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micro unit 5 > urinary tract infections > Flashcards

urinary tract infections Flashcards

1
Q

e coli characteristics

A

gram negative. facultative. lactose fermenter. indole positive. H2S negative. maybe motile or immotile. normal GI flora.

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2
Q

what virulence factors does e coli have?

A

can acquire many from plasmids, etc.

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3
Q

does e coli ferment lactose?

A

yes

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4
Q

indole and h2s?

A

indole positive, sulfur negative.

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5
Q

what kind of metabolism?

A

facultative.

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6
Q

what does e coli cause?

A

gastroenteritis, UTIs, bloody stool, meningitis and pneumonia .

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7
Q

do hosts carry uropathogenic strains of e coli as normal flora?

A

yes of course, thats why UTI are so common

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8
Q

what virulence factor do the uropathogenic strains have?

A

P fimbriae.

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9
Q

what risk does UTI with e coli confer?

A

bacteremia with urinary obstruction.

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10
Q

how do we diagnose e coli UTI

A

physical, blood culture, semiquantitative urine culture.

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11
Q

what is the treatment for e coli UTI

A

sulfa-trimethylprim or ampicillin.

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12
Q

what if the e coli has become septic or extended UTI?

A

third generation cephalosporin (cefotaxime)

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13
Q

what can be used as prevention for recurrent UTI?

A

cranberry juice. must be taken early enough for home remedy to be effective.

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14
Q

how does e coli become an ascending infection?

A

attachment by pili access to deeper and higher regions by exfoliation and inflammation

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15
Q

what gram are the klebsiella/enteric/serratia groups

A

gram negative rods.

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16
Q

klebsiella motility, capsule and sulfur?

A

nonmotile, encapsulated and H2S (-)

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17
Q

do klebsiella and enterics ferment lactose?

A

yes they do

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18
Q

are klebsiella and enteric normal flora?

A

yes. also usually opportunistic nosocomial

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19
Q

who is at higher risk for klebsiella and enteric?

A

men, neonates, elderly

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20
Q

what is a major problem for the klebsiella/enterics

A

antibiotic resistance

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21
Q

who is predisposed to klebsiella pneumonia?

A

elderly, alcoholics, diabetics, chronic respiratory disease. this is a common nosocomial outbreak

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22
Q

what protects klebsiella for pathogenesis?

A

the polysaccharide capsule. it defends against phago, complement.

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23
Q

what other klebsiella pathogenesis is involved in infection

A

adhesins bind the gut wall, and siderophores bind iron.

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24
Q

what is the most lethal presentation of klebsiella pneumonia?

A

current jelly sputum. seen from lobar pneumonia with necrosis inflammation and hemorrhage

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25
Q

what are the less lethal forms of klebsiella

A

bronchitis, UTI, wound infection, catheter infection

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26
Q

enterobacter found where?

A

ICU nosocomial infections

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27
Q

what is the mortality related to with enteric infection

A

the underlying disease.

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28
Q

what is a problem with enteric infection?

A

antibiotic resistance

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29
Q

S. marcenscens found where?

A

opportunistic nosocomial

30
Q

where does S. marcenscens infection adults?

A

bloodstream, lower respiratory tract, urinary tract, surgical wounds, skin and soft tissues.

31
Q

where does S. marcenscens infection children>

A

meningitis, wound infection, arthritis.

32
Q

where does S. marcenscens infection heroin addicts?

A

endocarditis, osteomyelitis.

33
Q

how do we diagnose klebsiella/enterics/serratia?

A

exam: nosocomial infection. Ab resistance, gram stain and culture.

34
Q

what appearance does klebsiella have

A

mucoid appearance

35
Q

what appearance does S. marcenscens have

A

red-pigmented colonies.

36
Q

treatment for klebsiella/enterics/serratia?

A

need to do Ab resistance testing. begin with amino glycoside + cephalosporin for K and S. need to consult for enterics.

37
Q

prevention of klebsiella/enterics/serratia?

A

removal of catheters, maintain respiratory devices, minimize hospital stays.

38
Q

proteus/providencia/morganella more or less pathogenic than enterics?

A

less.

39
Q

proteus/providencia/morganella gram stain and lactose? H2S, where are they found?

A

they are gram negative rods and lactose fermenters. proteus is H2S (+). they are normal flora usually opportunistic.

40
Q

what special characteristics do proteus/providencia/morganella have?

A

they produce phenylalanine deaminase and urease.

41
Q

what does proteus do that is unique?

A

they swarm or produce H2S

42
Q

what is problematic with proteus/providencia/morganella

A

they are AB resistant

43
Q

how do proteus/providencia/morganella cause UTIs

A

fimbriae attach to urinary tract. mobile bacteria can move upward.

44
Q

what does urease do?

A

raises the urine pHand leads to stones. the stones causes worse infection. untreated leads to bacteremia.

45
Q

what else does proteus cause?

A

pneumonia and wound infections

46
Q

what else does providencia cause?

A

gastroenteritis, ocular infections, endocarditis.

47
Q

what does morganella cause?

A

wound infections, sepsis, pneumonia.

48
Q

which is the rarest proteus/providencia/morganella to get infected with?

A

morganella.

49
Q

how do we diagnose proteus/providencia/morganella

A

exam: UTI, flank pain, beta-lactam Ab therapy

50
Q

labs for proteus/providencia/morganella

A

gram stain and culture, UTI then urine culture, enzyme immunoassays to determine between the groups.

51
Q

treatment for proteus/providencia/morganella

A

remove infected catheters. drain abscesses. Ab need to test for sensitivity.

52
Q

what do we start with for proteus/providencia/morganella

A

aminoglycoside and sulfa-trimethylprim.

53
Q

how do we prevent proteus/providencia/morganella

A

remove catheters.

54
Q

enterococcus species?

A

faecalis and faecium

55
Q

how do the enterococcus grow?

A

cocci in chains, grow in high salt.

56
Q

what are the enterococcus resistant too?

A

penicillin

57
Q

what is the enterococcus metabolism?

A

facultative anaerobes.

58
Q

where are the enterococcus found?

A

normal flora, they cause opportunistic

59
Q

what kind of AB resistance do the enterococcus have?

A

intrinsic and acquired. they are becoming a more serious pathogen

60
Q

what does VRE stand for?

A

vancomycin resistant enterococcus

61
Q

what is the pathogenesis of the enterococcus

A

they escape the GI due to a medical procedure and seed various regions.

62
Q

where are the most common places for the enterococcus to seed>

A

UTI, surgical site (wound infections and intraabdominal), blood (endocarditis, and meningtis), clinic (nosocomial infections)

63
Q

what are the risk factors for infection with enterococcus

A

recent use of broad spectrum AB particularly 3rd gen cephalosporins. because they kill all the competing bacteria

64
Q

what is interesting about the enterococcus

A

they are not particularly pathogenic but they are extremely resistant q

65
Q

how do we diagnose enterococcus

A

echo for endo, CT or ultra for abscess or bowel, take samples before starting ABs. any positives need sensitivity

66
Q

treamtent for the enterococcus

A

may not be necessary. swap out the catheters, drain the abscesses, treat principle pathogens. could just need replenishment of the normal flora. similar to C diff.

67
Q

what to treat uncomplicated enterococcus with?

A

ampicillin

68
Q

what to treat allergic enterococcus with?

A

vancomycin

69
Q

what to treat VRE?

A

nitrofurantoin

70
Q

what if endocarditis enterococcus

A

treat with ampicillin/vancomycin plus gentamicin/streptomycin/ceftrixone

micro unit 5 (2 decks)

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