UTI's Flashcards
1
Q
Who get’s more UTI’s, women or men?
A
Women
2
Q
What % of women have recurrent UTI’s at some point in their life?
A
20-30%
3
Q
After what age do men experience UTI’s?
A
> 50
4
Q
What is the route that bacteria normally take to cause a UTI?
A
from the urethra –> bladder
5
Q
What is the main mechanism to cause nosocomial UTI’s?
A
catheters
6
Q
What is the #1 cause of community and hospital acquired UTI’s?
A
E. coli
7
Q
What % of community UTI’s are from E. coli?
A
80%
8
Q
What % of community UTI’s are from coagulase-ned staph?
A
10%
9
Q
What % of community UTI’s are from Proteus mirabilis?
A
5%
10
Q
What % of nosocomial UTI’s are from E. coli?
A
40%
11
Q
What % of nosocomial UTI’s are from other gram negatives?
A
25%
12
Q
What % of nosocomial UTI’s are from other gram positives?
A
16%
13
Q
What % of nosocomial UTI’s are from Proteus?
A
11%
14
Q
What % of nosocomial UTI’s are from Cadida?
A
5%
15
Q
What is the virulence factor for Proteus to cause urinary stones?
A
urease
16
Q
Why are Cirobacter, Klebsiella, Enterobacter, Proteus, and Pseudomonas aeruginosa more frequently found in hospital-acquired UTI’s?
A
Because their resistance to antibiotics
17
Q
Case: a young sexually active woman presents with a UTI. Which bug is common in these people?
A
Staphylococcus saprophyticus
18
Q
So the other forms of coagulase-neg staph (epidermidis and enterococcus) are common in which patients?
A
Hospitalized pts
19
Q
How do the human polyomaviruses (JC virus and BK virus) enter the body?
A
Respiratory tract
20
Q
After entering the respiratory tract, where do the human polyomaviruses reside and become latent?
A
Kidneys
21
Q
In which “situation” can human polyomaviruses reactivate asympatomatically and present as large amounts of viruses in the urine?
A
Pregnancy
22
Q
Reactivation of human polyomaviruses in immunocompromised hosts may lead to what condition?
A
Hemorrhagic cystitis
23
Q
In addition to human polyomaviruses, which other virus can cause hemorrhagic cystitis?
A
Adenovirus
24
Q
Which parasite infectiosn result in cystitis and hematuria?
A
Schistosoma haematobium
25
What is the vector for Schistosoma haematobium?
Aquatic snails
26
How do the infected snail larvae enter the host?
By penetrating the skin
27
Where does Schistosoma haematobium mature in the body?
Liver
28
After maturing in the liver and entering the blood, how does Schistosoma haematobium enter the bladder to cause cystitis?
by penetrating the beins of the bladder wall
29
Schistosoma haematobium causes granulomatous reactions in the bladder, which leads to what change in the eggs?
calcification
30
Calcification of a Schistosoma haematobium egg in the bladder may obstruction of a ureter, leading to what pathology of the kidney?
Hydronephrosis
31
How can u screen for Schistosoma haematobium infections to make a Dx?
Look for eggs in urine
32
Where is the spine on the Schistosoma haematobium?
"T"erminal end
schistosoma haema"T"obium
33
Which form of Schistosoma has a spine on the lateral side?
Schistosoma mansoni
| "M" for "M"iddle
34
What anatomical defect in females predisposes them to UTI's?
Short urethra
35
What "activity" predisposes women to UTI's?
Bumpin uglies
36
What leads to more instances of UTI's in men, circumcised or uncircumcised?
Uncircumcised
37
How does pregnancy, BPH, renal calculi, tumors, and strictures predispose you to UTI's?
Obstruction
38
How does loss of neurological control of the bladder and sphincters predispose you to UTI's?
↑ residual volumes
39
This is the reflux of urine form the bladder cavity up the ureters, which can go to the renal pelvis or parenchyma.
Vesicoureteral reflux (VUR)
40
True or False: diabetes predisposes you to UTI's.
True
41
This is the main E. coli strain to cause UTI's.
