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Renal 21 UTI

Dugan: Urinary Tract Infections

Urinary Tract Infection Epidemiology Community More common in women, particularly pregnant women In elderly: 15% females 10% males
Urinary Tract Infection Epidemiology Nosocomial Instrumentation and catherization Up to 10% of hospitalized pts develop UTI
Normal Flora in Women Lactobacillus Coag - Staph Streptococcus Mycoplasma Enteric Gram-
Normal Flora in Men Coag - Staph Streptococcus Mycoplasma
Community Acquired Infections (Agents) E.coli 80% Proteus-Morganella Klebsiella Staph. saprophyticus Enterococcus
Nosocomial Infections (Agents) E. Coli 20% Entercoccus Pseudomonas Proteus Klebsiella Staphlococcus coag-
Escherichia coli Most commonly isolated organism Called coliforms as they live in the colon Biochem: Indole+, Lactose fermentation+, Voges-Proskauer-, Lysine decarboxy+
Host defenses Micturition pH of urine Phagocytosis Urinary secretory IgA Prostatic secretions
Entry of Pathogens Ascending 95-99% Descending Rare
Bacterial Virulence Factors Adherence- P&type1 Hemolysins Aerobactin Capsular polysac K antigen (E.coli) Lipopolysaccharide
Female predisposing factors Anatomy Pregnancy Sex Nonsecretor status Diaphragm/spermicide use Increase cellular adherence
Other Predisposing Factors for Males and Females Stones/calculi Urethral strictures Bladder tumor Instrumentation Systemic disease
Classifications of Symptomatic Infections Urethritis: dysuria and mucopurilent discharge-STI Cystitis: dysuria, frequency and urgency from enteric organisms Pyelonephritis: fever, flank pain, systemic signs (WBC casts)
Asymptomatic Infections Bacteruria >10^5 30-40% of all elderly pts Generally don't treat Treat before Sx and during pregnancy Treat in presence of WBCs
Uncomplicated UTI Pt has normal UT w/o underlying disease 80-90% E.coli Most are relatively sensitive to antimicrobioal agents Most common: Sex. act. women
Complicated UTI Pt has functionally, metabolically, anatomically abnormal UT Broad range of bacteria Many are MDR Maybe >1 organism
Complicated UTI Suspect Populations Young child/neonate Young adult male Pregnant female Catheterized pt Elderly
Localization of Infections Good H&P Selective uretheral catheterization with quantitative culture
Spectrum Collection *Clean catch midstream* Indwelling cath Bilateral urethral cath Suprapubic aspiration
Specimen Transport Refrigeration @ 4C Commercial kits: -Boric acid -Sodium formate
Quantitative Culture Media Blood agar (red) MacConkey Agar (pink)
Microorganisms that don't grow on BAP or MAC Anaerobes, Chlamydia Gardnerella, Herpes Haemophilus, Mycoplasma Neisseria, Most yeasts
Treatment Acute Uncomplicated Cystitis 3 day TMP/SMX Nitrofurantion If recurrent, eliminate infxn first then TMP/SMX
Treatment Child <5 y/o 7 day TMP/SMX Nitrofurantion
Treatment Acute Uncpomplicated Pyelonephritis Mild/mod: 7 days TMP/SMX Fluoroquinolone Severe: PE until fever is gone Fluro, or Gent+Amp Piper-tazobactam, ect Followed by 14-21 days oral
Prevention Urinate frequently Drink plenty of liquids Wipe front to back Cotton underwear Showers Empty bladder after sex
Created by: bcriss