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26 Cards in this Set
- Front
- Back
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UTI route of infection
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ascending
easier in women due to short urethra, closeness to anal canal, and colonization introital pyelonpehritis ascending infection due to vesico-urteric reflux (inability to sphicter to prevent reflux) |
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most common uropathogenic organism
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Ecoli
then Staph. Saprophyticus |
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how to discriminate staph saprophyticus from aureus and epidermatus
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staph saprophyticus is resistant to novobiocin
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host defenses against UTI
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urine flow is antiseptic and washes away bacteria - urea/high electrolytes/acid is not growth promoting
ureters prevent back up into kidneys tamm horsfall protein contains mannos which binds ecoli and prevents binding to bladder wall immune system apoptosis of bladder wall cells and replacement |
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bacterial evasion of host defense
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osmoregulatory genes
adhesins == type 1 pili - mannose - see with bladder infection == P-frimbrae - Dgalactose-Dgalactose - see with pyelonephritis |
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T/F you need to collect, handle, and process urine samples immediately
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true - otherwise bacteria can continue to multiply or sample can be contaminated
some casts and crystals might disolve over time |
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telling the difference between Lower UTI and Upper UTI
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upper UTI - fever, flank pain
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for upper UTI need how much bacteria/ml?
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10^5 cfu/ml
this number does not hold for cystitis (Lower UTI) |
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lower UTI - if see < 10^5 cfu/ml
w/ bacteriuria AND pyuria |
likely ecoli or S. Saprophyticus
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lower UTI - if see < 10^5 cfu/ml
pyuria but NO bacteria |
C. trachomatis or Ureoplasma urealyticus
also M. Tuberculosis |
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lower UTI - if see < 10^5 cfu/ml
no bacteriuria or pyuria |
dont know etiologic agent
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if bacterial counts < 10^5 cfu/ml can you ignore?
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no can't ignore L-UTI problems with bacterial less than < 10^5 especially if symptomatic
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uncomplicated UTI
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most often ecoli
or s. saprophyticus usually 18--25 year old females - increased seasonal late summer to early fall |
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complicated UTI
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repeat (new organism) or repalpsing (same organism) infections
often patients have some other problem - diabetes, PKD, sickle cell, structural abnormality etc |
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proteus mirabalis
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can cause severe damage
urea splitter make NH3 which is directly toxic, also increases urine pH and forms calculi acidfy urine to make antiboitics effective |
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S. Saprophyticus UTI is more common in what group of people
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elderly males with prostatic disease
Zinc ion from prostate is cidal for many gram negs Staph Saprophyticus is a gram+ |
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urethral infection vs prostate infection
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more bacterial colony count of urethral specimen vs prostatic spcicmen
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how do you identify upper tract as source of infection
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ureteral catherization
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what can mimic a UTI
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chemical irritation
phosphate crystals calculi stones |
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six major UTI pathogens
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Ecoli
S. Saprophyticus Proteus mirabls Klebsiella Enterobacter Pseudomonas aeruginosa |
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when are the times that males are more prone to UTI
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1st year of life due to structural problems
50+ year old with BPH - secondary infection - non-ascending infection |
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nitrofurantoin
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primarily g- LOWER UTI infections - acute or prophylaxis
single most important indication is lower UTI prophlyaxis - especially post intercourse nitro anion that forms is toxic selective against bacteria since they reduce it to its toxic form b no effect on mammals due to slow reduction by mammals and rapid metabolism/excretion because its rapidly excreted - does not treat pyelonephritis - don't give to renal failure patients adverse effects: dequamative interstitial pneumonia w/ fibrosis -> ARDS, birth defects, interaction with gout therapy and quinolones |
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methenamine
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hydrolyzed in acid pH (in the bladder) to liberate ammonia and formaldehyde
effective against ecoli and g- takes 2-3 hours for effective concentration - don't reach effective concentration in kidney does not treat upper UTI urine acidifiers help, don't give too much water (dilutes acid) don't give with sulfonamides don't give to patients with renal failure (can crystallize) not for acute infections - prophylactic therapy for recurring UTI |
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Hemolytic Uremic Syndrome
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Ecoli O157:H7 or S. Pneumoniae
see micoangiopathic hemolytic anemia, acute renal failure, thrombocytopenia -no fever! -no PMN |
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Ecoli vs S. pneumonae in HUS
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Ecoli
--bloody diarrhea --mechanism shiga like tox --don't treat with antibiotics, releases more toxin --get from injestion S. Pneumonae --no bloody diarrhea --mechanism pneumococcal nuramindases - complement mediated injury --treat with antibiotics --get from pneumonia |
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definition of a urinary antiseptic
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drugs that exert effects in urine and are devoid of signficant systemic effects
high use for prophylaxis |
