Term
| What population is most affected by UTI's? |
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Definition
Young women with bladder only infections being most prevalent.
Rate in men increases after age 50! |
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Term
| What are the 3 paths of bacterial in UTI pathogenesis? |
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Definition
1) Ascending via urethra (95%)
- E. coli, Proteus, Enterobacter
2) Hematogenous (blood>kidney>bladder)- rare but serious
- Endocarditis (Staph aureus)
- E coli and TB
3) Direct (bowel:bladder fistula)
- passing air/gas through urethra
- urine culture with pus and MULTIPLE organisms |
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Term
| What are the 4 major bacterial factors that promote risk of UTI? |
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Definition
1) Colonization
2) Adherence factors
- E. coli adhere to urothelial cells
- Proteus, Providencia adhere to lumen of catheter
3) Inoculum size (stasis of urine increases)
4) Virulence |
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Term
| What 4 host defense mechanisms decrease UTI risk? |
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Definition
1) Mechanical
- Dilution and flow of urine
- Length of urethra (female is shorter)
2) Interference
- Normal bacterial flora prevents overgrowth of pathogens
3) Chemical
- Osmolarity and pH of urine
- Prostatic fluid
4) Immune
- Anti-adherence mechanisms in bladder
- Urinary IG
- Mucosal antibacterial activity |
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Term
| What are the 6 major risk factors for developing UTI? |
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Definition
1) Alteration of colonizing bacteria
- Antibiotics, sexual partner, previous UTI
2) Retrograde introduction of bacterial
- Vaginal sex (vag stuff goes to urethra)
- Insertive rectal sex (GI into male urethra)
- Inserting items into urethra (catheters)
3) Urinary stasis
- Neurogenic bladder
- Reflux into ureters (pregnancy)
- Prostate hypertrophy
4) Nutrients- Diabetes Mellitus
- Glycosuria (and neurogenic bladder)
5) Foreign materials
- stones, stents and caths
6) Genetic
- Previous UTI
- UTI's in female relative |
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Term
| Which of the following factors is associated with occurrence/prevention of UTI? |
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Definition
1) Beverage consumption
2) Pre-coital voiding
3) Frequency of urination
4) Tampon use
5) Urinary stasis |
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Term
A patient has discomfort when voiding, with a burning sensation.
What is this and what can cause it? |
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Definition
Dysuria
1) Vaginitis- no pyuria and <10^2 cfu/ml due to Candida (overgrowth) or Trichomonas (sex)
2) Vaginal atrophy (post-menapausal)
3) Urethritis- pyuria (pus) and <10^2 cfu
- Chlamydia or Neisseria gonorrhoeae
4) Cystitis- pyuria and > 10^3-5 cfu/ml |
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Term
A patient presents with dysuria, pyuria and >10^4 CFU.
Which of the following does she have?
1) Vaginitis
2) Urethritis
3) Cystitis
4) Vaginal atrophy |
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Definition
Cystitis
All 4 are causes of Dysuria
1) Vaginitis has no pyuria and <10^2 cfu/ml (Candida or Trichomonas)
2) Urethritis has pyuria, but <10^2 cfu/ml (Chlamydia or N. gonorrhoeae)
4) Vaginal atrophy is not an infection, and occurs normally after menapause. |
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Term
True or False:
Acute uncomplicated cystitis occurs in women with normal GI tract |
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Definition
True!
Dysuria, suprapubic pain, Pyuria and >10^3-5 cfu/ml |
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Term
A young healthy woman presents with costovertebral pain, fever and bacteraemia.
What is going on? What would you find on urinalysis |
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Definition
Sounds like Pyelonephritis (healthy women with CVA tenderness and bacteria)
WBC casts |
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Term
| How does complicated UTI differ from uncomplicated UTI? |
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Definition
| "complicated" means that there was a previous structural or functional abnormality in the urinary tract. |
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Term
| What types of labs are useful for diagnosing UTI? |
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Definition
1) Urinalysis
- WBC's and gram stain
- Dipstick (Leukocyte esterase for pyuria and Nitrite from bacterial nitrate reduction).
