Urinary Tract Infections - Hunter Flashcards
1
Q
what is the most common upper UTI?
A
pyelonephritis
2
Q
what two structures does pyelonephritis involve?
A
kidney and ureter
3
Q
What is the more serious version of pyelonephritis?
A
perinephric abscess
4
Q
What is the ratio of UTIs in women to men?
A
30:1
5
Q
what percent of females have at least one UTI in their life?
A
40%
6
Q
the incidence of UTI increases with what two factors?
A
age and sexual activity
7
Q
why do postmenopausal women have higher rates of UTI?
A
bladder or uterine prolapse and other hormonal changes
8
Q
Males will get more UTIs in their fifties because of..
A
BPH
9
Q
What is the most common cause of uncomplicated UTI in all age groups?
A
E. Coli
10
Q
What is the second most common cause of UTI, especially in sexually active females 13-40
A
Staph saprophyticus
11
Q
What are the infectious causes of complicated UTI from catheterization or obstructions?
A
E. coli Proteus mirabilis Klebsiella pneumoniae Enterococcus Pseudomonas aeruginosa
12
Q
T/F: Fungal UTIs are much more serious that bacterial
A
true, but less common
13
Q
Nosocomial UTIs are caused by (blank) resistant organisms
A
multi-drug resistant
14
Q
What are the two anatomic reasons females develop UTIs more frequently than males?
A
shorter urethra
urethra closer to anus
15
Q
Intercourse promotes contamination of the female urethra with….
A
fecal organisms
16
Q
T/F: any cause of incomplete emptying can lead to UTI
A
true; BPH, neurogenic bladder
17
Q
What type of reflux is a risk factor for UTI?
A
vesicoureteral reflux
18
Q
Calculi, catheters, and pregnancy are all risk factors for ….
A
UTIs
19
Q
In what substance do you find the organisms that cause UTIs?
A
feces
20
Q
Contamination of the periurethral region with fecal organisms leads to (blank)
A
urethral colonization
21
Q
ascension of bacteria up the urinary tract is aided by bacterial (blank) which bind to uroepithelial cells
A
fimbrae
22
Q
What are the natural factors which protect against UTI?
A
normal urine flow
uroepithelial cell sloughing
large numbers of lactobacilli in the the vaginal mucsosa (leading to vaginal pH)
23
Q
T/F: blood-borne causes of UTI are common
A
false
24
Q
T/F: staph aureus is a common causative agent of UTI
A
false
25
type 1 fimbrae are encoded by what gene?
fimH
26
P fimbrae are encoded by what gene?
papGAP
27
what type of fimbrae bind to mannose-containing host epi receptors?
type 1 fimbraie
28
type 1 fimbrae leads to (cystitis/pyelonephritis)
cystitis
29
what type of fimbraie bind to glycosphingolipid host epithelial receptors?
P fimbrae
30
P fimbrae strains cause (pyelonephritis/cystitis) and bateremia
pyelonephritis
31
Most uropathogenic strains have a (hemolysin/streptolysin) that can damage uroepithelium
hemolysin
32
genes for UTI virulence factors are carried on (blank) in the E. coli
pathogenicity islands
33
pts who have cystitis also have symptoms of...
urethritis
34
What are the signs of cystitis?
-urgency and frequency of urination
- voiding small volumes of urine (oliguria)
- painful urination (dysuria)
suprapubic tenderness just before or immediately after voiding
35
What is the standard treatment for an uncomplicated UTI?
TMP-SFX
36
what will you see on UA in an uncomplicated UTI?
leukocytes and blood
37
Does an uncomplicated UTI present with back pain, CVA tenderness, or fever?
nope
38
A low urine pH argues against which infectious agent?
proteus mirabilis
39
Gram negative rods in a UA are consistent with which bug?
E. coli
40
If the pH of the urine is >7.9 and it contains bacteria and WBCs, the patient has a infx due to UREASE-PRODUCING bugs such as...
proteus mirabilis
41
what are the methods for determining pyuria?
1. wet mount of SPUN urine
2. cell counting
3. dipstick for leukocyte esterase
42
Which two bugs convert nitrates to nitrites?
E. coli and proteus mirabilis
43
what type of urine sample should be used for culture?
clean-catch
44
What is the result that is sig. for bacteriuria?
>100,000 CFUs
45
T/f: Asymptomatic bacteriuria is uncommon
false! commmon!
46
Which three groups of patients with ASYMPTOMATIC bacteruria should get abx?
1. pregnant women
2. renal transplant pts
3. GU surgery pts
47
why do you give preggerz abx for asymptomatic UTI?
likely to develop pyelonephritis or preterm delivery following an asymptomatic bacteriuria
48
A complication of pyelonephritis is (blank); This can also occur secondary to bacterermia
perinephric abscess
49
Patients with pyelonephritis usually experience symptoms of (blank)
cystitis
50
what are the symptoms of pyeloephritis?
```
fever >38C
N/V
flank pain and tenderness
CVA tenderness
urinary frequency
FOUL SMELLING urine
```
51
What is a major risk factor for pyelonephritis?
previous UTI
52
what is the cause of pyelonephritis in 90% of cases?
E. coli
53
What is the Tx for pyelonephritis?
