Manna-UTI Quizlet DS

Directed Study: UTIs
765/OM5/GU
Feb 8th, 2016 at 4:30pm
David Manna Ph.D.
Instructions: Review the PowerPoint slides uploaded to SOLE regarding urinary tract infections (UTI’s).
The learning objectives are listed below. This material is relevant to the upcoming TBL activity on
sexually transmitted diseases (STDs) on February 11 th, 2016 at 9:30am.
Learning Objectives:
1. Differentiate between urethritis, cystitis, and pyelonephritis.
 Urethritis: dysuria & mucopurulent discharge caused by sexually transmitted agents.

o Gram neg diplococcic, Trichomonas vaginalis, Chlamydia trachomatis
 Cystitis: dysuria, frequency & urgency caused by multiplication of enteric organisms

w/in bladder
 Pyelonephritis: fever, flank pain & systemic signs caused by invasion of kidney tissue by
enteric organisms
- WBC casts seen
2. Explain the salient features of urinary tract infections (UTIs)

 Can develop pyelonephritis
 Account for almost half of all infections acquired in hospitals
 Cath’s, Instruments – up to 10% of all hospitalized patients.
 Normal flora for men & women = Coag-neg Staph, Streptococcus, Mycoplasma. (women also
have lactobacillus)
3. List the common etiologic agents for:

a) community acquired
*Ecoli 80%
 proteus-Morganella
 Klebsiella-Enterobacter
 Staphylococcus saprophyticus
 Enterococcus (grp D strep)
-more common among women, esp pregnant.

-high incidence in elderly
b) nosocomial UTIs.
 Proteus-Morganella
 Pseudomonas aeruginosa
 Klebsiella-Enterobacter
 Staphylococcus coag neg
 Enterococcus (grp D strep)
 Serratia, Citrobacter
- these make up 80%
 E. coli - 20%
 instrumentation & catheterization
c) Describe the role of host defenses in preventing UTIs.
 micturition - most important

 pH of urine
 phagocytosis
 urinary secretory IgA
 prostatic secretions in male
*Ascending infection (common) – Feces  Periurethra  Urethra  Bladder  kidney

*Descending entry (rare) – Body  Blood  Kidney.
Note: the more compromised, the less virulence required to cause infection.
d) List the predisposing factors involved in UTIs.
Female –
 Anatomy (shorter urethra), Prego, Sexual activity
 Diaphragm (spermicide use), Increased cellular adherence (genetic predisposition)
 Nonsecretor status – (a secretor is a person who secretes their blood type Ag’s into
body fluids).
Male & Female – Stones/Calculi, Uretheral structure, Bladder tumors, Instrumentation, Systemic
dz.
e) Discuss the important E. coli virulence factors associated with UTIs
E.coli (#1) in community acq’d

 Lactose fermentation POSITIVE.
 Lysine decarboxylase POSITIVE.
 Indole POSITIVE  can split Indole from typtophan
 Voges-Proskauer NEGATIVE  CAN’T break down glucose to acetylmethylcarbinol.
 Virulence factors:
o P & Type 1 Fimbriae  Adherence
o K antigen capsule
o SAT (secreted autotransporter toxin)
o Hemolysins – dmg epithelium
o The more compromised the host, the less virulence required of E.coli to
cause infection.
f) Describe the strategies for diagnosing UTIs.
Specimen collection
 clean catch midstream urine
 Indwelling cath, Straight cath, Cystoscopy, Suprapubic aspiration.
Quantitative culture – Blood agar, MacConkey agar.

 > 105  cystitis, pyelonephritis, bacteriurea
 > 102  Cath associated – can progress to 105 in 1day.
LN Strip (Nitrite & Leukocyte esterase) – rapid screen
g) Describe the general approach to therapy for urinary tract infections.
Uncomplicated UTI – normal urinary tract without underlying disease

 E.coli, Sensitive to ABX, Usually 1 organism.
 MC in sexually active women.
(uncomplicated)
Empiric Tx of acute cystitis in women – TMP/SMX or Nitrofurantoin  Alternative =
Fluoroquinolone.
Empiric Tx of recurrent cystitis in woman – Decision to use prophylaxis (same abx as above)
Empiric Tx of acute pyelonephritis – Fluoroquinolone, 3rd gen ceph (cefotaxime, ceftriaxone,
ceftazidime)
 Do urine culture & sensitivity and adjust tx.
Complicated UTI – Functionally, metabolically, or anatomically abnormal urinary tract

 Resistance to ABX, may be more than 1 organism.
 Child, male, cath patients.
Empiric Tx of complicated UTI:

 Mod ill – Fluoroquinolone
 Severely ill – Cefepime, Ceftazidime, Imipenem, Piperacillin/Tazobactam
 Do urine culture & sensitivity and adjust tx.

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Directed Study: UTIs

1. Differentiate between urethritis, cystitis, and pyelonephritis.

 Urethritis: dysuria & mucopurulent discharge caused by sexually transmitted agents.

 Cystitis: dysuria, frequency & urgency caused by multiplication of enteric organisms

2. Explain the salient features of urinary tract infections (UTIs)

3. List the common etiologic agents for:

-more common among women, esp pregnant.

c) Describe the role of host defenses in preventing UTIs.

 micturition - most important

*Ascending infection (common) – Feces  Periurethra  Urethra  Bladder  kidney

d) List the predisposing factors involved in UTIs.

e) Discuss the important E. coli virulence factors associated with UTIs

E.coli (#1) in community acq’d

f) Describe the strategies for diagnosing UTIs.

Quantitative culture – Blood agar, MacConkey agar.

LN Strip (Nitrite & Leukocyte esterase) – rapid screen

g) Describe the general approach to therapy for urinary tract infections.

Uncomplicated UTI – normal urinary tract without underlying disease

Complicated UTI – Functionally, metabolically, or anatomically abnormal urinary tract

Empiric Tx of complicated UTI:

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