2) Culture
- Quantitative and specialized cultures (TB, fungi)
3) Microscopy
- Pyuria is >10 leukocytes/ mm^3 unless catheter in place
- Lack of epithelial cells rules out contamination
4) Microbiology
- Positive culture (either >10^ 5 or >10^3 with symptoms) |
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Term
| What are the indications to perform microbiological culture analysis? |
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Definition
| Culture urine if indicated AND abnormal urinalysis (LE and Urinary nitrite) |
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Term
| What types of dipstick UA are performed for UTI? |
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Definition
1) Leukocyte esterase (released from WBCs)
- if symptomatic and LE is negative, STILL do microscopy
2) Urinary Nitrite (Specific but not sensitive)
- Evidence of bacterial reduction of urinary nitrate |
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Term
| How can you tell if you are looking at a "real UTI"? |
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Definition
1) Pyuria (>10 leukocytes/mm^3)
2) Lack of epithelial cells
3) Positive culture (>10^5 cfu/ml or > 10^3 with symptoms) |
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Term
True or False:
Screening and Treatment of asymptomatic bacteriuria is indicated in young women with urinary stasis? |
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Definition
False!
This is not indicated, NO MATTER WHAT THE RISK FACTORS, UNLESS PREGNANT
asymptomatic bacteria are only as issue in pregnant women, where they increase the risk of
- Pyelonephritis
- Pre-term delivery
- Group B Strep is risk for meningititis |
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Term
| When is treatment of asymptomatic bacteriuria indicated? |
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Definition
Early during pregnancy because of risk of
1) Pyelonephritis
2) Pre-mature birth
3) Meningitis (Group B strep)
** ALso for pre uroloical-surgery |
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Term
A patient presents with dysuria, frequent, urgent trips to the bathroom, supra pubic discomfort and a low-grade fever.
Her UA comes back with a nitrite (+) dipstick and a positive LE/WBC (>10 WBC's)
What is the most common cause of this condition? |
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Definition
Sounds like acute, uncomplicated UTI (cystitis)
Clinical symptoms & UA analysis fit, but need to rule out vaginitis and STI's (Culture not routinely performed)
Most commonly caused by
1) E. coli (80-90%), but can be caused by
2) Staph saprophyticus, proteus and klebsiella |
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Term
| How do you treat acute uncomplicated UTI in a non-pregant adult female? |
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Definition
1) Treat symptoms (rarely progressive)
2) Nitrofurantoin or Fosfomycin (if CrCl is <50)
** Can use TMP-SMX for 3 days or Flouroquinolone for 3 days (second choice) |
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Term
| How would you treat a patient for recurrent uncomplicated cystitis? |
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Definition
Obtain UA and culture.
1) If relapse (<2 weeks), think about non-complicance and consider urologic evaluation
2) If re-infection (same or different after >2 weeks)
- Hygiene
- Post-coital (pregnancy) instructions (prophylaxis?)
- Vaginal atrophy (topical estrogen)
- Post-void residual (prolapse) |
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Term
| How can you treat acute pyelonephritis? |
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Definition
Usually E. coli, but get urine culture and blood culture (if hospital)
1) Mild/Moderate
- TMP/SMX or FQ for 10-14 days (should feel better in 2-3)
2) Severe with life-threatening urosepsis
- IV Ceftriaxone + Aminoglycoside for 48-72h
- Continue therapy for 2 weeks |
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Term
What is the most common cause of relapsing UTI in males?
Why is it difficult to treat? |
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Definition
Chronic Bacterial Prostatitis (chronic pain, dysuria and recurrent UTI's with the same organism)
Biofilm and Calculi make treatment difficult, but use FQ and TMP-SMX
** Can also be Urethritis (STI) from Gonorrhea, Chlamydia or Ureoplasma ** |
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Term
What are the most common etiologies of Prostatitis leading to UTI in males?
How do you treat? |
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Definition
1) Gram negative rods
2) Enterococci
3) Staph. aureus
1) Acutely, you see fever, chills, dysuria and prostatic tenderness (most antibiotics will work)
2) Chronically you see pain, dysuria and recurrent UTI (need to use TMP-SMX or FQ) |
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Term
| What are the most common complications in catherized patients and how do you prevent UTI's? |
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Definition
1) Bacteriuria with Providencia most commonly.
- Pyuria is common, but you need Fever and Pyelonephritis to diagnose UTI!
2) Avoid cath, Close drainage (contamination) |
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Term
True or False:
Antiseptic use in drainage bags of patients with urethral catheters prevents UTI |
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Definition
False! Unproven.
Just avoid extrinsic contamination and remove as soon as possible. |
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Term
| What are the indications for treating asymptomatic candiduria? |
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Definition
Always arise from catheters and Fluconazole or Amphotericin B can be used for short-term only
1) UT obstruction (fungus ball)
2) Neutropenia
3) Renal transplant
4) Urologic procedure in next 48-72h |
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Term
A patient presents with dysuria and renal functional defects. You discover sterile pyuria.
What should you do? |
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Definition
Cold be GI TB (they wouldn't grow on normal culture)!
1) PPD test or Interferon Gamma-release Assay
2) Imaging
3) Culture M. tuberculosis from urine |
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