Uropathogenic E. coli (UPEC)
42
What is the virulence factor on UPEC that allows these organisms to inhibit phagocytosis?
Capsular acid polysaccharide (K) antigens
43
What is the virulence factor on UPEC that allows it to colonize?
P. fimbriae (pyelonephritis-associated pili)
44
What is the virulence factor on UPEC that allows it to adhere to the bladder uroepithelial cells?
Mannose-sensitive fimbriae (FimH)
45
What is the virulence factor on UPEC that allows the organisms to cause damage to the kidney membranes?
Hemolysins
46
What is the virulence factor of Proteus that causes pyelonephritis and stones?
Urease
47
At what level of organisms/mL on urinalysis do you need to determine a UTI?
> 10^5 organisms/mL
48
During what part of the stream is urine collected?
Mid-stream
49
This is the term for collecting urine mid-stream and cleaning the external genetalia which allows you to contain the cleanest and purest result for a urinalysis.
Clean catch
50
How often do you collect routine specimens for M. tuberculosis?
3 early morning urine samples on consecutive days
51
How do you collect for a S. Haematobium infection?
the last few mL of a urine sample in the early afternoon after exercise
(get them eggs for brunch!)
52
What class of drugs is trimethoprim?
Antimetabolite/nucleic acid synthesis inhibitor
53
What is the increasing problem with trimethoprim?
incidence of resistant strains increasing
54
What class of drug is co-trimoxazole?
it's a combo of trimethropim with sulphamethoxazole (also an antimetabolite nucleiuc acid synthesis inhbiitor)
55
What is the first line treatment for UTI's?
co-trimoxazole
56
What is the class of drug for nitrofurantoin?
Urinary antiseptic
57
When do you use nitrofurantoin?
for uncomplicated UTI caused by E. coli and S. sapro
58
Why can't you use nitrofurantoin for proteus?
It's not active in alkaline pH
59
What is the class of drug for cirpofloxacin-floxacin family?
Quinolone
60
Though cipro is a pretty broad-spectrum agent, what bug does it not work against?
Enterococci
61
What 3 parts of the kidney are affected by pyelonephritis?
Tubules, interstitum, and renal pelvis
62
What is the main causitive agent for acute pyelonephritis?
bacterial infection
63
In chronic pyelonephritis, bacterial infection plays a dominant role, but what other factors play a role?
VUR and obstruction
64
What is the most common bacterial to cause pyelonephritis?
E. Coli
65
Who is susceptible to pyelonephritis from polyomavirus, CMV, and adenovirus?
Immunocompromised
66
What is the most common transmission for pyelonephritis?
From own fecal flora (endogenous infection)
67
What are the 2 etiologies for the hematogenous cause of pyelonephritis?
Septicemia or infective endocarditis
68
Where is the most common location where spread occurs from in pyelonephritis?
Lower urinary tract
69
What is the first step in a UTI?
colonization of the distal urethra and introitus
70
What virulence factors do bacteria use to adhere to the urethral epithelium?
Adhesions and pili
71
After colonicaztion of the distal urethra, what is the 2nd step in ascending infections?
Spread from the urethra --> bladder
72
What problems might exist to cause further ascending infection from the bladder?
Obstruction and subsequent stasis
73
So if there's an obstruction, the further ascending infection can continue of there's what congenital problem?
VUR
74
Once the VUR shoots bacteria up the ureter and into the renal pelvis, what can the kidney do to further spread bacteria to the papillae and into the renal parenchyma?
Intrarenal reflux
75
What 2 locations in the kidney are most common for pyelonephritis?
Upper and lower poles
76
This is an acute suppurative inflammation of the kidney caused by bacterial and sometimes viral infection, either from hematogenous or ascending spread.
Acute pyelonephritis
77
What are the 3 hallmarks of acute pyelonephritis?
Patchy interstitial suppurative inflammation
Intratubular aggregates of neutrophils
Tubular necrosis
(PIT)
78
Once bacteria spreads from the interstitial tissue --> tubules, what causes destruction of the tubules in acute pyelonephritis?
