Repro - 1-15 Adult Utis

Front 1

Most community-acquired UTIs manifest as...

Back 1

uncomplicated bacterial cystitis. Mainly in females.

Front 2

Why females are more at risk?

Back 2

Urethra exits the bladder near the vaginal area, while in the mall the urethra has to pass through prostate and penis after exiting the bladder.

Front 3

Contamination

Back 3

Organisms introduced during collection. No health care concerns

Front 4

Colonization

Back 4

Organisms are present in the urine but cause no symptoms. The pt may not need tx.

Front 5

Infection (UTI) definition

Back 5

Combo of a pathogen in the urinary system and human host symptoms/inflamm response.

Treatment and management is needed.

Front 6

Hematogenous spread - incl organisms involved

Back 6

This is an uncommon cause of UTIs

S. aureus, candida and mycobacterium tuberculosis.

Often seen in immunocompromised pts or neonates.

Can also be secondary to imcompletely treated prostatic/kidney infections.

Front 7

Bacteria causing most UTIs

Back 7

E. Coli serotypes.

Front 8

Type 1 Pili

Back 8

E. Coli mediators of pathogenesis

Pili - Confer resistance to bacteriocidal activity and mediate invasiveness. They control adherence.
Type 1 - adhere to mannose in the urinary epithelial mucopolysacch lining and to PMNs (so susceptible to phagocytosis).

Front 9

P Pili

Back 9

E. Coli mediators of pathogenesis

Pili - Confer resistance to bacteriocidal activity and mediate invasiveness. They control adherence.
P pili - mannose resistant, adhere to renal glycolipid receptors. Don't bind PMNs. Therefore, resistant to phagocytosis.

Most often associated with kidney infections.

Front 10

Expression of K antigen

Back 10

Makes bacteria more resistant to bacteriocidal activity.

Front 11

Hemolysin

Back 11

Can augment tissue invasiveness and predispose tissue to infection.

Seen in some bacteria.

Front 12

Host defences to UTIs

Back 12

Urethral length
Complete bladder emptying
Integrity of the uretrovesical junction
acidic pH
high urea content
high osmolality
mucosal mucopolysacch lining
systemic/local antibody production

Front 13

Genetic predisposition to UTIs

Back 13

certain HLAs and Lewis blood group (a non-secretor status)

Front 14

Common causative pathogens in adult UTIs

Back 14

E. coli
Klebsiella; enterobacter
proteus
pseudomonas
staphylococcus saprophyticus (Gram +)
Enterococcus
candida
adenovirus type 11

Front 15

Bacteria in normal perineal flora

Back 15

lactobacillus
corynebacteria
staphylococcus
streptococcus
anaerobes

Front 16

Sx of cystitis (bladder infection), urethritis, prostatitis...

Back 16

Urinary urgency, freq, dysuria, hematuria, foul-smelling urine, suprapubic pain.

Front 17

Sx of upper urinary tract infections (e.g. pyelonephritis)

Back 17

those with cystitis as well as fever, rigors, flank/abdominal pain, nausea, vomiting.

Front 18

3 methods of urinary collection

Back 18

clean catch midstream voided urine

catheterized urine

suprapubically aspirated urine

Front 19

Urinalysis

Back 19

Dipstick

Finding of nitrites tell you that gram negatives are converting nitrates.
Tells nothing about G(+) - e.g. saprophyticus.
Very specific.

Elev WBC in urine is the most reliable indicator of infection
Very sensitive

Front 20

Quantitative urine culture

Back 20

>100K colonies/mL is dx of UTI.

clean mid-stream urine is best.

Front 21

How to localize upper urinary tract infections

Back 21

Stamey test - bladder urine is cultured after catheterization, before and after a saline wash.

If the second bladder culture is positive, upper tract bacteria may be entering the bladder.

Front 22

How to dx chronic prostatitis

Back 22

4 glass method

1. Initial voided urine - urethra
2. Mid-stream - bladder
3. Collection during prostate massage - prostatic secretions
4. Post-massage voided urine - reflects prostatic bacteria.

Dx is prostatitis if there is more bacteria in third and fourth glass.

Front 23

When do image?

Back 23

Patients who didn't respond to treatment or those with predisposing factors.

Front 24

DDx of symptoms

Back 24

(these mimic UTI)

Herpes
urethritis
gonorrhoeae
chlamydia
trichomonas
vaginitis
prostatitis
nephrolithiasis
trauma
GU tuberculosis
GU neoplasm
intra-and abscess
sepsis

Front 25

Treatment of UTI

Back 25

hydration, relief of obstruction, removal of foreign body/catheter, judicious use of antibiotics.

Front 26

Where are antibiotics concentrated?

Back 26

the urine

Front 27

When considering tx, what to do first?

Back 27

determine if it is complicated or uncomplicated case.

Complicated - those with obstructed urinary flow, prostatic obstruction, poor bladder emptying, vesicoureteral reflex, foreign bodies, diabetes, pregnancy, males partic in anal intercourse.

Front 28

Tx of uncomplicated UTI

Back 28

3 days of oral TMP/SMX (Bactrim)

If resistance is there, use fluoroquinolones.

Front 29

When to use 7-10 days of antibiotics

Back 29

pts with diabetes, symptom duration of more than a week before seeking treatment, pregnancy, age>65, recent UTI, past hist of pyelonephritis or UTI with resistant organisms.

Front 30

Tx of complicated UTI

Back 30

oral quinolone for 10-14 days.
If severely ill, ampicillin plus aminoglycoside.

Front 31

Tx of acute pyelonephritis with abscess

Back 31

Tx the UTI and add drainage.

Front 32

Tx of epididymitis

Back 32

TMP/SMX or fluoro for at least 3 weeks.

Front 33

Tx of acute bacteria prostatitis

Back 33

TMP/SMX or fluoro for at least 4 weeks.

Front 34

Tx of chronic bacteria prostatitis

Back 34

TMP/SMX or fluoro for 6-12 weeks.

Front 35

Re-infection

Back 35

a rapid recurrence of UTI with the same OR DIFFERENT organism.

Front 36

relapsing infection

Back 36

failure to clear the pathogen despite a reasonable treatment course.

Front 37

When does asymptomatic bacteriuria need tx?

Back 37

pregnancy

Front 38

Acute bacterial prostatitis

Back 38

Rare and the pt is very sick.

IV antibiotics

Front 39

Chronic bacterial prostatitis

Back 39

Infrequent - tx discussed earlier.

Front 40

Chronic pelvic pain syndrome associatd with prostatitis

Back 40

Common.

Intermittent perineal pain, low back pain, obstructive sx.

Increased WBCs in expressed prostatic secretions.

Front 41

Dx of uti...

Back 41

made by urine examination and clinical picture of illness.

Front 42

Most hospital acquired UTIs...

Back 42

are catheter related

Front 43

What if you have a large number of normal perineal flora?

Back 43

bad, it should be relatively low.

Front 44

workup of pt unresponsive to tx

Back 44

kidney/bladder US
non-contrast CT (looking for a stone)
cystoscopy (rare)

Front 45

does cranberry juice help with UTIs?

Back 45

no - but real cranberries do.