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Block 9; Week 5-M > UTI-Hunter > Flashcards

UTI-Hunter Flashcards

1
Q

What are the infections of the lower urinary tract?

A

urethritis (urethra)

cystitis (urinary bladder) -prob w/ accompanying urethritis

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2
Q

What is an upper urinary tract infection?

A

pyelonephritis (kidney & ureter)

perhaps a perinephric abscess

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3
Q

Which gender are UTIs more common in?

A

Females! 30:1

incidence increases w/ age & sexual activity

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4
Q

T/F Postmenopausal women have lower rates of UTIs.

A

False. bladder or uterine prolapse & hormonally induced changes–increases rates of infections

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5
Q

What is a case where males sometimes get UTIs?

A

in their 50s b/c of incomplete voiding of bladder due to BPH

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6
Q

What are the most common cause of uncomplicated UTI?

A
  1. 80-90% E coli

2. Staph Saprophyticus for females 13-40 who are sexually active.

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7
Q

What is a complicated UTI? What are the most common organismal causes of this?

A 
resulting from anatomic obstructions or catheterization or weird bugs.
E coli
Proteus Mirabilis
Klebsiella pneumonia
Enterococcus
pseudomonas aeruginosa
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8
Q

T/F Fungal UTIs are common.

A

False. Uncommon but serious. Ex: candida.

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9
Q

T/F UTI (particularly nosocomial) are frequently caused by multi-drug resistant organisms

A

True.

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10
Q

What is the vesicoureteral reflux?

A

reflux of urine from bladder to kidney, can increase risk of UTIs

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11
Q

Other risk factors for UTI?

A

pregnancy–like BPH causes incomplete voiding
calculi in urinary tract
catheters

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12
Q

What can lead to urethral colonization?

A

contamination of periurethral region w/ fecal organisms

then ascension = UTI

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13
Q

What facilitates the ascension of organisms w/ UTIs?

A

bacterial fimbrae (flagella like) that bind to uroepithelial cells

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14
Q

What are some host factors that prevent UTIs?

A

urine flow
uroepithelial cell sloughing
lactobacilli in vagina (alter pH to prevent colonization)

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15
Q

T/F Blood borne infections of the urinary tract is common.

A

False. Infrequent. In rare cases this happens w/ staph aureus b/c it has SO many virulence factors.

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16
Q

What are the virulence factors of E Coli?

A

Type I Fimbriae
P Fimbrae
Hemolysin
**genes for these carried on pathogenecity islands

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17
Q

What are Type I Fimbriae?

A

bind to mannose-containing epithelial receptors. can cause cystitis (not pyelonephritis)
Gene: fimH
Note: found in all E Coli

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18
Q

What are P fimbrae?

A

bind glycosphingolipid epithelial receptor (found in kidney). Cause pyelonephritis & sometimes bacteremia.
Gene: papGAP
Note: only found on some E coli

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19
Q

What does hemolysin do?

A

damages uroepithelium

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20
Q

If an Ecoli bug didn’t have P fimbrae (often they don’t)…which UTI type could they NOT cause?

A

pyelonephritis

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21
Q

What is cystitis? What is it always accompanied by?

A

infection of bladder

accompanied by urethritis

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22
Q

What are the signs & symptoms of cystitis?

A

frequent & urgent urination
oliguria
dysuria
suprapubic tenderness w/ voiding

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23
Q

urinary frequency, burning, urgency. no back pain or costovertebral angle tenderness. sexually active. no vaginal discharge. suprapubic tenderness. WBCs & a little blood on UA. urine pH=5.6 neutrophils & gram neg. rods. Treatment?

A

no vaginal discharge–prob not STD
no back pain or costovertebral angle tenderness–not pyelonephritis.
WBCs, a little blood, urinary changes, suprapubic tenderness–cystitis.
low pH–>not proteus mirabilis
gram neg. rod–>E Coli!!!
Treatment: trimethoprim-sulfamethoxazole (bactrim) OR ciprofloxacin for 3 days

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24
Q

Which lab tests should be done when you suspect a UTI?

A

UA
dipstick test (UA)-to check pH, bacteria, leukocyte esterase etc.
gram stain of urine

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25
Q

What is pyuria?

A

leukocytes in the urine.

26
Q

Is a urine pH of 5.6 normal?

A

depends on diet & time of day

but doesn’t get above 7.5ish.

27
Q

What is the presentation of Proteus mirabilis UTI?

A

pH>7.9
bacteria & WBCs in urine
note: this bug is urease-producing

28
Q

What is the purpose of checking for bacteria in urine?

A

you want to know if it is resistant

29
Q

What are you looking for when you are looking for bacteria?

A

NITRITES-bacteria

gram neg causes of UTI–make nitrites in the urine from nitrates

30
Q

When you do want to count the cultures in the urine w/ a UTI?

A

when the patient is super sick & you suspect bacteriuria–>proven w/ >100K colony-forming units per mL

31
Q

T/F Asymptomatic bacteriuria is common.