Neutrophils
79
True or False: glomeruli are always destroyed in acute pyelonephritis.
FALSE
80
What are the 2 instances in which glomeruli are destroyed in acute pyelonephritis?
Only in severe large areas of necrosis and in fungal pyelonephritis (Candida)
81
This is the complication of acute pyelonephritis in which there is coagulative necrosis of the renal papillae and is usually b/l.
Papillary necrosis
82
What does SODA stand for in the causes of papillary necrosis?
Sickle Cell
Obstructive pyelonephritis
Diabetes
Analgesics
83
This is a complication of acute pyelonephritis where total obstruction of the upper urinary tract causes suppurative exudates fill the renal pelvis, calyces, and ureter with pus.
Pyonephrosis
84
This is a complciation of acute pyelonephritis where supporative inflammation bursts through the renal capsule and enters the perinephric tissue.
Perinephric abscess
85
What are the acute Sx of acute pyelonephritis?
Flank pain, fever, malaise, and dysuria.
86
What do you see in the urine in acute pyelonephritis?
sterile pyuria and WBC casts
87
What do you see in the tubular epithelial cells in polymavirus pyelonephritis?
Intranuclear inclusions
88
This is a disorder in which chronic tubulointerstitial inflammation and renal scarring leads to end stage renal disease.
Chronic pyelonephritis
89
This si the more common form of chronic pyelonephritis where VUR and interarenal reflux causes renal damage.
Reflux nephropathy
90
This is the other cause of chronic pyelonephritis where recurrent infections leads to bouts of renal inflammation and scarring.
Chronic obstructive pyelonephritis
91
In chronic pyelonephritis, is renal involvement symmetrical or asymmetrical?
Asymmetrical
92
What are the 3 hallmarks of chronic pyelonephritis?
Coarse, discrete corticomedullary scars
Blunted calyces
Flattened papilla
93
This is the change in chronic pyelonephritis in which dilated tubules with flattened epithelium fill with colloid casts.
Thyroidization of the kidney
94
What bug causes xanthogranulomatous pyelonephritis?
Proteus
95
What do you see on radiography for chronic pyelonephritis?
Asymmatrically contracted kidneys with coarse scars and blunted calyces
96
What happens in the interstitum in chronic pyelonephritis?
Interstitial fibrosis?
97
What happens to the tubules in chronic pyelonephritis?
Atrophy of tubules
98
What structures confine an "Upper UTI"?
anything above the bladder: ureters, kidneys, and peri-renal tissues (pyelonephritis)
99
What are the Sx to an upper UTI?
fever, n/v, flank pain, and CVA tenderness
100
What are the Sx to a lower UTI (cystitis)?
dysuria, frequency, urgerncy, and viarable suprapubic tenderness
101
What are the 3 first-line treatments to cystitis?
Nitrpfurantonin monohydrate or macryocrystals
TMP-SMZ
Fosformycin trometamol
102
What is the 2nd line treatment for cystitis?
Flouroquinolones
103
THis is the bactericidal agent (1st line for cystitis) that enters teh abcteria, gets reduced, and damages bacterial DNA.
Nitrofurantoin
104
This is the drug that is a syndergistic combination of folate antagonists and blocks purine production and nucleic acid synthesis.
TMP-SMZ
105
This is the abctericidal that inhbiits baacterial cell wall biogenesis by inactivating the enzyme UDP-NAG-3-EPT (MurA).
Fosfomycin
106
This is the antibiotic that inhibits nucleic acid synthesis by binding to the alpha subunit of DNA gyrase
Fluoroquinolones
107
This is an extended spectrum penicillin that binds specifically to penicillin binding protein 2 (PBP2)
Pivmecillinam
108
How long do you give nitrofurantoin, TMP-SMZ, Fosfomycin, and Fluoroquinolones for the treatment of cystitis?
3 days
109
How long do u give Pevmecillinam and other B-lactams for the treatment of cystitis?
5-7 days
110
Is the mechanism of resistant to nitrofurantoin known?
No
111
What are the 3 mechanisms of resistance to TMP-SMZ?
