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71 Cards in this Set
- Front
- Back
are UTI common
what are they do to more common in M or W |
ya THE MOST common bacterial infection in humans
bc of stasis and reflux W>M |
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what are hte 3 categoris of UTI
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1. Nocosomial- 48 hour rule (if you get UTI BEFORE 48 hrs in hospital it was community)
2. Community 3. Primary or Recurrent |
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what is a primary, recurrnet or relapse UTI
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1. Primary: first one
2. recurrent: 3 or more sx episodes/year Relaspse: infection w/i 2 weeks of AB tx |
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ok so you had a UTI and it was treated but 8 days after AB tx was finished the darn thing came back. is this relapse or recurrent
what does this indicate |
relapse
atructural abnormality of microbe, microbial invasion of tissue |
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whats the dif btwn relapse and reinfection
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1. Relapse: infection w/i 2 weeks of completing AB. SAME microbe that wasnt elimated bc of structural abnormality or tissue invasion
2. NEW infection, same or dif pathogen. usually way less than 2 weeks after resolution of initial. NEW tx to interrupt cycle of colonization |
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what is an uncomplicated UTI
complicated |
1. Uncomplicated: structurally normal UT, NO known comprimise. ONLY E COLI. W>M
2. Complicated: anatomical variation in urinary tract, DM, preggo, transplant, AIDS, candida, W=M, Any male UTI is comlicated |
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if an E coli based UTI occurs in anyone other than a woman who is non preggo and healthy what is it
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COMPLICATED
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most bugs that cause UTI come from ________
the exceptino to this is _____ which comes from the _______ |
GI tract
Staph saprophyticus, from transient skin flora OR GI |
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what are the most common bugs that cause uncomplicated UTI
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1. E COLI!!!!!!
2. Staph saprophyticus (~15%, from skin or GI) 3. proteus, klebsiella, strep afalactiae |
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what bugs cause complicated UTI's
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1. E coli
2. Enterococcus faecalis, S agalactiae 3. pseudomonas, proteus, kelbsiella 4. candida |
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what organism commonly causes a biofilm of catheters
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proteus- motile so can swim up
gram -, urease + |
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if a girl <1 yo has UTI whats the deal
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think congenital abnormality
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why do healthy females get UTI, so much more than healthy males
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the anatomy is different, such a short urethra in women that bugs can crawl up!
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ok so in the eldery what is the M:F ratio of UTI
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1:1 (compare to the younger healthy crowd that was F>>>M)
men get more UTI in old age bc of BPH |
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why does pregancy and old age predispose women to UTI
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1 Preggo: babes head blocks the ureter at the pelvic brim
2. Old; prolapse, loss of estrogen changes normal flora of vagina |
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can lubes promote UTI
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ya, lactobacilli esp
lactobacilli |
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what are some predisposing factors for UTI in women
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1. woman
2. preggo 3. old 4. sexualy active "honey moon cystitis" 5. new partner 6. lubes/spermicide 7. menses |
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is a more woman more likely to have UTI when she is on her period or not
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more common when on period bc normal flora sloughs off
increased E coli/S saprophyticus |
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we know a UTI in a man is uncommon, what increases liklihood
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1, not circumsized- gram - bacilli like foreskin
2. sex 3. obstruction, liek BPH |
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what type of bacteria like foreskin
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gram neg bacilli
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ok so tehre are some things that predispose men (foreskin, BPH) that increase liklihood of UTI, and women (menses, preggo etc etc) but what are some predisposing factors for BOTH
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1. sex
2. DM 3. catheter 4. AFTER AB 5. inflammatory, immune system disorders 6. congenital abnormality- vesiculouretertal reflux |
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tell ,me about adhesions associated with e coli
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help bacteria colonize the vagina
2 kinds 1. type 1 2. P fimbriae |
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what are hte 2 types of fimbria of ecoli
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1. type 1: help colonize LOWER tract, bind mannose residues on target cells
2. P fimbrea: associated with UPPER tract, pyelonephtiris, bind P blood group AG |
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what type of fimbria is used by e coli bugs to colonize lowet tract, how does it work
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type 1 fimbreia
**binds to mannose residue on target cells recall type P fimbrea colonize the upper tract by binding P blood group AG |
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how does e coli colonize lower tract
upper |
lower- type 1 adhesion, binds mannose
Upper- P type, binds P blood group AG |
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what are the 2 toxins associated with e coli
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hemolysin
endotoxin *e coli is 2 toxins and an enzyme, the enzyme is urease |
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two toxins and an enzyme are associated with that bug
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e coli
**hemolysin, endotoxin, urease |
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tell me about the urease enzyme (2 toxins and an enzyme) associates with e coli
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increases the pH, this increased pH is toxic to the epithelium
*can also increase stone formation |
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what mediated epithelial damage to the urinary tract w/ ecoli infection
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urease, increases pH which damages
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name 5 urease producers
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1. pseudomonas
2. proteus 3. kelibsella 4. ureaplasma urealyticum 5 mycoplasma hominis **causes crystal formation |
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what causes crystal fromation on a catheter
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urease
1. pseudomonas 2. proteus 3. kelibsella 4. ureaplasma urealyticum 5 mycoplasma hominis |
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what does capsular polysaccharide do as a UTI virulence factor (2)
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1. creates a biofilm on the catheter (a slime layer wll also create a biofilm)
2. capsular K AG. ONLY seen with gram - enterobacteria |
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what prevents gram - from phago
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capsular K AG
**this is a capsular AG that is seen ONLY in gram - |
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A patient has been in the hospital for 36
hours when he develops a UTI. Gram-negative bacilli have been isolated from his urine. Based on this current data, the best description of this UTI is: 1. Uncomplicated HA UTI due to Staphylococcus epidermidis 2. Recurrent CA UTI due to Pseudomonas aeruginosa 3. Complicated CA UTI due to E. coli 4. Relapsing HA UTI due to Ureaplasma urealyticum |
complicated UTI due to e coli
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do the majority of UTI occur bc of the ASCENT of bacteria UP the urethra
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ya, most common is e coli
common in GI contamniation |
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what is teh source of a descending UTI
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rare, hematogenous or lymphatic spread
most common descending is a aureus, recall the most common ascending was e coli |
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pt continues to sffer UTI and has had catheter for 2 days. ass mannose to diet. when placement of catheter there are catheters. dx chanegs to...
