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35 Cards in this Set
- Front
- Back
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Pyelonephritis.
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Inflammation of the kidney and associated organs.
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Upper urinary tract includes?
Lower urinary tract includes? |
Upper: Kidney, Ureters
Lower: Bladder, Urethra |
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Acute urethral syndrome.
Features and Symptoms. |
in sexually active young females
mechanical trauma, bacteria pushed into urethra pyuria dysuria |
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Cysitis.
Features and Symptoms. |
- localized therefore no fever
- urine maybe bloody, cloudy, foul smelling - dysuria, frequency, urgency, tender bladder |
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Pyelonephritis.
Features and Symptoms. |
- >40% progress to bacteremia
- vomiting, diarrhea, chills and fever, lower back pain - UTI symptoms (discharge) |
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Prostatitis.
Features and Symptoms. |
- chronic
- perineal, low back or abd pain - dysuria, urinary frequency |
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Two methods of classifying UTIs.
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Frequency: single/chronic,recurrent
Severity: Complicated/Uncomplicated |
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two major routes of UTI.
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Ascending
Descending |
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4 defence mechanisms against UTIs.
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1. urine composition (de'd pH, in'd urea, organic acids)
2. acid labile mucopolysaccharides (de'd adherence) 3. voiding 4. reflux prevention |
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9 predisposing factors to UTIs.
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1. Gender
2. Age 3. Institutionalization 4. Defective defence mech 5. Neurogenic impairment 6. Functional impairment 7. Pregnancy 8. Underlying diseases 9. Bacteremia |
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Why are females more proned to UTIs?
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1. shorter urethra
2. urethral entrance closer to perirectal region 3. sexual intercourse 4. pregnancy (hormonal + structural change) |
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Outpatient UTI.
Common pathogens. |
E. coli **** 85%
S. saprophyticus Klebsiella sp. Enterococcus sp. Group B Strep |
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Inpatient UTI.
Common pathogens. |
Pseudomonas spp.
Klebsiella sp. (LFs) Enterococcus sp. |
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Common contaminants in MSU.
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Micrococcus
Gardnerella |
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5 methods of urine collection
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1. MSU or clean catch (outpts)
2. Catheter 3. Suprapubic aspirate (infants or difficult pts) 4. Cystoscopy (pts with stones) 5. Ped U-bag |
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What are the factors that contribute to false positives for Leukocyte esterase?
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Vitamin C
incr'd glucose |
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Under what condition is culture not necessary?
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Pt present with classic symptoms of uncomplicated UTI and abx are going to be prescribed.
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Under what condiont is culture necessary with uncomplicated UTIs?
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when treatment is conditional on C&S results
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Cultures will be performed with what macro and micro results?
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Macro: + for leukocyte esterase and/or nitrites
Micro: WBC present |
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Why is nitrofurantoin a useful abx to treat urinary tract infections?
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Interfere with metabolism of carbs by the bacteria & formation of cell wall
Drug is processed by kidney and concentrated in urine. Take effect as it goes through the urinary tract. |
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1 species isolated.
> 10 x 10^6 CFU/L |
ID and sensitivities
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2 species isolated.
both > 100 x 10^6 CFU/L |
ID and sensitivities on both
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2 species isolated.
one > 100 x 10^6 CFU/L one < 100 x 10^6 CFU/L |
ID and sen on >100
describe only (gram smear) on <100 |
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3 or more species isolated.
any amount. |
NO WORK UP
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Isolates from Cystoscopy or suprapubic aspirate.
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ID and sen on all
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Rapid ID for E. coli
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LF (dry)
BH Spot Indol (+) Ox (-) |
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Rapid ID for Proteus
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Spreading
NLF Ox (-) Indole (+) -> vulgaris amp (S), Indole (-) -> mirabilis |
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SXT is not therapeutic, what is it used for?
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to check for thymidine levels in MH agar.
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3 factors contribute to nosocomial UTI.
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1. abx use decrease NF in pts
2. catheterization 3. instrumentation |
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Hematogenous route (descending).
Common pathogens. |
Salmonella typhi
S. aureus M. tb E. coli |
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Effective for uropathogens excluding Pseudo & enterococci
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SXT
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Effective for uropathogens excluding Proteus and Pseudo
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Nitrofurantoin
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Which abx is NOT suitable for treating pyelonephritis?
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Nitrofurantoin
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What do Ciprofloxacin treat?
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Enterobacteriaceae
Staph ++ strep Pseudo |
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Which abx to treat pyelonephritis, which is toxic to renal?
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Aminoglycosides
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