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Block 9 Week 5 > UTI-Hunter > Flashcards

UTI-Hunter Flashcards

1
Q

What are the infections of the lower urinary tract?

A

Urethritis (urethra)

Cystitis (urinary bladder)

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2
Q

What is the most common upper urinary tract infection?

A

pyelonephritis (kidney and ureter)

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3
Q

What is a less common but more serious infection around the kidney?

A

Perinephric abscess

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4
Q

Most cases of UTI occur in males or females

A

females!

female to male ratio is 30:1

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5
Q

The incidence of UTI increases with (blank) and (blank)

A

age

sexual activity

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6
Q

About (blank) percent of all females have at leat one UTI at some time in their lives

A

40%

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7
Q

(blank) women have higher rates of infection because of bladder or uterine prolapse and other hormonally induced changes

A

Postmenopausal

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8
Q

Males experience a rapid increase in UTI incidence some time in the (blank) decade of life due to obstruction of the urethra following development of (blank)

A

fifth

benign prostatic hypertrophy

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9
Q

(blank) is the most common cause of uncomplicated UTI in all age groups (80-90%)

A

Escherichia coli

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10
Q

(blank) is the second most common cause of these infections, particularly in whom?

A

Staphylococcus saprophyticus

sexually active females between the ages of 13 and 40

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11
Q

In cases of COMPLICATED UTI such as those resulting from anatomic obstructions or from catheterization, the most common causes are (blank X 5)

A 
E. coli, 
Proteus mirabilis
Klebsiella pneumoniae
Enterococcus spp.
Pseudomonas aeruginosa
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12
Q

Fungal UTI is LESS common but serious. What can cause this?

A

Candida spp

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13
Q

UTI (particulary nosocomial) are frequently caused by (Blank) organisms

A

drug resistant organisms

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14
Q

Why do females develop UTI more frequently than males?

A

shorter urethra and closer proximity of the urethra to the anus

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15
Q

(blank) promotes contamination of the urethral opening with fecal organisms and leads to an increased number of infections in women

A

sexual intercourse

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16
Q

Any (blank or blank) leading to incomplete elimination of urine from th eblader can also lead to UTI.

A

anatomic obstruction (BPH) or neurologic disorder

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17
Q

Reflux of urine from the bladder to the kidney is called (blank) and can cause UTI

A

vesicoureteral reflux

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18
Q

Physiologic changes leading to incomplete emptying of the bladder can lead to UTI. what is an example of this?

A

pregnancy

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19
Q

What is something that is used in hospitals that can cause UTI?

A

urethral catheters

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20
Q

(blank) in the urinary tract can cause obstructions and lead to UTI

A

calculi

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21
Q

Organisms that commonly cause UTI are found in (blank)

A

feces

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22
Q

Contamination of the periurethral region with fecal organisms leads to (blank). How do these organisms cause a UTI?

A

urethral colonization

They ascend up the urethra to the bladder and sometimes to the kidneys.

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23
Q

What facilitates the ascention of bacteria up the urinary tract?

A

bacterial fimbrae that bind to uroepithelial cells

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24
Q

What are the host factors that protect against UTI?

A
  • normal daily urine flow
  • constant uroepithelial cell sloughing
  • large numbers of lactobacilli in the vaginal mucosa (pH)
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25
Q

T or F

Blood-born infections ot the urinary tract are infrequent

A

T

However, staph aureus can cause this

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26
Q

What are the three major virulence factors of E. coli that allows it to effect urothelium?

A

Type I fimbriae (fim H)
P Fimbrae
hemolysin

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27
Q

What is the importance of type I fimbriae?

A

binds to mannose-containing host epithelial receptors (causes cystitis more than pyelonephritis)

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28
Q

What is the importance of P fimbrae?

A

binds to glycosphingolipid host epithelial receptors (abundant in kidney epithelium); .

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29
Q

What will P fimbrae strains of e coli cause?

A

pyelonephritis (90%) and can cause bacteremia

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30
Q

What does hemolysin cause?

A

damage to the uroepithelium

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31
Q

Where will you find the genes for the creation of virulence factors of E. Coli?

A

pathogenicity islands

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32
Q

(blank) is an infection of the urinary bladder

A

cystitis

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33
Q

Patients who have symptoms of cystitis will also have symptoms of (blank)

A

urethritis

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34
Q

What are the signs and symptoms of cystitis?