1. klebsiells due to type I fimbreas 2. enterococcus due to biofilm 3. staph 4. proteus due to urease production |
4 proteus bc of urease production
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is urethritis a confirmatory signs of UTI
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nope, this is just a local inflammation
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what are some sx of UTI
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dysuria, pyuria, hesistance, increased frequency/urge,
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can a UTI be cuaed bt std agents like chlamydia and n gonorrohea
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ya, UTI can be STD or NON STD infectiosn
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what are some signs/sx of a lower UTI
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LOCALIZED infection/inflammation of bladder
**irethritis, bacteremia >10^2 pyuria, suprapubic tenderness |
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what does bacteremia need to be in a clean catch midstream catch in order to be lower UTI
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10^2
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cystitis vs uthritis
cystisi is... |
1. more severe
2. super acure onset 3. hematuria |
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whats pyelonephritis
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upper UTI infection, renal infection
will see CASTS, localized infection w/SYSTEMIC efects, can be an ascending or descending infection, can ppt premaure labor |
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wht tyoe of infection can ppt premature labor
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pyelonephritis
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if you have flank pain, w/CVA tenderness and a fever whats the deal
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pyelonephritis
**can have lower UTI sx also- bacteruira, dysuria, urgency, pyuria |
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if you have a UTI w/o specific sx its called asx bacteremia, what is ths is risk for
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upper tract UTI
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what is urethral syndrome
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aka frequency dysuria syndrome
its when you have the sx of cystitis but yuor urine culture is neg, happens in white females. there are NO urological abnormalities caused by:? bacteroides hormones skene gland inflammation reaction to food/chemical/douch/soap/spermicide/lube |
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if you pt has complaints of cystitis but the cultures are neg and there are NO urological abnormalities whats the deal
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urethral syndrome, aka frequency dysuria syndrome
**occurs in white female |
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when you have sx of cystitis but have neg cultures its called urethral syndrome, what do they think causes this
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1. anerobe- bacteroides
2. hormones 3. skene gland inflammation 4. reaction to food/chemical/soap/spermicides |
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what are the ways to catch an approtriate urine sample for a UTI
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midstream clean catch
catheter suprapubic bladder aspiration |
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ok so if your pt has sx of UTI adn pyuria, what is the CFU of the culture in order to be dx
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10^2
they say 10^5 but that misses ppl |
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typically we are looking for a urine culture to show 10^2 for a UTI, what if the sample was taken from a suprapubic aspiration or is s aureus
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ANY bacteria is a ++++
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can you do a rapid dipstick test to test for becterua and pyuria
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you bet!
EMB agar CLED agar MacCOnsky Agar |
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what are some normal flora that can contaminate lab samples for UTI analysis
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staph epidermidis
corynebacterium lactobacillus viridans streptococci a hemolytic |
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if your dipstick shows pH 7,5 what might you be thinking
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proteus or other urease producers that would RAISE the pH
normal pH is 6 |
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if your dipstick shows nitrates, what are you thinking
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indirect test for bacteria. e coli, proteus and klebsiella make nitrates
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proteus, e coli and kleibsiella will all make what additional feature on urine dipstick
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nitrate
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whats a kirby bauer test
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AB sensitivity so determine what AB used for a UTI
**needs a PURE CULTUER |
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what are osem things to consider when choosing an AB
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1. sensitivity as determiend from a pure culture and kirby bauer
2. levels in urine 3. ability to penetrate renal tissue |
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how long is tx for incomplicated UTI
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lower UTI (cystitis) 3-7 days
upper uti (pyelonephritis) 5-7 days |
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what are hte 2 most commonly used AB for UTI (cystitis)
what about upper UTI, pyelonephritis |
1. nitrofurantoin
2. TMP-SMX Pyelonephtirits: ciprofloxacin |
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how is methenamene hippurate used in UTI tx
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propholaxis
used for recurring UTI, makes formaldehyde in urine so its antiseptic |
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what is the drug that makes urine antiseptic and is used for recurring UTI
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methenamine hippurate
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what does phenazopyridine do
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analgesic for UTI, improves dysuria, frequency and urgency
**give for like a day until AB kick in |
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what is used to tx the sx of UTI (pain, dysuria, urgency)
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phenazopyridine hydrochloride
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if you have that asx bacturia do you treat
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only in...
1. preggo women 2. preschool kids 3. pts w.abnormal UT, or scheduled UT instrumentation |
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hwo can you help a pt who gets a UTI after sex everttime
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AB after sex
pee after sex |
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what is used to reestablish normal flora in menopausal women
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intravaginal estrogen cream
probiotics |
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how can you prevent UTI
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drink and pee. keep things moving
vit C, fruit, protein cranberry juice -tannins inhibit adherence of P fimbria -fructose inhibits type I fimbria |
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what is the most common bacterial infection
what is the most common cause of this most common bacterial infection dx is based on |
UTI
E coli (UPEC) bacteruira, WBC |