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Urinary Tract Infect

Urinary Tract Infections

UTI Epidemiology ? * Community Acquired = more common in pregnant women and the elderly ...... * Nosocomial = 10% of cathed pts will receive one
Usu gram stain of men and women normal flora ? * Gram - staph and see strep too
Top Community Acquired Infections ? * Escherichia coli (80%) .... * The rest are -- Proteus-Morganella --- Klebsiella-Enterobacter --- Staphylococcus saprophyticus --- Enterococcus (Grp D strep)
E. Coli basics ? * Indole (+) --- Voges-Proskauer (-) --- Lysine decarboxylase (+) --- Lactose fermentation (+)
Nosocomial Infections ? * E. Coli = 20% ...... * the rest of the 80% is the same as Community
Host Defenses against UTI ? * IgA, pH, Prostatic fluid, micturition
E. coli Virulence Factors ? * adhere by fimbraie and P ..... * capsular polysaccharide.... * have hemolysins..... * resistant to serum bacterialcidal activity
E.Coli Patho ? * contamination and then adhere to uroepi. cells ... * see inflammation and hemolysis, with possible spread to kidneys
E. coli Virulence vs Host Defenses ? * The more compromised the host defenses, the less virulence required of E. coli to cause an infection
Female predisposing factors ? * spermicide use, anatomy, sexual activity, pregnancy
Both male and female factors ? * stones, urethral strictures , tumors, instrumentation (caths), and systemic diseases
dysuria and mucopurulent discharge caused by sexually transmitted agents ? * Urethritis - usu see gram (-) diplococci.... see Trichomonas vaginalis or even Chlamydia
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
fever, flank pain, and systemic signs caused by invasion of the kidney tissue by enteric organisms ? * Pyelonephritis - see WBC casts in UA
Asymptomatic Infections ? * can happen, and we usu see it in the elderly and only treat before a surgery or pregnancy
Uncomplicated Urinary Tract Infections ? * Patient has normal urinary tract without underlying disease - usu infected with E. Coli and in sexually active women
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
Getting a sample ? * clean and catch sample midstream for a UA or can insert a needle straight in to the bladder
Quantitative Culture ? * Media = Blood agar(red) or MacConkey (pink) agar...shows lactose fermenting pink or red colonies
Interpretation of Quantitative Culture ? * > 10n5 + WBC = acute pyelonephritis and cyctitis
Tmt of umcomplicated cystitis in women ? * short course (3 days) oral TMP/SMX or Nitrofurantoin...... * use FQ is resistant
Empiric treatment of acute uncomplicated pyelonephritis ? * Fluoroquinolone or 3rd gen cephalosporin (cefotaxime, ceftriaxone, or ceftazidime) ........ * base tmt off of UA/labs
Empiric treatment of complicated UTI ? * Moderately ill -- Fluoroquinolone ...... * Severely ill - Cefepime -- Ceftazidime -- Imipenem -- Piperacillin/tazobactam ...... * base drug tmt off of UA/labs
Prevention ? * urinate frequently, stay hydrated, pee after sex, shower..... * Cranberry Juice - actually contain that stop adherence of E.Coli, so can help
Created by: thamrick800