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Renal > UTI microbiology > Flashcards

UTI microbiology Flashcards

1
Q

what is a lower UTI

A

infection confined to the bladder= cystitis

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2
Q

what is an upper UTI

A

infection onvolving the ureters +/- the kidneys (pyelonephritis)

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3
Q

urine where is sterile

A

kidneys, ureters and bladder

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4
Q

is the urethra sterile

A

no colonised by bacteria (coliforms and enterococci from the large bowel due to the proximity to the anus)

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5
Q

what types of bacteria usually colonise the urether

A

coliforms and enterococci (from large bowel)

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6
Q

what is a complicated UTI

A

UTI complicated by systemic symptoms or urinary structural abnormalities/ stones

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7
Q

what is bacteriuiria

A

bacteria in the urine- doesnt always mean infection (esp in elderly patients/ catheterised patients)

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8
Q

what is cystitis

A

inflammation of the bladder- not always due to infection

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9
Q

what are the risk factors for a UTI

A

women > men (short, wide urethra, proximity of urethra to anus, increased risk with sexual activity/ pregnancy)
catheterisation
abnormalities of the urinary tract

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10
Q

what is the path of an ascending infection

A

bacteria from bowel- perineal skin- lower end of urethra- bladder- ureters- kidneys

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11
Q

what is the path of infection from the blood to the urinary system (this is rare)

A

bacteraemia- seeded into kidneys

- small multiple abscesses- bacteria in urine

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12
Q

what specimen do you want to diagnose a UTI

A

mid stream urine (first part of stream washes out lower colonised urethera- in STIs want first part of urinary stream)
dipstick/ culture
microscopy

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13
Q

what are coliforms

A

gram negative bacteria

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14
Q

name the gram -ve bacteria that commonly cause UTIs

A

coliforms (gram -ve bacilli):

  • E COLI
  • klebsiella
  • enterobacter
  • serratia
  • citribacter
  • morganella
  • proteus
  • providencia

not coliforms:
-pseudomonas aeruginosa

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15
Q

what is the most common cause of UTIs

A

e coli

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16
Q

what is the only non coliform that commonly causes UTIs

A

pseudomonas aurginosa

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17
Q

what type of bacteria is e coli

A

gram negative coliform

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18
Q

what is the key virulence factor of e coli for UTIs

A

endotoxin in LOS layer

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19
Q

what type of bacteria is proteus

A

gram negative coliform

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20
Q

what is proteus associated with - why

A

struvite stones (stag horn calculi)

produces urase which breaks down urea to form ammonia - increases urinary pH- precipitation of salts

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21
Q

what are the features of proteus

A 
swarming cultures 
foul smelling (burnt chocolate)
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22
Q

what is urothiasis and what infection is it associated with

A

kidney stone formation

=proteus infection

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23
Q

what is pseudomonas associated with

A

catheters and instrumentation

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24
Q

what antibiotics for pseudomonas aeruginosa

A

RESISTANT TO MOST ORAL except ciprofloxacin (quinolone)

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25
Q

who cant take ciprofloxacin

A

young children and pregnant women (is a quinolone)

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26
Q

how does ciprofloxacin work

A

inhibits bacterial DNA gyrase

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27
Q

what does ciproloxacin treat

A

pseudomonas, almost all coliforms, some enterococci but NOT s aureus or MRSA

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28
Q

how can you give ciprofloxavin

A

oral or IV

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29
Q

what is the only oral anti-psuedomonal antibiotic

A

ciprofloxacin

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30
Q

what are the SE of ciprofloxacin

A

tendonitis, tendon ruptures, seizures

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31
Q

what are the gram positive causes of UTIs

A

enterococcus:

  • ENTEROCOCCUS FAECALIS
  • enterococcis faecium

staph:
staphylococcus saphrophyticus
staph aureus (uncommon)

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32
Q

what is associated with gram enterococcus (gram +ve) UTI associated with

A

hospital acquired infections

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33
Q

what type of bacteria is staph saphrophyticus

A

coagulase negative staph

usually affects women of child bearing age

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34
Q

what does a staph saphrophyticus UTI cause

A

UTI in women of child bearing age

causes cystitis in community

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35
Q

when do you get staph aureus UTIs

A

uncommon (usually bacteraemia)

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36
Q

what are the symptoms of a UTI

A

dysuria
frequency of urination
nocturia
haematuria

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37
Q

what are the symptoms of an upper UTI

A

fever
loin pain
rigors

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38
Q

what are the symptoms of cystitis

A 
frequent and urgent urination 
dysuria 
suprapubic pain 
nocturia 
haematuria 
malaise
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39
Q

what usually causes cystitis

A

e coli
klebsiella
staph saprophyticus
enterococcus faecalis

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40
Q

what are the risk factors for cystitis (lower UTI)

A 
female 
history of UTI
vaginal infection 
diabetes 
obesity 
genetic susceptibility
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41
Q

what are the risk factors for polynephritis (upper UTI)

