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