A
  • urgency and frequency of urination
  • voiding small volumes of urine (oliguria)
  • painful urination (dysuria)
  • suprapubic tenderness just before or immediately after voiding
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35
Q

Why do you want to do a UA on a UTI patient?

A

to determine:
pH
Pyuria (WBC in urine)
bacteriuria (bacteria in urine)

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36
Q

The pH of the urine is usually determined using a (blank)

A

dipstick

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37
Q

Is the pH elevated in a UTI?

What if it is?

A

not usually

-then it is proteus mirabilis (urease producing)

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38
Q

What are the all the lab findings you would see if you had a UTI infection caused by proteus mirabilis?

A
  • pH > 7.9
  • bacteriuria
  • pyuria
39
Q

How can you determine pyuria?

A

microscopic wet mount of spun urine, cell counting technique or dipstick test for LEUKOCYTE ESTERASE

40
Q

How can you determine bacteriuria?

A

dipstick check for NITRITES (uropathogens convert nitrates to nitrites)

41
Q

How do you do a urine test and what would indicate signif bacteriuri?

A

clean-catch urine (midstream urine)-> plate the specimen-> count
>100,000 colony-forming units per mL = bacteriuria

42
Q

T or F

asymptomatic bacteriuria is common

A

F

IT IS NOT COMMON, IE you have infection you will feel it!

43
Q

A 19-year-old, sexually active woman presents to the emergency room complaining of a 2-day history of urinary frequency, burning, and urgency. She denies vaginal discharge or itching, fever, chills, nausea, vomiting, back pain, abdominal pain, or hematuria. She has no history of UTI or a sexually transmitted disease. She recently began using a diaphragm for birth control, and reports that her last menstrual period occurred 3 weeks ago. She has only one sexual partner, who denies penile discharge or burning on urination. On physical examination, she is noted to be afebrile with a normal blood pressure and pulse. There is no costovertebral angle tenderness. Her abdomen is soft and there is mild suprapubic tenderness in response to palpation. A urinalysis reveals 2+ leukocytes and 1+ blood. The urine pH is 5.6. Gram staining of an unspun urine specimen reveals abundant neutrophils and moderate gram-negative rods. A clean-catch urine specimen is sent to the microbiology laboratory for culture. The emergency room physician diagnoses an uncomplicated UTI (cystitis) and prescribes trimethoprim-sulfamethoxazole, one double-strength tablet twice a day for 3 days.
Tell me how you know it isnt proteus mirabilis and how you know she doesnt have kidney infection

A

no costovertebral angle tenderness (rib 12 and spine)= no kidney infection

no elevated pH= not proteus mirabilis (has alkaline urine)

44
Q

How do you treat cystitis?

A

trimethoprim-sulfamethoxazole (bactrim) or ciprofloxacin for 3 days

45
Q

What are three groups of patients who benefit from treatment even though they have asymptomatic bacteriuria?

A
  • pregnant women
  • renal transplant patients
  • pnts prepping for genitourinary tract surgery
46
Q

How does pyelonephritis usually begin?

A

begins as lower urinary tract infect that ascends the ureters to enter the kidney

47
Q

What is a complication of pyelonephritis?

A

perinephric abscess

can also occur secondary to bacteremia

48
Q

Patients with pyelonephritis usually experience symptoms of (blank)

A

cystitis

49
Q

What are the symptoms of pyelonephritis?

A
  • fever (>38° C)
  • nausea and vomiting
  • flank pain and tenderness
  • costovertebral angle tenderness
50
Q

The patient was a 22-year-old female with a history of urinary tract infection 3 months prior to admission. She had been treated with trimethoprim-sulfamethoxazole (Bactrim) without complications. One day before admission she developed left flank pain, nausea, vomiting, fever, and chills. She noted increased urinary frequency and foul-smelling urine on the day of admission. She presented with a temperature of 38.7° C, and physical examination showed left costovertebral angle tenderness. Urinalysis of a clean-catch urine sample was notable for leukocyte esterase (+), >50 WBC and 10 RBC per high-power field, and 3+ bacteria. Urine culture was subsequently positive for a gram-negative, beta hemolytic organism identified as Escherichia coli. She was diagnosed with (blank) and treated with (blanK)

A

acute pyelonephritis and treated with Bactrim for 14 days.

51
Q

What will a kidney look like in acute pyelonephritis?

