UTI's Flashcards
Adult UTI defined by
dysuria, frequency, and urgency with >100 organisms/mL by semiquantitative urine culture; common in ADULT WOMEN
Uropathogenic E coli causes; almost all others are;
Prevention:
75-90% UTI’s; OPPORTUNISTIC and can be Enterbacteriaceae, enterococcus, STIs, others: the opportunistic Enterobacteriaceae and Enterococci are less pathogenic than E coli but just as drug-resistant;
can remove/switch catheters
Pediatric UTI is
tenderness in the lower abdo with inadequate urine flow and >50000 IUs/mL (see dribble, poor stream, straining)
Enterobacteriaceae are
gamma-proterobacteria (gram neg rods) including E coli, shigella, salmonella, and two groups of opportunistic pathogens that can cause UTIs: Kleb/Enterobacter/Serratia and Proteus/Providencia/Morganella
Enterobacteriaceae are promiscuous to
incorporating foreign DNA leading to rapid acquisition of virulence factors and antibiotic resistance; they are gram neg rods, facultative anaerobes, mostly normal GI flora
Typical UTI is
sexually active woman colonized in GI with uropathogenic E coli; think annoying recurrent infections that can be dangerous if untreated (obstruction leads to sepsis)
Uropathogenic E coli use
major virulence factor P fimbrae to attach to uroepithelial cells, working their way gradually up the tract (diabetes is a risk factor);
gamma-proteobaceria, straight gram neg rod, facultative anaerobe, lactose fermenter, can be mobile or nonmobile;
leading cause of NOSOCOMIAL bacteremia
Atypical UTIs are
opportunists: sequals of urinary tract procedures/catheters, diabetes, or sepsis
CDS
Kleb/Enterobacter/serratia: in addition to UTIs,
encapsulated K (to defend against phagocytosis and complement) can cause dangerous hemorrhagic pneumonia in alcoholic men (diabetes, advanced age), E can become “panresistant” (but rarely causes disease in previously-healthy; has exotoxin called cytolysin) and S can cause endocarditis in heroin addicts; all can be dangerous nosocomial infections and antibiotic-resistant “ICU bugs”;
gram neg rods, Ab resistance problematic, think men, elderly, neonates at greatest risk (MEN); opportunistic nosocomial infections;
K pneumoniae: currant jelly sputum; think 100% mortality with alcoholics and bacteremia
Proteus/Providencia/Morganella: cause
UTIs with struvite stones using urease virulence factor (raises pH of urine and bladder); attach with fimbrae;
make urease, DON’T ferment lactose, gram neg rods; increases prevalence of antibiotic resistance;
can see urinary tract obstruction leads to septicemia if untreated; proteus can lead to pneumonia/wound infection, providentia to gastroenteritis, morganella the rarest
Enterococci are NOT
enterobacteriaceae; more like strep (gram pos cocci in chains; grow in high salt) BUT drug resistant; VREs are a growing nosocomial problem and cause UTIs, endocarditis, contribute to polymicrobial intra-abdo infections; PUEG
can pass resistance genes to S aureus;
risk factors include recent broad-spec antibiotics, like third-gen cephalosporins
Cystitis:
uncomplicated UTI, treat with ampicillin (lower tract only)
Polynephritis:
kidney infection, third-gen or combined drugs and antibiotic sens testing (see fever and flank pain from upward spread of infection)
Cranberry juice window:
pts with recurring infections learning to recognize very early symptoms, before antibiotics are indicated; b/c microbial numbers are so low at this stage, use home remedies (rest, nutrition, hydration, family visits, physical therapy, prayer and meditation, anti-inflamms, expectorants, analgesics, nasal irrigation, stress relief, NOT overdose of vitamins or refusing med care) that could be effective; counsel pt to try one but ALWAYS present to MD if symptoms worsen
UTI diagnosis:
Besides the symptoms, take urine samples for semiquantitative culture (streak out on agar plate for colonies)
