PC 2 mod 2.3 lec 1

presence of microorganisms in the urinary tract that cannot be classified as contaminants or colonizers

UTI

uncomplicated UTI refers to infection in a ______ urinary tract

structurally normal

UTI may be complicated by processes that impede _____ or alter ______

- urinary flow

- defense

recurrent UTI is defined as...

--> ____ UTIs within 6 months

--> ____ UTIs within 1 year

- 2+

- 3+

natural defenses of urine

--> ____ pH

--> LOW/HIGH osmolality

--> urinary inhibitors of _____

--> competitive inhibitors of ______ to ______ cells

--> ______ of urine flow

- acidic

- high

- bacterial adherence

- attachment --> uroepithelial cells

- mechanical flushing

natural defenses of mucosal integrity

--> uroethial secretion of _____ and ______

--> ______ lining increases difficulty of penetration

--> mucosal Ig___

--> in men --> prostatic secretions contain ______ and ______ is longer

- cytokines and chemokines

- mucopolysacchride lining

- IgA

- zinc

- urethra

pathophysiology of UTI 5 steps...

1. colonization

2. uroepithelial penetration (cystitis)

3. ascension

4. pyelonephritis

5. acute kidney injury

in COLONIZATION phase of UTI, pathogen colonizes the _______ and ascends through ______ to bladder

- periurethral space

- urethra

in UROEPITHELIAL PENETRATION phase of UTI, ______ allows bladder epithelial cell attachment and penetration, where bacteria continues to ______ and may form ______

THIS STAGE IS CALLED:

- fimbriae

- replicate

- biofilm

- cystitis

in ASCENSION stage of UTI, once sufficient colonization occurs, bacteria may ascend on _____ towards _____ using _____, and bacterial toxins can assist this my inhibiting ______

- ureters

- kidney

- fimbria

- peristalsis (urine flow)

in PYELONEPHRITIS phase of UTI, infection of ______ causes inflammation and this can occur from ascension or ______

- renal parenchyma

- hematogenous spread

in ACUTE KIDNEY INJURY stage of UTI, if inflammatory cascade continues, _______ obstruction and damage occurs, leading to ______ which can cause ______ resulting in AKI

- tubular

- interstitial edema

- interstitial nephritis

signs/symptoms of CYSTITIS

--> ___uria

--> _____ and _____ urination

--> ____uria

--> altered _____

--> _____

--> _____ pain

- dysuria

- frequency and urgency

- hematuria

- mental state

- malaise

- suprapubic

signs/symptoms of PYELONEPHRITIS

--> ____

--> chills/rigor

--> _____ pain

--> _____

--> _____ tenderness

--> _____ in urine

- fever

- flank

- N/V

- costovertebral angle tenderness (overlays kidney)

- WBC cast

pyelonephritis can progress to _____ meaning it is in ______, resulting in _____ and _____ failure

- urosepsis

- blood

- circulatory and organ failure

complicating factors of UTI...

--> _____ or _____ abnormalities effecting (FLOW)

--> urinary tract _______ (FLOW)

--> _______ (COLONIZATION)

--> _______ (IMMUNOSUPPRESSION)

--> ______ (IMMUNOSUPPRESSION)

- structure or function

- obstruction

- indwelling catheter

- renal transplant

- diabetes

complicating factors of UTI cont.

--> ______

--> _____ (FLOW and COLONIZATION)

- pregnancy

- kidney stones

having UTI during pregnancy can result in _____ birth and _____ birth weigh

- premature

- low

3 diagnostic tools for UTI

- urinalysis

- urine culture

- urine microscopy

urine should be transported to the lab within ___h of collection

1

urine culture more than ___cfu/mL is UTI

10^5

urine nitrites in the blood are high signifiers of _____ family of bacteria is present, breaking down _____ to _____

- enterobactericeae

- nitrates

- nitrites

one of best indicators of UTI is ________, indicating ____ in blood

- urine leukocyte esterase

- WBC

pyuria is considered _____ WBC/HPF

>10

urinalysis positive for squamous epithelial cells points to...

contamination

WBC cast in urinalysis signifies...

kidney inflammation

does WBC cast always indicate kidney infection?

no, inflammation

which 4 bacteria cause uncomplicated UTI?