A

enlarged, discrete, yellowish, raised abscesses apparent on surface

52
Q

Why do you want to use trimeothprim sulfamethoxazole or ciprofloxacin for UTI?

A

cuz it partions into the urine.

53
Q

What is the pathognomonic histologic feature of acute pyleonephritis?

A

suppurative necrosis or abscess in kidney

54
Q

What will the kidneys look like in chronic pyelonephritis?

A
  • gross scars (in one or both kidneys)

- inflammatory changes in pelvic wall with papillary atrophy and blunting

55
Q

What will the parenchyma look like in chronic pyelonephritis?

A

interstital fibrosis with an inflammatory infiltrate of lymphocytes, plasma cells, and occasionally neutrophils

56
Q

A 48-year-old man with a history of pyelonephritis presents to the emergency department with fever (38.4° C), nausea, vomiting, and sharp costovertebral pain. He had been diagnosed with pyelonephritis caused by Escherichia coli a month earlier and was treated with trimethoprim-sulfamethoxazole for two weeks. He is admitted to the hospital. His WBC count is 21,500/mm3 with a left shift. His hematocrit is 32 and he has an elevated ESR. Urinalysis shows leukocyte esterase (+) and nitrite (+). Urine culture grows E. coli, but blood cultures are negative. What does he have and how do you treat it?
What is the mortality?

A

perinephric abscess
Drain abscess and give IV antibiotics of ceftriaxone and gentamicin
45%!

57
Q

How do you diagnose a perinephric abscess and what is it secondary to?

A

imaging!

pyelonephritis

58
Q

What is a hallmark sign of periphenric abscess?

A

leukocytosis with left shift

59
Q

Occasionaly you can get a perinephric abscess secondary to a blood infection. What can cause this?

A

staph aureus

60
Q

(blank) is a motile gram-negative rod that can cause UTI, it has SWARMING GROWTH on agar

A

Proteus mirabilis

61
Q

How does proteus mirabilis cause stones?

A

it produces urease which breaksdown urea to ammonia and CO2.
Ammonia increases urine pH which causes formation of magnesium ammonium phosphate kidney stones (struvite calcuili)
i.e staghorn stones

62
Q

Why can kidney stones cause recurrent UTI?

A

bacteria can hide out in them and escape antibiotics

63
Q

A 59-year-old man presents to his primary care physician with a complaint of sharp left flank pain that has been getting progressively worse for two months. His vital signs are temperature 38.7°C, blood presure 130/82, respirations 18, and pulse 78. He has oliguria, dysuria, and hematuria. A clean catch urine sample reveals a pH of 7.9 and >100,000 CFUs per milliliter. No abscess is present.
What is this and how do you know?

A

It is a kidney stone caused by proteus mirabilis (due to high urine pH)

64
Q

What can proteus mirabilis cause in the urinary tract system?

A

cysitits
pyelonephritis
prostatitis

65
Q

What are the risk factors for struvite kidney stones?

A

catheterization, recurrent UTI, anatomical defects

66
Q

How do you treat a struvite kidney stone?

A

give ceftriaxone and refer to urologist

67
Q

Moderately ill patients with pyelonephritis can often be treated as outpatients with (blank) or (blank) for (blank) days

A

trimethoprim-sulfamethoxazole (bactrim) or ciprofloxacin

14

68
Q

How should you treat a patient with severe pyelonephritis (high fever, toxic, unable to care for themselves)?

A

treated in hospital with IV antibiotcs (i.e ceftriaxone or a fluoroquiolone) until 24 hours AFTER fever breaks

69
Q

How long do you give antibiotics to patients with pyelonephritis?

A

14 days

70
Q

What is the prophylactic tx for women with recurrent pyelonephritis infections?

A

Long-term low dose antibiotic

71
Q

How do

-you prevent future UTIs?

A
  • high fluid intake
  • cranberry juice
  • Dont withold urination
  • avoid spicy foods, alcohol, or caffeine (causes irritation of bladder)
72
Q

Why does cranberry juice help with prevention of UTIs?

A

-tannins in cranberry juice prevent binding of bacteria to uroepithelial cell surface receptors

73
Q

How can sexually active who get recurrent UTIs prevent them?

A
  • avoid spermicide-containing contraceptives

- take antimicrobial agent before intercourse

74
Q

How can postmenopausal women with recurrent UTI prevent recurences? Why does this tx work?

