Dugan: Urinary Tract Infections
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| Urinary Tract Infection Epidemiology | Community
More common in women, particularly pregnant women
In elderly: 15% females 10% males
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| Urinary Tract Infection Epidemiology | Nosocomial
Instrumentation and catherization
Up to 10% of hospitalized pts develop UTI
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| Normal Flora in Women | Lactobacillus
Coag - Staph
Streptococcus
Mycoplasma
Enteric Gram-
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| Normal Flora in Men | Coag - Staph
Streptococcus
Mycoplasma
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| Community Acquired Infections (Agents) | E.coli 80%
Proteus-Morganella
Klebsiella
Staph. saprophyticus
Enterococcus
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| Nosocomial Infections (Agents) | E. Coli 20%
Entercoccus
Pseudomonas
Proteus
Klebsiella
Staphlococcus coag-
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| Escherichia coli | Most commonly isolated organism
Called coliforms as they live in the colon
Biochem: Indole+, Lactose fermentation+, Voges-Proskauer-, Lysine decarboxy+
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| Host defenses | Micturition
pH of urine
Phagocytosis
Urinary secretory IgA
Prostatic secretions
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| Entry of Pathogens | Ascending 95-99%
Descending Rare
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| Bacterial Virulence Factors | Adherence- P&type1
Hemolysins
Aerobactin
Capsular polysac
K antigen (E.coli)
Lipopolysaccharide
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| Female predisposing factors | Anatomy
Pregnancy
Sex
Nonsecretor status
Diaphragm/spermicide use
Increase cellular adherence
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| Other Predisposing Factors for Males and Females | Stones/calculi
Urethral strictures
Bladder tumor
Instrumentation
Systemic disease
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| 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)
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| 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
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| 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
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| Complicated UTI | Pt has functionally, metabolically, anatomically abnormal UT
Broad range of bacteria
Many are MDR
Maybe >1 organism
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| Complicated UTI Suspect Populations | Young child/neonate
Young adult male
Pregnant female
Catheterized pt
Elderly
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| Localization of Infections | Good H&P
Selective uretheral catheterization with quantitative culture
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| Spectrum Collection | *Clean catch midstream*
Indwelling cath
Bilateral urethral cath
Suprapubic aspiration
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| Specimen Transport | Refrigeration @ 4C
Commercial kits:
-Boric acid
-Sodium formate
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| Quantitative Culture Media | Blood agar (red)
MacConkey Agar (pink)
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| Microorganisms that don't grow on BAP or MAC | Anaerobes, Chlamydia
Gardnerella, Herpes
Haemophilus, Mycoplasma
Neisseria, Most yeasts
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| Treatment Acute Uncomplicated Cystitis | 3 day TMP/SMX
Nitrofurantion
If recurrent, eliminate infxn first then TMP/SMX
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| Treatment Child <5 y/o | 7 day TMP/SMX
Nitrofurantion
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| 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
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| Prevention | Urinate frequently
Drink plenty of liquids
Wipe front to back
Cotton underwear
Showers
Empty bladder after sex
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