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27 Cards in this Set
- Front
- Back
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Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+). TOW?
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Cystitis due to E. coli
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Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of
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> 1,000 cfu/mL
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Mode of acquisition of uropathogen is
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Endogenous
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Microbial (structure) factor favoring bacterial persistence /colonization and UTI is
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bacterial binding via fimbriae
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Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is
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high bacterial growth rates
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Host factor favoring bacterial persistence/colonization and UTI is
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Urinary stasis
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Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is
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Absence of bactericidal effects of secreted proteins
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Pyogenic inflammation in complicated UTI due to Gram negative bacteria is due to
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Lipopolysaccharide (LPS)
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Empiric DOC to treat community-acquired UTI in adults is
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ciprofloxacin
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The abx class that inhibits DNA gyrase or topoisomerase IV and blocks with bacterial DNA replication is
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Fluoroquinolones
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DOC to treat UTI in pregnant women is
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Nitrofurantoin
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Gram-positive bacteria that cause uncomplicated UTI in sexually active, young women are
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Staphylococcus saprophyticus
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Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on
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novobiocin resistance
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In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?
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Pyelonephritis due to E. coli
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Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:
Clue: GNR; fermenter; encapsulated; intrinsic ampicillin resistance) |
Klebsiella pneumoniae
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Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:
Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance) |
Serretia marcescens
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Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:
Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance) |
Proteus mirabilis
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Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:
Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance) |
Pseudomonas aeruginosa
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Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:
Clue: GPC in chains; catalase-neg; grows in high salt; penicillin resistance) |
Enterococcus faecalis
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If a patient with complicated UTI is severely ill or not improving with therapy, do what rapid test next?
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renal ultrasound (to rule out urinary tract obstruction)
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For a patient with complicated UTI, once culture and sensitivity available, switch to what?
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Narrow-spectrum abx
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2 or more of the following: fever (T>38°C) or hypothermia (T< 36°C), tachycardia (HR>90), tachypnea (RR>20), leukocytosis (WBC>12,000 or differential w/ >10% bands). TOW?
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SIRS
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SIRS + infection (e.g., positive blood culture) is
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sepsis
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Sepsis + organ failure, decreased perfusion (lactic acidosis, oliguria, altered mental status) or low BP. TOW?
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Severe sepsis
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Severe sepsis + hypotension despite fluids + lactic acidosis, oliguria, altered mental status.
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Septic shock
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Septic shock due to Gram-negative bacteria (e.g., E. coli, Klebsiella spp., or Pseudomonas aeruginosa) is
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Endotoxic shock
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Endotoxin that mounts pro-inflammatory cytokines, responsible for endotoxic shock, is
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Lipid A of LPS
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