UTI- Micro

Question 1

T/F Most UTI’s are caused by enteric bacteria

Answer 1

True

Question 2

First line Ab in uncomplicated UTI’s

Answer 2

Nitrofurantoin or TMP-SMX for women

Fluroquinolone of TMP-SMX for men

Question 3

Nitrofurantoin

Answer 3

Uncomplicated UTI’s and recurrent UTI’s
* NOT effective for Kidney infections*
Damages bacterial DNA by reactive intermediates

Question 4

TMP-SMX (Bactrim)

Answer 4

UTI’s M/F, kidney infections

Stops the metabolism of folate- DHFR

Question 5

Fluroquinolones

Answer 5

Broad coverage- gram + and gram -
First line for acute pyelonephritis or prostatitis (inpatient)
tendon rupture
Selective inhibition of topoisomerase II and IV- preventing unwinding and replication of DNA

Question 6

UTI facts

Answer 6

More common in adults 20-50 yo

50x more likely in women

Question 7

Factors that keep urinary tract free of infections

Answer 7

Acidity of urine
Urination- flushing
IHO and physical barriers to infection- mucosal lining of the tract and urethral sphincter

Question 8

90% of UTI’s occur when…

Answer 8

bacteria ascends the urethra to the bladder or ureter to the kidney
** remainder are hematogenous in origin**

Question 9

Complicated UTI’s

Answer 9

Underlying factors that predispose and individual to an ascending bacterial infection
- catheters, anatomic abnormalities, obstruction of flow or poor emptying (calculi, tumors, neurogenic, pregnancy, prostate, uterine prolapse and cystocele)

Question 10

Uncomplicated UTI’s

Answer 10

Occurs without an underlying abnormality or impairment of flow
- unprotected intercourse, uncircumcised, diaphragm, spermicide, Ab use, history of recurrent UTI’s

Question 11

Most common organism causing uncomplicated UTI’s

Answer 11

E.coli- 75%
Staph. saprophyticus 5-15% younger women
(Klebsiella, Proteus, Enterococcus, Citrobacter= 5-10%)

Question 12

3 factors that lead to UTI’s

Answer 12

1. Environment: urinary stasis, stones, catheters, vaginal ecology, anatomy, tissue-specific receptors
2. Host: familial disposition, behavioral, receptors
3. Microorganism: presence and expression of VF’s

Question 13

Virulence Factors of E. coli

Answer 13

Surface adhesions which facilitate binding to epithelial cells to initiate colonization= P. fimbriae; Type 1 pilus is possessed but not always expressed in E. coli

Question 14

Diagnosis of UTI

Answer 14

Analysis and culture of urine- can take up to 24 hours

Symptoms + bacteria, WBC’s and inflammatory cytokines

Question 15

Asymptomatic bacteriuria ABU

Answer 15

Absence of symptoms but with presence of bacteria in the urine

Question 16

E. coli

Answer 16

Gram -, bacilli, catalase +, oxidase -
Reduces nitrates to nitrites
Green metallic sheen on EMB agar
VF’s= pili, immune evasion with capsular Ag’s and flagella

Question 17

Staph saprophyticus

Answer 17

Young, sexually active Females
gram + cocci
VF: adhesins and urease

Question 18

Klebsiella pneumoniae

Answer 18

gram - rod, encapsulated, lactose-fermenting, facultative anaerobe
Produces urease
VF: pili, adhesins, immune evasion with capsule and flagella

Question 19

Proteus mirabilis

Answer 19

???

Question 20

Enterococcus faecalis

Answer 20

Gram + rod, catalase -
facultative anaerobe
GI tract
Nosocomial & drug resistant
VF: pili, adhesins, EPA

Question 21

Pyelonephritis

Answer 21

E. coli= 90% of cases
Klebsiella
Enterococcus

Question 22

ASB

Answer 22

ASB during pregnancy is associated with preterm birth and perinatal death of the fetus and with pyelonephritis in the mother

Question 23

Males

Answer 23

75% have an anatomical abnormality- usually prostatic hypertrophy
Lack of circumcision is also associated with an increased risk of UTI because E. coli is more likely to colonize the glans and prepuce and subsequently migrate into the urinary tract.

Question 24

Females and UTI’s

Answer 24

2-3 fold rate higher in diabetics for ABU and UTI- especially with insulin use
May have impaired cytokines

Question 25

Complicated UTI bugs

Answer 25

E. coli, aerobic gram-negative rods= P. aeruginosa, Klebsiella, Proteus, Citrobacter, Acinetobacter, and Morganella species
Gram-positive bacteria (e.g., enterococci and Staphylococcus aureus) and yeasts

Question 26

Pyelonephritis

Answer 26

low-grade fever with or without lower-back or costovertebral-angle pain, whereas severe pyelonephritis can manifest as high fever, rigors, nausea, vomiting, and flank and/or loin pain. Symptoms are generally acute in onset, and symptoms of cystitis may not be present. Fever distinguishes cystitis and pyelonephritis. The fever of pyelonephritis typically exhibits a high spiking “picket-fence” pattern and resolves over 72 h of therapy. Bacteremia develops in 20–30% of cases.

Question 27

Prostatitis

Answer 27

Acute bacterial prostatitis presents as dysuria, frequency, and pain in the prostatic pelvic or perineal area. Fever and chills are usually present, and symptoms of bladder outlet obstruction are common. Chronic bacterial prostatitis presents more insidiously as recurrent episodes of cystitis, sometimes with associated pelvic and perineal pain.

Question 28

Ddx for dysuria

Answer 28

Cervicitis (C. trachomatis, Neisseria gonorrhoeae), vaginitis (Candida albicans, Trichomonas vaginalis), herpetic urethritis, interstitial cystitis, and noninfectious vaginal or vulvar irritation

Question 29

Casts in urine

Answer 29

Seen in pyelonephritis

Question 30

Pyelonephritis pathogens

Answer 30

1. E.coli 90%
2. Enterococcus faecalis
3. Klebsiella spp.

Question 31

Tx of recurrent UTI’s

Answer 31

Continuous, postcoital, and patient-initiated Ab therapy