UTI microbiology Flashcards
what is a lower UTI
infection confined to the bladder= cystitis
what is an upper UTI
infection onvolving the ureters +/- the kidneys (pyelonephritis)
urine where is sterile
kidneys, ureters and bladder
is the urethra sterile
no colonised by bacteria (coliforms and enterococci from the large bowel due to the proximity to the anus)
what types of bacteria usually colonise the urether
coliforms and enterococci (from large bowel)
what is a complicated UTI
UTI complicated by systemic symptoms or urinary structural abnormalities/ stones
what is bacteriuiria
bacteria in the urine- doesnt always mean infection (esp in elderly patients/ catheterised patients)
what is cystitis
inflammation of the bladder- not always due to infection
what are the risk factors for a UTI
women > men (short, wide urethra, proximity of urethra to anus, increased risk with sexual activity/ pregnancy)
catheterisation
abnormalities of the urinary tract
what is the path of an ascending infection
bacteria from bowel- perineal skin- lower end of urethra- bladder- ureters- kidneys
what is the path of infection from the blood to the urinary system (this is rare)
bacteraemia- seeded into kidneys
- small multiple abscesses- bacteria in urine
what specimen do you want to diagnose a UTI
mid stream urine (first part of stream washes out lower colonised urethera- in STIs want first part of urinary stream)
dipstick/ culture
microscopy
what are coliforms
gram negative bacteria
name the gram -ve bacteria that commonly cause UTIs
coliforms (gram -ve bacilli):
- E COLI
- klebsiella
- enterobacter
- serratia
- citribacter
- morganella
- proteus
- providencia
not coliforms:
-pseudomonas aeruginosa
what is the most common cause of UTIs
e coli
what is the only non coliform that commonly causes UTIs
pseudomonas aurginosa
what type of bacteria is e coli
gram negative coliform
what is the key virulence factor of e coli for UTIs
endotoxin in LOS layer
what type of bacteria is proteus
gram negative coliform
what is proteus associated with - why
struvite stones (stag horn calculi)
produces urase which breaks down urea to form ammonia - increases urinary pH- precipitation of salts
what are the features of proteus
swarming cultures foul smelling (burnt chocolate)
what is urothiasis and what infection is it associated with
kidney stone formation
=proteus infection
what is pseudomonas associated with
catheters and instrumentation
what antibiotics for pseudomonas aeruginosa
RESISTANT TO MOST ORAL except ciprofloxacin (quinolone)
who cant take ciprofloxacin
young children and pregnant women (is a quinolone)
how does ciprofloxacin work
inhibits bacterial DNA gyrase
what does ciproloxacin treat
pseudomonas, almost all coliforms, some enterococci but NOT s aureus or MRSA
how can you give ciprofloxavin
oral or IV
what is the only oral anti-psuedomonal antibiotic
ciprofloxacin
what are the SE of ciprofloxacin
tendonitis, tendon ruptures, seizures
what are the gram positive causes of UTIs
enterococcus:
- ENTEROCOCCUS FAECALIS
- enterococcis faecium
staph:
staphylococcus saphrophyticus
staph aureus (uncommon)
what is associated with gram enterococcus (gram +ve) UTI associated with
hospital acquired infections
what type of bacteria is staph saphrophyticus
coagulase negative staph
usually affects women of child bearing age
what does a staph saphrophyticus UTI cause
UTI in women of child bearing age
causes cystitis in community
when do you get staph aureus UTIs
uncommon (usually bacteraemia)
what are the symptoms of a UTI
dysuria
frequency of urination
nocturia
haematuria
what are the symptoms of an upper UTI
fever
loin pain
rigors
what are the symptoms of cystitis
frequent and urgent urination dysuria suprapubic pain nocturia haematuria malaise
what usually causes cystitis
e coli
klebsiella
staph saprophyticus
enterococcus faecalis
what are the risk factors for cystitis (lower UTI)
female history of UTI vaginal infection diabetes obesity genetic susceptibility