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29 Cards in this Set

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Bacteruiria
Bacteria in urinalysis
Pyuria
White blood cells in urinarlysis from anywhere
"Significant" bacteriuria
More than 10^3 colony count in urine culture
>10^5 is documented true UTI

Multiple organisms = false + contaminated specimen
Lots of squamous cells = contamination
Dysuria
Discomfort when voiding, burning
Lower urinary tract infection
Does not involve pelvis
Urethritis
Just urethra involved
Pyelonephritis
Infection in the medulla
Acute urethral syndrome
Burning, frequency, irriatation when voiding, all inflammatory response restricted to urethra
What is the leading cause of dysuria?
2nd most common?
3rd most?
Causes of acute urethral syndrome?
Cystitis = inflamed bladder, organisms adhering to wall causing inflammation
Cystitis = inflamed bladder, organisms adhering to wall causing inflammation
What is the most common cause of bacterial infections? Where do most come from? Which one is the most common? 2 other common ones?
Causative Bacteria
95% from G.I. tract
E. coli – most common
Staph. saprophyticus
Other “niche” organisms
What are age and sex differences in UTIs?

Infants? Years 3-50? What is seen in elderly (>65 yrs old)
Infants: males > females
Years 3-50: females >>>males
Elders (>65 years old)
Increased Bacteriuria
Multiple factors
Is there an increase in UTIs in pregnancy?

Sex?
Pregnancy
Bacteriuria in 4-10%
Twice the expected rate
25% progression

Sex is a risk factor for UTI.
Which contraceptives show the highest incidence of bacteruria? Lowest bacteruria?
Highest = diaphragm-spermicide user
Lowest = oral contraceptive
What are the two types of route of infection? Majority?

What can cause ascending route infection?

Who might get hematogenous infections? Where will bacterial be?
Route of Infection
Ascending route 95+%
Urethral trauma
Intercourse
Instrumentation
Diaphragm use

Hematogenous route <5% = endocarditis or central lines, renal cortex localization
By what mechanisms do UTIs occur?
Adhesion
Colonization
Invasion
Phase variation
What are bacterial factors?
What are two types of adhesions on fimbriae?
Bacterial factors:
Uropathogenic E. coli
Virulence factors

Adhesions on fimbriae
Type I fimbriae
P- fimbriae
Bacterial factors:
Uropathogenic E. coli
Virulence factors

Adhesions on fimbriae
Type I fimbriae
P- fimbriae
What are the mechanisms of bacteria/host cell interactions?
What are some host defense mechanisms to UTIs?
Bacterial growth inhibition
Urine flow
Epithelial cell turnover
Antibodies
What are some predisposing host factors?
Urine flow obstruction
Female factors
Abnormal urine flow
Urethral trauma
Vesiculo-ureteral reflux
Instrumentation
General health
Urine flow obstruction
Female factors
Abnormal urine flow
Urethral trauma
Vesiculo-ureteral reflux
Instrumentation
General health
What are some clinical manifestations of lower urinary tract infections?
Frequency of urination
Dysuria - painful urination
Turbid urine
Suprapubic discomfort
Hematuria
Asymptomatic cystitis
What are clinical manifestations of upper tract infections?
Fever
Chills
Flank pain and “CVAT”
Asymptomatic pyelonephritis
How do you diagnose UTI?
Microscopic urinalysis
Gram stain of urine
Urine culture
Blood cultures (PRN)
Screening tests
What are some complications of UTI?
Gram negative sepsis
Intrarenal or extrarenal abscess
Chronic renal insufficiency
Struvite renal calculi
Recurrent infection
How do you prevent UTIs?
Proper use of urinary catheterization
Correction of anatomic abnormalities
Prophylactic antibiotics - RARELY
How long does it take to treat a lower tract infection? Males and females?
When can it take longer?
Males: 1 week
Females: 1-3 days
Longer if complicated UTI
How long does it take to treat an upper tract infection?
How do you treat it?
1-6 weeks
IV vs oral thearpy
How do you treat asymptomatic bacteriuria?
Not treated in elderly (and others)
What seems to have the best efficacy for uncomplicated UTIs?

Complicated?
Ciprofloxacin

Ciprofloxacin, Ceftriaxone
Ciprofloxacin

Ciprofloxacin, Ceftriaxone
What is this?
What is this?
Wall didn't know either.

Possibly aminoglycosides at the far left has the highest level of intrarenal concentration --> proximal tubule interstitial damage