Bactrim (TMP/SFX) for 14 days
54
Desribe the appearance of the kidney in acute pyelonephritis?
somewhat enlarged, and discrete, yellowish, raised abscesses are apparent on the surface
55
What is the pathognomonic feature on the kidney for pyelonehritis?
suppurative necrosis or abscess formation within the renal substance
56
in chronic pyeloneph, one or both kidneys will have (blank),
gross scars
57
Describe the changes to the pelvic wall in chronic pyeloneph?
1. inflamm changes
| 2. papillary atrophy and blunting
58
What would the kidney parenchyma show on chronic pyeloneph?
interstitial fibrosis with an inflammatory infiltrate of lymphocytes, plasma cells, and occasionally neutrophils
59
what will blood work show with perinephric abscess?
elevated WBC with left shift
elevated ESR
negative blood culture
60
what will UA show in perineprhic abscess?
leukocyte esterase
nitrites
pos. urine culture
61
What is the cause of perinephric abscess?
smoldering E. coli infx which accessed the perinephric space
62
T/F: you can palpate a perinephric abscess
true sometimes. think about this if you see (palpable mass on the lower back or abd)
63
T/f: perinephric abscess can be seeded by a blood infx
true
64
what is the most common blood-borne pathogen that causes perinephric abscess?
staph aureus
65
What is the treatment for perinephric abscess?
surgical drainage
| IV abx
66
What is the mortality rate of perinephric abscess?
45%
67
a motile, gram negative rod with SWARMING GROWTH on agar is most likely....
proteus mirabilis
68
Proteus causes stones because it produces (blank) which catalyzes the breakdown of urea into ammonia and CO2
urease
69
What kind of stones are formed by proteus?
struvite caliculi; aka magnesium ammonium phosphate
70
explain the relationship between kidney stones and UTI
Kidney stones can serve as a location in which bacteria can escape antibiotics and cause recurrent UTI (it's a NIDUS)
71
what is the major risk factor for a proteus UTI?
catherization!!
| also recurrent UTI, anatomical weirdness
72
why do you order imaging when suspecting a proteus infx?
to rule out stones;
73
what abx do you use to treat proteus?
ceftriaxone
74
what are the types of UTI that people present with with a proteus infection?
cystitis
pyelonephritis
prostatitis
75
Moderate pyeloneph. is treated outpatient with...
bactrim (TMP/SFX) for 14 days
76
what ist the Tx for someone who is septic from pyeloneph?
IV abx like ceftriaxone or fluoroquinolone for 24 hours after the fever breaks
77
After giving IV abx after the fever breaks, how do you treat severe pyeloneph?
bactrim 14 days
78
when do you give long term low dose abx for UTI?
women with recurrent infections to prevent future urinary tract infections
79
What two things do you drink to prevent UTI?
1-2 quarts of water and cranberry juice
80
what is in cranberry juice that prevents UTI?
tannins which prevent binding of the bacteria to the uroepithelial cell surface receptors
81
what types of foods should people avoid to prevent UTI?
spicy foods, alcohol, or beverages containing caffeine that may irritate the bladder
82
What type of contraceptive should women avoid to not get UTI?
spermicide containing contraceptives
83
What can postmenopausal women do to lower the chance of getting a UTI?
oral or vaginal estrogen; shifts flora to lactobacilli
84
How does lactobacilli help prevent UTI?
lower the vaginal pH, which reduces colonization of the vagina by uropathogens
85
T/F: prostatitis can be caused by infection or chronic pain syndromes
true; its an umbrella term
86
what is the most common cause of bacterial prostaitis?
E. coli
87
what are the less common bacterial causes of prostatitis?
Klebsiella, Pseudomonas, Enterobacter, Serratia, Proteus, and Enterococcus
88
what is the most common cause of prostate issues in men under 35?
prostatitis
89
T/F: prostatitis is more common in sexually active males
true
90
T/F: one episode of bacterial prostatitis predisposes you to future episodes
true
91
T/F: prostatitis most often follows a blood infection
false; from ascension from the urethra
92
T/F: the e. coli that causes prostatitis has the same virulence factors as the ones that cause other UTIs
true
93
Infected urine refluxes into the glandular prostatic tissue via the (blank) ducts
the ejaculatory and prostatic ducts
94
Infiltrating neutrophils around the acini are associated with....
intraductal desquamation and cellular debris
95
what types of cells makes up the tissue infiltrate in prostatitis?
lymphs
plasma cells
macrophages
96
is prostatitis Dx'd clinically or with labs?
clinically
97
T/F: prostatitis will also present with urethritis, cystitis, or pyeloneph
true
98
What will a rectal exam show you if someone has prostatitis?
boggy, swollen, warm, and tender to the touch
99
Asymptomatic prostatitis will show with elevated (blank) in the blood
PSA
100
what are the symptoms associated with prostatitis?
painful urination
urinary frequency
suprapubic and abd tenderness
distended bladder
101
How do you Dx prostatitis?
midstream catch
102
what would you look for on UA for prostatitis?
pH
leukocyte esterase
nitrites
103
How many CFUs and WBCs would you see for prostatitis?
>100,000 CFUs
| >10 WBC per HPF
104
What is the Tx for bacterial prostatitis?
TMP/SFX or cipro for 10-14 days
105
T/f: treat asymptomatic bacterial prostatitis with abx
TRUE
106
T/F: using a condom can prevent prostatitis
true
