasites
  • specimen on Dacron swab
  • EB and RB stages of life cycle
  • won’t grow on a normal plate
A

Chlamydia trachomatis

28
Q
  • Gram negative dipplococci
  • oxidase -
  • grows on MTM
  • utilizes glucose
A

Neisseria gonorrhoeae

29
Q

Lab Diagnosis of UTI

A
  • colony count: leukocyte count at least 10/mm^3 in more than 96% of patients with bacteruria
  • Urine culture and other tests for diagnosis
30
Q

Types of urinary infections (women)

A
  • Symptomatic pyuria without bacteruria
  • Asymptomatic bacteruria (with or without pyuria)
31
Q

Specimen collection

A
  • Voided midstream specimen collection (CCMS)
  • Catheterized specimen collection (best for kids)
  • Suprapubic aspiration (for anaerobes)
  • 24hr old specimen is unacceptable
  • first morning urine is best
32
Q

Specimen processing

A
  • processed within 2 hours
  • refrigerated if not processed immediately
  • avoid contamination of specimen
  • rapid nonculture screening or manual screening
33
Q

Microscopy

A
  • pyuria: 5-10 leukocytes in urine
  • detect fungi and mycobacteria (use acid fast stain)
  • chemical tests
34
Q

Specimen rejection

A

Reject if inadequate collection/transportation

35
Q

Culturing urine specimens

A
  • usually BAP and MAC
  • incubate 24 hours
  • plate to more plates for fastidious organisms
36
Q

Interpreting culture results

A
  • colony count indicates level of pyuria
  • presence of symptoms also indicative
37
Q

Culture with 3 or more uropathogens

A

probably contamination

38
Q

Culture with 2 significant uropathogens (>10^5)

A

identify and perform susceptibility

39
Q

Culture with 1 or 2 uropathogens (small numbers >10^2)

A

identify if clinical situation warrants

40
Q

Reportable results

A
  • a pure culture of S. aureus is significant
  • yeast in any culture is significant
  • unusual organisms are reportable
  • only report significant UTI antibiotics

medical microbiology (29 decks)

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