A

True. And should be treated if you are pregnant, renal transplant pts, and those undergoing genitourinary tract surgery.

32
Q

What are the possible complications for pregnant women w/ asymptomatic bacteriuria?

A

pyelonephritis

preterm delivery

33
Q

What is a possible complication of pyelonephritis? Can also be a complication of bacteremia…

A

perinephric abscess

34
Q

What are the symptoms of pyelonephritis?

A 
fever (>38° C)
nausea and vomiting
flank pain and tenderness
costovertebral angle tenderness
\+ symptoms of cystitis
35
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. What does this patient have? suggested treatment?

A

acute pyelonephritis–flank pain, costovertebral angle tenderness, fever, cultures >100K. + cystitis symptoms.
Treatment: same as cystitis but for longer. trimethoprim-sulfamethoxazole (bactrim) for 14 days. After susceptibility test of E Coli. Could also switch to ceftriaxone.

36
Q

What is the gross appearance of acute pyelonephritis?

A

kidney enlarged

discrete, yellowish, raised abscesses on surface

37
Q

What is the histo appearance of acute pyelonephriits?

A

suppurative necrosis or abscess formation

38
Q

What is the gross appearance of the kidneys in chronic pyelonephritis?

A

gross scars on kidneys, inflammatory changes in pelvic wall, papillary atrophy, blunting

39
Q

What does the parenchyma of a kidney with pyelonephritis show?

A

interstitial fibrosis w/ inflammatory infiltrate–lymphocytes, plasma cells, neutrophils a little.

40
Q

How do you diagnose a perinephric abscess? How does it come to be?

A

blood work/UA see evidence of pyelonephritis. Ex: see left shift leukocytosis OR less commonly can be secondary to bacteremia
CT scan reveals it.

41
Q

What is the treatment for a perinephric abscess?

A

drain abscess percutaneously

IV antibiotics

42
Q

What is the mortality rate of a perinephric abscess?

A

45%!!!!

43
Q

If you see a lot of neutrophils–think what? If you see lymphocytes everywhere–think what?

A

neutrophils-bacteria

lymphocytes–viruses

44
Q

What is proteus mirabilis?

A

motile
gram neg. rod
can cause UTI
swarming growth on agar

45
Q

What does proteus mirabilis produce?

A

produces urease–causes stones urease–>breaks urea to ammonia & CO2.
ammonia can cause ammonium phosphate kidney stones (struvite calculi, stag horn)
also increases urine pH

46
Q

What is the risk of recurrent kidney stones?

A

location in which bacteria can escape antibiotics

recurrent UTI

47
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. Gram stain shows gram-negative rods; What does the patient have? What might the CT show? Treatment?

A

proteus mirabilis
CT–struvite kidney stone
ceftriaxone
urology will remove stone

48
Q

Patients with proteus mirabilis often present with what? Risk factors?

A

Patient often present with cystitis, pyelonephritis, or prostatitis
Risk factors include: catheterization, recurrent UTI, anatomical defects

49
Q

How should moderately ill patients with pyelonephritis be treated?

A

trimethoprim-sulfamethoxazole OR ciprofloxacin for 14 days

50
Q

How should patients with severe pyelonephritis be treated?

A

hospital setting
IV antibiotics-ceftriaxone or fluoroquinolone until 24 hours after fever stops, then oral antibiotics for the rest of 14 days

51
Q

How should women with recurrent infections be treated?

A 
long term low dose antibiotic treatment
high fluid intake
cranberry juice-tannins
empty bladder
avoid spicy foods, caffeine
52
Q

How can you treat sexually active women with recurrent UTIs?

A

avoid spermicide containing contraception

antimicrobial agent prior to intercourse

53
Q

HOw can you treat postmenopausal women w/ recurrent UTI?

A

oral or vaginal estrogen-gets more lactobacilli going

54
Q

what is the most common bug to cause prostatitis? Others?

A

Most common: E Coli

Others: Klebsiella, Pseudomonas, Enterobacter, Serratia, Proteus, and Enterococcus

55
Q

T/F Sexually active males are more likely to get prostatitis.

A

True.

56
Q

How does prostatitis happen?

A

ascension of fecal organisms that have colonized distal end of urethra

57
Q

Which virulence factors does E coli depend on to cause prostatitis?

A

same ones as it depends on for female UTIs

58
Q

What do infiltrating neutrophils around the acini of the prostate mean?

A

intraductal desquamation

cellular debris

59
Q

Aside from neutrophils, what are other things that invade the prostate tissue?

A

lymphocytes
plasma cells
macrophages

60
Q

What is the presentation of a patient with prostatitis?

A

symptoms of urethritis, cystitis, pyelonephritis
rectal exam shows swollen, warm, tender prostate
PSA elevated

61
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 ? Treatment?

A

acute bacterial prostatitis

Bactrim

62
Q

T/FSome infections of the prostate can be prevented by using a condom during sexual interactions

A

True.

Block 9; Week 5-M (5 decks)

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