Reduced cell permeability
Overproduction of dihydrofolate reductase
Production of altered reductase
112
What is the mechanism of resistance to fluoroquinolones?
one or more point mutations in quinolone binding region of the target enzyme
113
What is the mechanism of resistance for fosfomycin?
inadequate transport of drug into the cell
114
What is the mechanism of resistance to pivmecillinam?
modification of target PBPs
115
What is the first line treatment for pyelonephritis?
Fluroquinolones
116
What is the 2nd line treatment for pyelonephritis?
TMP-SMZ
117
What is the treament for mild/moderate pyelonephritis?
Oral fluroquinolones + IV cephalosporin or aminoglycoside
118
What are the drugs u give for severe pyelonephritis?
IV fluroquinolone, aminoglycoside, cephalosporin, PCN, or carapenam
119
Are fluroquinolones bactericidal or bacteristatic?
Bactericidal
120
Which enzymes does fluroquinolones bind to?
DNA gyrase (topoisomerase II) and topoisomerase IV
121
What are the 2 main fluroquinolones used?
Cipro
| Levofloxacin
122
Are aminoglycosides bactericidal or bacteristatic?
Bactericidal
123
Which subunit does aminoglcysides bind to?
30S
124
Which site of the subunit (EPA) does aminoglycosides bind to?
A
125
What is the mechanism of aminoglycosides to kill bacteria?
Interferes with assembly of ribisomes
| Causes misreading of RNA
126
Are cephalosporins bactericidal or bacteristatic?
Bactercidal
127
What class of drug are cephalosporins?
B-lactam
128
What is the MOA of cephalosporins?
inhibit PBP crosslinking of the peptidoglycan wall --> cell lysis
129
What are the 3 mechanisms of resistance to fluroquinolones?
chromosomal mutations in bacterial DNA gyrase
↓ porins
Efflux systems
130
What are the 2 mechanisms of resistance to aminoglycosides?
Absence of O2-dependent transport system
| Production of enzymes that modify and inactivate aminoglycosides
131
What are the 3 mechanisms of resistance to cephalosporins?
B-lactamases
↓ permeability of the drug (or efflux pump)
Altered PBPs
132
What is the 4th generation cephalosporin that may be used for the treatment of hospital-associated UTI?
Cefepime
133
True or False: for the treament of asymptomatic bacteriuria, you can use amoxicillin, amoxicillin-clavulanate, cephalexin, fosfomycin, and nitrofurantoin
True
134
Since nitrofurantoin can cause birth defects, what terms in pregnancy can you not use it?
1st and 3rd
135
What are the 2 drug classes that are contraindicated in pregnancy?
Fluroquinolones (damage articular cartilage)
| Tetracyclines (affect bone formation)
136
What are the 4 drugs u can give for 3-7 days for complicated acute cystitis in pregnant women?
Amixicillin-clavulanate
Cefpodoxoime
Fosfomycin
Nitrofurantoin
137
You can also use TMP-SMZ for complicated acute cysititis only during which term in pregnancy?
2nd
| just like nitrofurantoin
138
What is the class of drugs used for the treatment of acute pyelonephritis in pregnant women?
3rd generation B-lactams (ceftriaxone, carbapenams)
139
Why are aminoglycosides avoided in the treatment of acute pyelonephritis in pregnant women?
Ototoxicity following prolonged fetal exposure
140
This is the class of drugs that can cause adverse effects of the bone marrow, skin, and hair (leukopenia, megaloblastic anemia, stomatitis, GI ulderations, and alopecia).
Antifolates
141
Which term should u not use antifolates because of the significant teratogenic risk?
First
142
This is the drug that selectively inhibits bacterial dihydrofolate reductase (DHR) which is needed for the bacteria to make DNA.
Trimethoprim
143
This is the sulfonamide drug that is a structural analong to PABA and inhibits dihydropteroate synthase (DHS) and folate synthesis.
Sulfamethoxazole
144
Why are trimethoprim and sulfamethoxazole used together (TMP-SMZ)?
they provide syndergistic activity of sequential inhibition of folate synthesis
