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71 Cards in this Set

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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
what are hte 3 categoris of UTI
1. Nocosomial- 48 hour rule (if you get UTI BEFORE 48 hrs in hospital it was community)

2. Community

3. Primary or Recurrent
what is a primary, recurrnet or relapse UTI
1. Primary: first one
2. recurrent: 3 or more sx episodes/year

Relaspse: infection w/i 2 weeks of AB tx
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
whats the dif btwn relapse and reinfection
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
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
if an E coli based UTI occurs in anyone other than a woman who is non preggo and healthy what is it
COMPLICATED
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
what are the most common bugs that cause uncomplicated UTI
1. E COLI!!!!!!
2. Staph saprophyticus (~15%, from skin or GI)

3. proteus, klebsiella, strep afalactiae
what bugs cause complicated UTI's
1. E coli
2. Enterococcus faecalis, S agalactiae
3. pseudomonas, proteus, kelbsiella
4. candida
what organism commonly causes a biofilm of catheters
proteus- motile so can swim up
gram -, urease +
if a girl <1 yo has UTI whats the deal
think congenital abnormality
why do healthy females get UTI, so much more than healthy males
the anatomy is different, such a short urethra in women that bugs can crawl up!
ok so in the eldery what is the M:F ratio of UTI
1:1 (compare to the younger healthy crowd that was F>>>M)

men get more UTI in old age bc of BPH
why does pregancy and old age predispose women to UTI
1 Preggo: babes head blocks the ureter at the pelvic brim

2. Old; prolapse, loss of estrogen changes normal flora of vagina
can lubes promote UTI
ya, lactobacilli esp

lactobacilli
what are some predisposing factors for UTI in women
1. woman
2. preggo
3. old
4. sexualy active "honey moon cystitis"
5. new partner
6. lubes/spermicide
7. menses
is a more woman more likely to have UTI when she is on her period or not
more common when on period bc normal flora sloughs off

increased E coli/S saprophyticus
we know a UTI in a man is uncommon, what increases liklihood
1, not circumsized- gram - bacilli like foreskin
2. sex
3. obstruction, liek BPH
what type of bacteria like foreskin
gram neg bacilli
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
1. sex
2. DM
3. catheter
4. AFTER AB
5. inflammatory, immune system disorders
6. congenital abnormality- vesiculouretertal reflux
tell ,me about adhesions associated with e coli
help bacteria colonize the vagina

2 kinds
1. type 1
2. P fimbriae
what are hte 2 types of fimbria of ecoli
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
what type of fimbria is used by e coli bugs to colonize lowet tract, how does it work
type 1 fimbreia

**binds to mannose residue on target cells

recall type P fimbrea colonize the upper tract by binding P blood group AG
how does e coli colonize lower tract
upper
lower- type 1 adhesion, binds mannose
Upper- P type, binds P blood group AG
what are the 2 toxins associated with e coli
hemolysin

endotoxin

*e coli is 2 toxins and an enzyme, the enzyme is urease
two toxins and an enzyme are associated with that bug
e coli

**hemolysin, endotoxin, urease
tell me about the urease enzyme (2 toxins and an enzyme) associates with e coli
increases the pH, this increased pH is toxic to the epithelium

*can also increase stone formation
what mediated epithelial damage to the urinary tract w/ ecoli infection
urease, increases pH which damages
name 5 urease producers
1. pseudomonas
2. proteus
3. kelibsella
4. ureaplasma urealyticum
5 mycoplasma hominis

**causes crystal formation
what causes crystal fromation on a catheter
urease

1. pseudomonas
2. proteus
3. kelibsella
4. ureaplasma urealyticum
5 mycoplasma hominis
what does capsular polysaccharide do as a UTI virulence factor (2)
1. creates a biofilm on the catheter (a slime layer wll also create a biofilm)

2. capsular K AG. ONLY seen with gram - enterobacteria
what prevents gram - from phago
capsular K AG

