Urinary Tract Infections
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| UTI Epidemiology ? | * Community Acquired = more common in pregnant women and the elderly ...... * Nosocomial
= 10% of cathed pts will receive one
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| Usu gram stain of men and women normal flora ? | * Gram - staph and see strep too
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| Top Community Acquired Infections ? | * Escherichia coli (80%) .... * The rest are -- Proteus-Morganella --- Klebsiella-Enterobacter
--- Staphylococcus saprophyticus --- Enterococcus (Grp D strep)
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| E. Coli basics ? | * Indole (+) --- Voges-Proskauer (-) --- Lysine decarboxylase (+) --- Lactose fermentation (+)
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| Nosocomial Infections ? | * E. Coli = 20% ...... * the rest of the 80% is the same as Community
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| Host Defenses against UTI ? | * IgA, pH, Prostatic fluid, micturition
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| E. coli Virulence Factors ? | * adhere by fimbraie and P ..... * capsular polysaccharide.... * have hemolysins..... * resistant to serum bacterialcidal activity
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| E.Coli Patho ? | * contamination and then adhere to uroepi. cells ... * see inflammation and hemolysis, with possible spread to kidneys
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| E. coli Virulence vs Host Defenses ? | * The more compromised the host defenses, the less virulence required of E. coli to cause an infection
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| Female predisposing factors ? | * spermicide use, anatomy, sexual activity, pregnancy
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| Both male and female factors ? | * stones, urethral strictures , tumors, instrumentation (caths), and systemic diseases
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| dysuria and mucopurulent discharge caused by sexually transmitted agents ? | * Urethritis - usu see gram (-) diplococci.... see Trichomonas vaginalis or even Chlamydia
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| dysuria, frequency, and urgency caused by multiplication of enteric organisms within the bladder ? | * Cystitis - LN Strip (nitrite and leukocyte esterase) often used as a rapid screening test in physician’s office
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| fever, flank pain, and systemic signs caused by invasion of the kidney tissue by enteric organisms ? | * Pyelonephritis - see WBC casts in UA
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| Asymptomatic Infections ? | * can happen, and we usu see it in the elderly and only treat before a surgery or pregnancy
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| Uncomplicated Urinary Tract Infections ? | * Patient has normal urinary tract without underlying disease
- usu infected with E. Coli and in sexually active women
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| If a stone causes the UTI, what do we see ? | * UA shows 75% are composed of a struvite-carbonate-apatite matrix and are are associated with urinary tract infections by urease-producing bacteria ---> Proteus mirabilis and Klebsiella
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| Getting a sample ? | * clean and catch sample midstream for a UA or can insert a needle straight in to the bladder
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| Quantitative Culture ? | * Media = Blood agar(red) or MacConkey (pink) agar...shows lactose fermenting pink or red colonies
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| Interpretation of Quantitative Culture ? | * > 10n5 + WBC = acute pyelonephritis and cyctitis
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| Tmt of umcomplicated cystitis in women ? | * short course (3 days) oral TMP/SMX or Nitrofurantoin...... * use FQ is resistant
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| Empiric treatment of acute uncomplicated pyelonephritis ? | * Fluoroquinolone or
3rd gen cephalosporin (cefotaxime, ceftriaxone, or ceftazidime)
........ * base tmt off of UA/labs
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| Empiric treatment of complicated UTI ? | * Moderately ill -- Fluoroquinolone
...... * Severely ill -
Cefepime -- Ceftazidime -- Imipenem -- Piperacillin/tazobactam ...... * base drug tmt off of UA/labs
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| Prevention ? | * urinate frequently, stay hydrated, pee after sex, shower..... * Cranberry Juice - actually contain that stop adherence of E.Coli, so can help
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