A

diabetes
HIV/AIDS
iatrogenic immunosuppression
congenital or acquired urodynamic abnormalities

42
Q

what are the symptoms of pyelonephritis

A

back and/or flank pain
fever, chills, malaise
nausea, vomiting, anorexia

43
Q

what are the common causative organisms of pyelonephritis

A 
e coli 
klebsiella 
staph aureus 
enterococcus faecalis 
proteus
44
Q

what are the alternative methods of urine specimen collection

A

suprapubic aspiration
straight in/out catheter

clean catch (children, cognitive/ physical restriction)

bag urine (babies- only negative culture useful as often contaminated)

45
Q

what is the process of collecting a mod stream specimen of urine

A

Label appropriate laboratory container
(Wash perineum / urethral meatus with sterile saline (not antiseptic))
Give patient a suitable wide mouthed sterile (foil) bowl
First urine passed into toilet
Without interruption ,Next part of urine stream collected in bowl
Last urine passed in toilet
Urine transfer from bowl to appropriate laboratory container

46
Q

what are the transport options for urine samples

A

boricon contain (contains boric acid- stops bacteria replicating, work for 24 hrs)

sterile universal container (must get to lab in 2 hrs)

47
Q

when and how can dipstick be used to see if there is infection

A

in selective patients
leukocyte esterase shows presence of leukocytes in urine (WBC)

nitrites indicate presence of bacteria in the urine

48
Q

when would a UTI give a negative nitrite dipstick test

A

many coliforms reduce nitrates to nitrites so do not give a positive test
(enterococcus, staph, pseudomonas)

protein + blood

49
Q

WHEN DO YOU NOT DO A DIPSTICK FOR UTI

A

DO NOT DIPSTICK URINE OF ELDERLY/ CATHETER PATIENTS FOR INFECTION!!!!

50
Q

is microscopy of urine done commonly

A

no

can be used to look for pus, bacteria +/- red cells

51
Q

what is kass’s criteria

A

criteria showing the likelyhood of women of childbearing age having a UTI depending on the number of organisms found in culture (>10*5 organisms/ ml= probable UTI)

52
Q

what does pure/ mixed growth on a urine culture mean

A

genuine UTI (in non catheterised patients) will be caused by a single organism

mixed growth is probably not significant

53
Q

what should an ideal antibiotic for a UTI be

A

excreted in urine high concentration
oral
inexpensive
few SE

54
Q

how long a course of antibiotics for an uncomplicated UTI in women

A

3 day course

55
Q

what is abacterial cystitis/ urethral syndrome

A

patient has symptoms of UTI and pus in urine but no significant growth on culture:

  • may be an early phase of UTI
  • may be due to urethral trauma (honeymoon cystitis)
  • may be due to urethritis caused by chlamydia, gonnorhoea
56
Q

what can help in abacterial cystitis/ uretheral syndrome

A

alkalinising the urine may provide symptomatic relief

57
Q

what is asymptomatic bacteriuria

A

significant bacteruria (>10*5 orgs/mL)
patient is asymptomatic (found incidentally)
no pus cells in urine

antibiotic treatment not required, especially in elderly
if you give antibiotics will recur

58
Q

who are the only people who should get antibiotics in asymptomatic bacteriuria

A 
pregnant women (all screened at first antenatal visit for it) 
if left untreated can 20-30% progress to pyelonephritis which can cause intra-uterine growth retardation/ premature labour
59
Q

when should catheterised patients with >10*5 orgs/mL be given antibiotics

A

when there is supporting evidence of UTI (fevers, symptoms)

unnecessary antibiotics result in catheter becoming colonised with increasingly resistant organisms

60
Q

empirical Tx for female lower UTI

A

nitrofurantoin or trimethoprim orally 3 days

61
Q

empirical Tx for uncatherterised male UTI

A

get cultures- need to consider prostatitis

nitrofuratoin or trimethoprim orally for 7 days

62
Q

empirical Tx for complicated UTI or pyelonephritis GP

A

co amoxiclav or co trimoxazole for 14 days

63
Q

empirical Tx for complicated UTI or pyelonephritis hospital

A

amoxicillin and gentamicin IV for 3 days

co trimoxazole and gentamcin if allergic

64
Q

what antibiotics for coliforms

A

gentamicin IV
amoxicillin
trimethoprim (lower tract)
co trimoxazole

65
Q

what antibiotic for enterococci

A

amoxicllin IV

cotrimoxazole

66
Q

what are the 1st and 2nd line antibiotics for UTI

A 
1st line
amoxicillin (IV, oral)
trimethoprim (oral, but can be given IV as cotrimoxazole)
nitrofurantoin (oral)
gentamicin (IV)
2nd line
pivmecillinam (oral)
temocillin (IV)
cefalexin (oral)
co-amoxiclav = amoxicillin + clavulanic acid (IV, oral)
ciprofloxacin (IV, oral)
67
Q

what is the workhorse for gram -ves

A

gentamicin (IV)

