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29 Cards in this Set
- Front
- Back
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Bacteruiria
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Bacteria in urinalysis
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Pyuria
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White blood cells in urinarlysis from anywhere
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"Significant" bacteriuria
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More than 10^3 colony count in urine culture
>10^5 is documented true UTI Multiple organisms = false + contaminated specimen Lots of squamous cells = contamination |
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Dysuria
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Discomfort when voiding, burning
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Lower urinary tract infection
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Does not involve pelvis
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Urethritis
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Just urethra involved
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Pyelonephritis
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Infection in the medulla
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Acute urethral syndrome
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Burning, frequency, irriatation when voiding, all inflammatory response restricted to urethra
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What is the leading cause of dysuria?
2nd most common? 3rd most? Causes of acute urethral syndrome? |
Cystitis = inflamed bladder, organisms adhering to wall causing inflammation
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What is the most common cause of bacterial infections? Where do most come from? Which one is the most common? 2 other common ones?
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Causative Bacteria
95% from G.I. tract E. coli – most common Staph. saprophyticus Other “niche” organisms |
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What are age and sex differences in UTIs?
Infants? Years 3-50? What is seen in elderly (>65 yrs old) |
Infants: males > females
Years 3-50: females >>>males Elders (>65 years old) Increased Bacteriuria Multiple factors |
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Is there an increase in UTIs in pregnancy?
Sex? |
Pregnancy
Bacteriuria in 4-10% Twice the expected rate 25% progression Sex is a risk factor for UTI. |
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Which contraceptives show the highest incidence of bacteruria? Lowest bacteruria?
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Highest = diaphragm-spermicide user
Lowest = oral contraceptive |
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What are the two types of route of infection? Majority?
What can cause ascending route infection? Who might get hematogenous infections? Where will bacterial be? |
Route of Infection
Ascending route 95+% Urethral trauma Intercourse Instrumentation Diaphragm use Hematogenous route <5% = endocarditis or central lines, renal cortex localization |
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By what mechanisms do UTIs occur?
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Adhesion
Colonization Invasion Phase variation |
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What are bacterial factors?
What are two types of adhesions on fimbriae? |
Bacterial factors:
Uropathogenic E. coli Virulence factors Adhesions on fimbriae Type I fimbriae P- fimbriae |
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What are the mechanisms of bacteria/host cell interactions?
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What are some host defense mechanisms to UTIs?
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Bacterial growth inhibition
Urine flow Epithelial cell turnover Antibodies |
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What are some predisposing host factors?
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Urine flow obstruction
Female factors Abnormal urine flow Urethral trauma Vesiculo-ureteral reflux Instrumentation General health |
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What are some clinical manifestations of lower urinary tract infections?
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Frequency of urination
Dysuria - painful urination Turbid urine Suprapubic discomfort Hematuria Asymptomatic cystitis |
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What are clinical manifestations of upper tract infections?
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Fever
Chills Flank pain and “CVAT” Asymptomatic pyelonephritis |
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How do you diagnose UTI?
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Microscopic urinalysis
Gram stain of urine Urine culture Blood cultures (PRN) Screening tests |
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What are some complications of UTI?
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Gram negative sepsis
Intrarenal or extrarenal abscess Chronic renal insufficiency Struvite renal calculi Recurrent infection |
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How do you prevent UTIs?
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Proper use of urinary catheterization
Correction of anatomic abnormalities Prophylactic antibiotics - RARELY |
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How long does it take to treat a lower tract infection? Males and females?
When can it take longer? |
Males: 1 week
Females: 1-3 days Longer if complicated UTI |
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How long does it take to treat an upper tract infection?
How do you treat it? |
1-6 weeks
IV vs oral thearpy |
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How do you treat asymptomatic bacteriuria?
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Not treated in elderly (and others)
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What seems to have the best efficacy for uncomplicated UTIs?
Complicated? |
Ciprofloxacin
Ciprofloxacin, Ceftriaxone |
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What is this?
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Wall didn't know either.
Possibly aminoglycosides at the far left has the highest level of intrarenal concentration --> proximal tubule interstitial damage |
