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 |