68
Q

how do you give gentamicin

A

hospital use only- has to be given IV

should be prescribed for 3 days only

69
Q

what does gentamicin not treat

A

enterococci

70
Q

who should you avoid giving gentamicin to

A

pregnant women

71
Q

what is ESBL

A

extended spectrum beta lactamase

72
Q

what does ESBL make bacteria resistant to

A

all cephalosporins and to almost all penicillins

73
Q

what antibiotics may be useful in EBSL

A 
nitrofuratoin oral 
pivemecillinam oral 
fosfomycin oral 
temocillin IV
meropenem IV 
ertapenem IV
74
Q

what are carbapenemase producing enterobacteriaceae

A

gram negative coliform that are resistent to meropenem= effectively resistant to all current antibiotics

75
Q

what antibiotic for anterococci

A

amoxicillin

76
Q

what 2nd lines doe gram -ves

A 
Aztreonam 
Egfr <20 , more expensive
Pivmecillinam (po)
Temocillin (ESBL 
Piperacillin/tazobactam
Meropenem
Quinonoles (e.g. ciprofloxacin)
fosfomycin
77
Q

what 2nd line antibiotics for enterococci

A 
Vancomycin
(chloramphenicol)
Linezolid
(Daptomycin)
(tigecycline)
78
Q

how does trimethoprim work

A

Inhibits bacterial folic acid synthesis

avoid in 1st trimester (3 months) of pregnancy

most coliforms, Staph aureus incl. MRSA but not Pseudomonas sp.

79
Q

why is nitrofurantoin only useful for lower UTIs

A

as reaches effective conc in bladder

80
Q

when should you avoid nitrofuratoin

A

late pregnancy (can cause neonatal haemolysis), breast feeding and children <3 months old

81
Q

what does nitrofuratoin treat

A

Most coliforms, Enterococci, Staph aureus incl MRSA, but not Proteus sp and Pseudomonas sp.

82
Q

what does amoxillin treat

A

Enterococcus faecalis

Some coliforms, but >50% E coli now resistant, and many other coliforms also resistant

83
Q

when is cefalexin used

A

when organisms is amoxicillin and trimethoprim resistant

84
Q

what does co amoxiclav treat

A

Most coliforms, enterococci, Staph aureus but not MRSA, not Pseudomonas sp

85
Q

when is temocillin useful and not useful

A

Useful for treating complicated UTI/urosepsis in patients whose renal function is too poor for gentamicin, but is NOT as effective as gentamicin clinically

NO activity against Staphylococci/Streptococci/Enterococci or Pseudomonas sp.

86
Q

what are the carbepenems

A

active against ESBL producers
meropenem
ertapenem

not against staph/strep/enterococci/ pseudomonas

87
Q

when is pevmecillinam used

A

has activity against ESBL, useful in uncomplicated UTI
doesnt work against staph/strep/enterococci or pseudomonas
NOT in pregnancy

88
Q

why is e coli the most common cause of UTI

A

most common aerobe in bowel- proximity of anus to urethra

89
Q

why is nitrofuratoin a suitable choice for the treatment of cystitis but not for pyelonephritis

A

concentrates in the bladder, not high enough concentration in kidneys to be affective

90
Q

antibiotic for pyelonpehritis in GP

A

co-amoxiclav

91
Q

what do you use to calculate the dose of gentamicin

A

body weight, gender, age, height, creatinine

92
Q

what is the workhorse against gram -ves

A

gentamicin

93
Q

why is erythromycin not suitable for pyelopnephritis in penicillin hypersensitive patient

A

not excreted by kidneys and is bacteriostatic (in pyelonephritis eant bacteriocidal)

94
Q

in a patient with symptoms of a UTI why might a urine culture be negative

A

poor sample
if already started antibiotics
aseptic cystitis

95
Q

what treatment for aseptic cystitis

A

emptying bladder after sex

alkalising urine with sodium citrate but no evidence for this

96
Q

what diagnosis if recurrent aseptic cystitis persitis

A

STI

recurrent cystitis

97
Q

what antibiotic for mild c diff

A

PO metronidazole

98
Q

do you send a stool culture after c diff symptoms resolve for a test of cure

99
Q

what antibiotics for a UTI in a pregnancy women

A

nitrofluritone oral in 1st trimester

trimethoprim in 2nd/3rd semester

100
Q

what can a dipstick tell you about presence of an infection

A

A negative dip stick test for leukocyte esterase (white cells) is a useful test to rule out UTI when combined with a negative nitrite test (negative predictive
value of 95%)

101
Q

what should you test if both blood an protein are present on dipstick

A

CRP, ANA, ANCA
and protein electrophoresis to look for other causes such as vasculitis or
myeloma

Renal (27 decks)

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