Urinary Tract Infections Flashcards
What risks increase your chance of getting a UTI?
- women over men have an increased risk
- pregnancy increases the risk
- sexual activity
- the elderly have an increased risk
- patients with comorbid conditions (diabetes, spinal cord injuries, catheters, GU tract abnormalities)
How is the urinary tract infection usually spread in the body?
- the bacteria is usually acquired from the urethra to the bladder, where the infection could then have the potential to spread to the kidney (occasionally can also penetrate into the bloodstream and cause septicaemia)
What is hematogenous spread of a UTI referring to?
- the kidney is the first organ that is affected by the infection
In which population of people is treatment recommend for certain individuals?
- during pregnancy and prostate resection
_______ are readily treated with antibiotics
Uncomplicated UTIs
_________ are more difficult to treat and the key risk factors include: underlying diseases, kidney stones, urinary tract abnormalities, indwelling urinary catheters
Complicated UTIs
What are the contributing factors that leads to an increased pathogenesis of the UTI infections?
- shorter length of urethra
- sexual activity in females
- uncircumcised male infants
- blockage of the urethra
- catheterization (3-10% increased risk/day of catheterization)
What is urethritis?
- infection of the urethra
- symptoms of dysuria (pain when urinating) and frequency
What is cystitis?
- bladder infection
- dysuria, frequency, urgency, pain over the bladder area
- signs: bloody urine, cloudy urine and a bad odour
What is acute urethral syndrome?
- same symptoms as cystitis but lower CFU/mL than cystitis
- pyuria: 8 leukocytes/mm of uncentrifuged urine
What is pyelonephritis?
- infection of the kidney and the renal pelvis
What is prostatitis?
- an infection involving the prostate
What is cervicitis?
- inflammation of the cervix
What is the epidemiology of UTIs in paediatrics?
- high morbidity
- impaired renal function
- hypertension
- end stage renal disease
- complications during pregnancy as an adult
What is the epidemiology of UTIs in geriatrics?
- incidence in both men and women increases but the ratio changes
- prostate enlargement, leads to poorer bladder emptying and an increased UTI incidence
What are the microbial virulence factors that allow the bacteria to attach to the urinary tract?
- adherence (via bacterial adhesins)
- calculi formation
- toxin and enzyme production (hemolysins and LPS)
- capsular polysaccharide
- biofilms
What are the host defences in protecting the body from bacterial infection?
- flushing action of urine
- growth inhibitory properties of urine (low pH, osmolarity, high urea, organic acid concentrations)
- mucopolysaccharides
- preventing reflux
When a baby is newborn, it will have a ______ urethra
sterile
Within 1-3 years of life, what bacteria start colonizing the urinary tract?
- Staphylococcus, enterococci, and diptheroids
From the time of 3 days to a few weeks old, what bacteria starts to colonize the urinary tract?
- lactobacillus acidophilus
In the prepubertal stages, what bacteria start to colonize the urinary tract?
- micrococci
- streptococci
- coliforms
- diptheroids
In the adult stages of life, what bacteria start to colonize the urinary tract?
- L acidophilus, Staph epidermidis, Streptococci (alpha and non-hemolytic) as well as E coli, diphtheroids and yeasts
In pregnancy, what bacteria begin to colonize the urinary tract?
- L acidophilus, yeasts and S epidermidis
In the postmenopausal stages of life, the urinary tract in similar to having the ____ flora
prepubertal
What are the two main agents of UTIs?
- gram negative bacilli, as well as gram positive cocci
What are the most common gram negative bacilli to infect the urinary tract?
- enterobacteriaceae
- – fecal E. coli, uncomplicated UTIs
- – MDR enterbacteriaceae, hospital acquired
What are the bacteria that are LEAST likely to have a hospital stay?
E coli
What bacteria causing a urinary tract infection are more likely to cause a stay in the hospital?
- pseudomonas, prteus, klebsiella, acinetobacter and enterobacter
What bacteria is a gram positive cocci and is most likely to cause a symptomatic UTI in sexually active women under the age of 40?
- staphylococcus saprophyticus
What gram positive bacilli are agents of causing UTIs?
- diphtheroids, mycobacteria, and Listeria monocytogenes
What fungi that can colonize the urinary tract can also lead to hospitalizations
- candiduria
What constitutes a lower urinary tract infection?
- bladder and urethra
- cystitis (infection of the bladder)
- can cause dysuria (pain during urination) and is more common than upper UTIs
- increased urgency to urinate as well as increased frequency of urination
What bacteria is likely to cause a lower UTI?
E coli, Klebsiella spp, other enterobacteriaceae and enterococci, CoNS
What are two upper UTI infections?
- acute pyelonephritis
- subclinical pyelonephritis
What are the symptoms of acute pyelonephritis?
- fever, lower UTI symptoms (typically caused by enterobacteriaceae and staph aureus)
What are the most common bacteria that cause subclinical pyelonephritis
candida spp, mycobacterium spp, mycoplasma hominis
What are the most vulnerable groups of people experiencing an upper UTI?
- pregnancy women and young children
- patients undergoing instrumentation in UT
- elderly and diabetics
When doing a laboratory diagnosis of a UTI, how is there a differentiation between a UTI and contamination of the urine by microflora at the distal end of the urethra
- there should be a collection of midstream urine - this should not have over 10^5 organisms within
- typically will see only one bacterial species
- collection and transportation methods are critical in ensuring a good sample
A urine sample should be cultured within ___ of collection and stored at 4 degrees for not over 18h
1 h
Uncomplicated UTIs usually resolve _____ within 4 weeks in up to 40% of patients
spontaneously
(tx with an Ab though ensures eradication)
- follow up recommended at the end of the treatment
With a UTI, the patient should also be advised to _______ to flush the bacteria?
- to drink large amounts of water
What is the treatment typically of a completed UTI - pyelonephritis?
- systemic IV treatment until the symptoms subside
- oral therapy can occur afterwards
- over 10 days to sterilize the kidney