A

oral or vaginal estrogen
-it shifts vaginal flora from uropathogens to lactobacilli which lowers vaginal pH which prevents colonization of uropathogens

75
Q

(blank) is an inflammation of the prostate gland

Prostatitis describes a wide spectrum of disorfers ranging from acute bacterial infections to (blank)

A

Prostatitis

chronic pain syndromes

76
Q

What is the mot common cause of prostatitis?

What else can cause it?

A

E. coli

-Klebsiella, Pseudomonas, Enterobacter, Serratia, Proteus, Enterococcus

77
Q

How common is acute bacterial prostatitis?

A

1 in 1000 adult men per year

78
Q

What is the most common malady of the prostate in patients younger than 35?

A

acute bacterial prostatitis

79
Q

T or F
Patients with a previous episode of acute bacterial prostatitis are more likely to experience future episodes of prostatitis

A

T

80
Q

The organisms that cause prostatitis are usually acquired following acension of (blank) organisms that have colonized the distal end of the urethra.

A

fecal

81
Q

Tjhe E. coli strains that cause prostatitis appear to use the same (blank) that cause other UTIs.

A

virulence factors

82
Q

How do you get prostatitis?

A
  • infected urine refluxes into the glandular prostatic tissue via the ejaculatory and prostatic ducts
  • neutrophils infiltrate around acini and cause intraductal desquamation and cellular debris
  • tissue invasion by lymphocytes, plasma cells, and macrophages
83
Q

How is acute bacterial prostatitis identified? It is often associated with infection in other parts of the urinary tract so patients may also have symptoms consistent with (blank X 3)

A

clinically

  • urethritis
  • cystitis
  • pyelonephritis
84
Q

If you do a rectal exam on someone wiht prostatitis what will you feel?

A

a swollen (boggy), warm, and tender to the tough prostate

85
Q

Asymptomatic prostatitis are often identified following routine (Blank) and have elevated levels of (blank) is the bloodstream

A

PSA testing

PSA

86
Q

A 55-year-old male patient presents to your clinic complaining of fever, chills and bodyaches, especially in the low back. He reports painful urination and urinary frequency over the last 3 days. He has had no prior similar symptoms. Vital signs are pulse 104, temperature 100.2°F, blood pressure 132/88, and respirations 18. On physical exam you note suprapubic abdominal tenderness and a distended bladder. Digital exam reveals a warm, tender, and enlarged prostate. Labs show a mildly elevated WBC count; BUN and creatinine are normal. Suspecting prostatitis, you order a urine sample which comes back leukocyte esterase (+), nitrite (+), and bacteria (3+). The lab reports large numbers of a gram-negative rods consistent with Escherichia coli. Based on this patient’s symptoms, exam and lab findings, you diagnose him with (blank) and begin treatment with (blank)

A

acute bacterial prostatitis

Bactrim

87
Q

What is the most common microbe in prostatitis?

A

E.coli

88
Q

To determine if a patient has prostatitis, what kind of specimen do you need to collect and what should you test it for?

A

midstream urine catch

test for pH, leukocyte esterase, nitrites, and number of bacterial cells

89
Q

A urine specimen of patient with acute bacterial prostatitis will have greater than (blank) and greater than (Blank) WBC per high powered field

A

10,000

10

90
Q

Patients with acute bacterial prostatitis usually respond well to tx with (blank) or (blank) for 10-14 days

A

trimethoprim-sulfamethoxazole

Ciprofloxacin

91
Q

How do you treat asymptomatic prostatitis?

A

same way with trimethoprim-sulfamethoxazole (bactrim) or ciprofloxacin for 14 days

92
Q

Some infections of the prostate can be prevented by using a (Blank) during sexual intercourse

A

condom

93
Q

A 32-year-old woman comes to the ED with severe costovertebral angle tenderness. Urinalysis reveals pyuria and bacteriuria. She is diagnosed with acute pyelonephritis and treated with oral Bactrim as an outpatient. After 4 days of therapy, she returns to the ED with persistent fever to 38.9 C (102 F), blood pressure of 100/65, respiratory rate 25, heart rate 110, and a WBC count of 14,500 ml. She appears lethargic. Given her recent medical history, urosepsis is suspected. She is hospitalized and started on IV ceftriaxone. Blood cultures reveal that the patients is bacteremic. What is the most likely pathogen causing this case of urosepsis?

A

E. coli

94
Q

What are the 2 major ways to get epsis?

A

urinary tract infection or respiratory tract

Block 9 Week 5 (5 decks)

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