**this is a capsular AG that is seen ONLY in gram -
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
do the majority of UTI occur bc of the ASCENT of bacteria UP the urethra
ya, most common is e coli

common in GI contamniation
what is teh source of a descending UTI
rare, hematogenous or lymphatic spread

most common descending is a aureus, recall the most common ascending was e coli
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
is urethritis a confirmatory signs of UTI
nope, this is just a local inflammation
what are some sx of UTI
dysuria, pyuria, hesistance, increased frequency/urge,
can a UTI be cuaed bt std agents like chlamydia and n gonorrohea
ya, UTI can be STD or NON STD infectiosn
what are some signs/sx of a lower UTI
LOCALIZED infection/inflammation of bladder

**irethritis, bacteremia >10^2

pyuria, suprapubic tenderness
what does bacteremia need to be in a clean catch midstream catch in order to be lower UTI
10^2
cystitis vs uthritis

cystisi is...
1. more severe
2. super acure onset
3. hematuria
whats pyelonephritis
upper UTI infection, renal infection

will see CASTS, localized infection w/SYSTEMIC efects,

can be an ascending or descending infection, can ppt premaure labor
wht tyoe of infection can ppt premature labor
pyelonephritis
if you have flank pain, w/CVA tenderness and a fever whats the deal
pyelonephritis

**can have lower UTI sx also- bacteruira, dysuria, urgency, pyuria
if you have a UTI w/o specific sx its called asx bacteremia, what is ths is risk for
upper tract UTI
what is urethral syndrome
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
if you pt has complaints of cystitis but the cultures are neg and there are NO urological abnormalities whats the deal
urethral syndrome, aka frequency dysuria syndrome

**occurs in white female
when you have sx of cystitis but have neg cultures its called urethral syndrome, what do they think causes this
1. anerobe- bacteroides
2. hormones
3. skene gland inflammation
4. reaction to food/chemical/soap/spermicides
what are the ways to catch an approtriate urine sample for a UTI
midstream clean catch
catheter
suprapubic bladder aspiration
ok so if your pt has sx of UTI adn pyuria, what is the CFU of the culture in order to be dx
10^2

they say 10^5 but that misses ppl
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
ANY bacteria is a ++++
can you do a rapid dipstick test to test for becterua and pyuria
you bet!

EMB agar
CLED agar
MacCOnsky Agar
what are some normal flora that can contaminate lab samples for UTI analysis
staph epidermidis
corynebacterium
lactobacillus
viridans streptococci a hemolytic
if your dipstick shows pH 7,5 what might you be thinking
proteus or other urease producers that would RAISE the pH

normal pH is 6
if your dipstick shows nitrates, what are you thinking
indirect test for bacteria. e coli, proteus and klebsiella make nitrates
proteus, e coli and kleibsiella will all make what additional feature on urine dipstick
nitrate
whats a kirby bauer test
AB sensitivity so determine what AB used for a UTI

**needs a PURE CULTUER
what are osem things to consider when choosing an AB
1. sensitivity as determiend from a pure culture and kirby bauer

2. levels in urine

3. ability to penetrate renal tissue
how long is tx for incomplicated UTI
lower UTI (cystitis) 3-7 days

upper uti (pyelonephritis) 5-7 days
what are hte 2 most commonly used AB for UTI (cystitis)

what about upper UTI, pyelonephritis
1. nitrofurantoin
2. TMP-SMX

Pyelonephtirits: ciprofloxacin
how is methenamene hippurate used in UTI tx
propholaxis

used for recurring UTI, makes formaldehyde in urine so its antiseptic
what is the drug that makes urine antiseptic and is used for recurring UTI
methenamine hippurate
what does phenazopyridine do
analgesic for UTI, improves dysuria, frequency and urgency

**give for like a day until AB kick in
what is used to tx the sx of UTI (pain, dysuria, urgency)
phenazopyridine hydrochloride
if you have that asx bacturia do you treat
only in...

1. preggo women
2. preschool kids
3. pts w.abnormal UT, or scheduled UT instrumentation
hwo can you help a pt who gets a UTI after sex everttime
AB after sex

pee after sex
what is used to reestablish normal flora in menopausal women
intravaginal estrogen cream
probiotics
how can you prevent UTI
drink and pee. keep things moving
vit C, fruit, protein
cranberry juice
-tannins inhibit adherence of P fimbria
-fructose inhibits type I fimbria
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