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Renal 21 UTI

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Created by: bcriss

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Medical Terminology: Root Words

Question	Answer
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