Week 3 - Urinary tract infections Flashcards
Most common infecting organism when it comes to UTI
Uropathogenic E. coli
Damage which UTI is related to
Vesicoureteral reflux
UTI are more common in men than in females
False, they are much more common in women
Is there any point in life when boys and girls have the same risk for developing a UTI
Yes, during infancy
Renal-Focused history and physical examination
- Age of toilet training
- Characteristics of frequency
- Family history of renal disease
- Color and odor
- Unexplained episodes of fever
3 ways to get a UTI
- Ascension to the kidneys
- Hematological way
- Damage caused by trauma con un fierro contaminado
2 types of UTI
- Cystitis
- Pyelonephritis
Cystitis characteristics
- Dysuria
- Frequency
- Tenesmus
- Suprapubic pain
Acute pyelonephritis characteristics
- Pain in renal fossa
- Fever with dysuria
- Tenesmus
- Frequency
Main characteristic to differentiate cystitis of pyelonephritis
Fever
When can you say its a complicated UTI
- Presence of foreign bodies
- Obstruction
- Immunosuppression
- Renal insufficiency
- Renal transplant
- Urinary retention
E. coli divides by binary fusion every…
15 to 20 minutes
Patient has E. coli UTI, you give them treatment and then it comes back bc it never went away (same E. coli)
Recurrence
Patient has E. coli UTI, you give them treatment and they feel better, 6 months later they get another UTI caused by the same E. coli
Relapse
Patient has E. coli UTI, you give them treatment and they’re now A-OK… 4 months later they get another UTI from a different pathogen
Reinfection
Sepsis related to UTI is known as
Urosepsis
When some bacteria UTI persists for months/ years with relapses, even after treatment it is called…
Chronic UTI
Pathological changes in the kidney bc of a UTI
Chronic pyelonephritis: augmented size, decreased size, renal scars
Host defenses mechanism can be divided into
- Nonimmune mechanisms (highly effective)
- Adaptive immunity
- Innate immunity
- Inflammatory response
Virulence factors for UPEC
- Pilli type 1 (F1C)
- P pilli
- S pilli
- Dr. adhesins
UPEC can form biofilms to be easier to identify
False, they produce biofilms to sorta “hide”
Proteus mirabilis characteristic
Produces urease and changes pH to alkaline
Diagnosis for UTI
- Urine dipsticks for pyuria and bacteriuria
- Gold standard: urocultivo
Important results of urianalisis
- Leukocytes
- Nitrates (only produced by bacteria)
- Leukocyte esterase (produced by active leukocytes)
- Microscopic bacteria presence
Types of agar used for urine culture
- Blood agar
- Agar MacConkey
Method of collection for urine culture
- Clean catch
- Chorro medio
Classification of UTI
- Altas/ upper
- Bajas/ lower
Treatment for uncomplicated cystitis in non pregnant women
Nitrofurantoin
Treatment for complicated cystitis in men or women
Fluroquinoloness or nitrofurantoin
Treatment for complicated cystitis in pregnant women
Cephalexin
Treatment for complicated pyelonephritis in non pregnant women and men
Cephalosporin or quinolones
When would you do an image study in regards to a UTI
- In any acute episode of pyelonephritis
- In a boys first UTI
- In a recurrent UTI infection in girls
The worst complication of pyelonephritis
- Perirrenal abcess with pus and air
- Intrarrenal abcess
Bacterias that LOVE to colonize catheters
Gram + cocci Streptococcus pneumoniae or Staphylococcus aureus
UTIs are most commonly caused by an ______ mechanism
Ascending
Bacteria that has fimbriae and bind themselves to the urinary tract cells
E. coli (UPEC)
Other bacteria that can cause UTI
- Staphylococcus saprophyticus
- Klebsiella pneumoniae
- Proteus mirabilis
Risk factors for cystitis
- Female
- Frequent sexual intercourse
- DM
- Indwellin catheter
- Impaired bladder emptying
Bacteria related to honeymoon cystitis
Staphylococcus saprophyticus
Gold standard to diagnose a UTI
Urine culture
CBC results when diagnosing cystitis
- @ CBC: WBC normal
- Dipstick test: + leukocyte esterase (pyuria) & + nitrites
- Microscopy: > 10 WBC/ high power field
Urethritis is the inflammation of the urethra and can be caused by
- Neisseria gonorrhoeae
- Chlamydia trachomatis
Risk factors for acute pyelonephritis
- Indwelling catheters
- Diabetes mellitus
- Pregnancy
- Obstruction @ UT
Ppl with acute pyelonephritis present: dysuria, urinary frequency and urgency, flank pain and systemic symptoms that distinguish them from cystitis, which systemic symptoms?
- Fever
- Chills
- Nausea
- Vomiting
Clinical examination @ patient with pyelonephritis is positive for
- Giordano’s sign
- Costovertebral tenderness
Results of diagnostic tests done to diagnose pyelonephritis
- CBC: WBC is high
- Urianalysis: leukocyte esterase and nitrates +
Renal interstitial has fibrosis and scaring that may lead to renal atrophy
Chronic pyelonephritis
Microorganism that alkalinize urine + give it ammonia smell
Proteus
Chronic proteus infection may lead to
Xanthogranulomatous pyelonephritis