- E.coli

- proteus miabilis

- klebsiella pneumoniae

- staph sprophyticus

which bacteria is GRAM POSITIVE and causes UNCOMPLICATED UTI

staph sprophyticus

which organisms cause complicated UTI (6)

- pseudomonas aeruginosa

- serratia

- providencia

- enterococcus

- staphylococcus

- candida

>95% of UTs are due to SINGLE/MULTIPLE organisms

single

multiple organisms in single urine culture may represent ______ or ______

- complicated infection

- poor specimen collection

resistance threshold for

--> cystitis is >____%

--> pyelonephritis is >____%

>20%

>10%

cannot use agent if ________ is higher than %

community susceptibility (resistance threshold)

5 drugs used to treat UNCOMPLICATED cyctitis

- nitrfurantoin macrocrystals

- TMP/SMX DS

- fosfomycin

- fluoroquinolones

- beta-lactams

nitrofurantoin macrocrystals are dosed ____mg ___x daily for ____ days

- 100mg

- 2x

- 5 days

TMP/SMX is dosed DS/SS ____mg ___x daily for ___days

- DS

- 160/800 mg

- 2x

- 3d

fosfomycin is dosed ____ g in ____d

3g

single dose

two fluoroquinolone used for treatment of uncomplicated cystitis

- ciprofloxacin

- levaquin

ciprofloxacin is dosed ____mg ____x daily for ____ days

levoquin is dosed ____mg ___x daily for ___ days

- 250mg 2x daily for 3 days

- 250mg 1x daily for 3 days

beta lactam drug/dose varies for ____days

3-7 days

which nitrofurantoin is most commonly prescribed for cystitis

macrobid

MOA of nitrofurantoin inactivation of ______ proteins interferes with cell well synthesis and DNA synthesis

ribosomal proteins (by flavoproteins)

is nitrofurantoin for cystitis or pyelonephritis?

cystitis only

fosfomycin is available as _____ that dissolves in _____ and MOA is interference with ______

- granules

- 4oz water

- cell wall synthesis

which fosfomycin is used for cystitis

monurol

is fosfomycin for cystitis or pyelonephritis?

cystitis only

fosfomycin is expensive, but good if there are ______ concerns

compliance

trim/sulf MOA is inhibition of _____ synthesis

folic acid

can trim/sulfa be used to cystitis or pyelonephritis?

both

fluroquinolones MOA is inhibition of DNA synthesis via ______ and ______ inhibition

- DNA gyrase

- topoisomerase IV

fluroquinolones are active against most urinary pathogens includes _______

pseudomonas

limitations for fluroquinolones are....

--> _____ damage

--> ____

--> local _____ issues

- collateral

- ADE

- resistance

fluoroquinolones have drug interaction with ______ and _____

- cation (inhibit absorption)

- warfarin

is fluorouquinolones for cystitis or pyelonephritis?

both

beta-lactam are active against most ________

enterobacterales

avoid _____ beta-lactams due to poor activity against enterobacterales

aminopenicillins

______ are active against most enterobacterales

______ are active against most pseudomonas

- beta-lactams

- fluroquinolones

ecological adverse effect, selection of drug resistant organisms

collateral damage

fluroquinilones can cause collateral damage of... (4)

- MRSA

- fluoroquinolone-resistant gram- bacilli

- ESBL producing klebsiella

- C diff

broad spec cephalosporins can cause collateral damage of (3)...

- ESBL producing klebsiella

- b-lactam resistant acinetobacter

- c diff

asymptomatic bacteriuria is defined as ___cfu/mL without _____

- 10^5cfu/mL

- signs/symptoms

most common causes for asymptomatic bacteriuria are due to...

indwelling catheters

is screening and treatment of asymptomatic bacteruria needed?

mostly no

when does asymptomatic bacteruira need to be screened and treated?

- pregnant women

- urologic procedure that involved mucosal bleeding

pregnant women with ASB have 20-30x increased risk of developing ______ during pregnancy

--> treat with ABX for ____ days

pyelonephritis

4-7 days

need to screen for ASB in patients undergoing urologic procedure w/ ______ and need _____ doses of antibiotics _____

- mucosal bleeding

- 1-2 doses

- prior to surgery

OTC agent for cystitis is ...

phenazopyridine

phenazopyridine is found ____ and is a urinary _____

- OTC

- urinary analgesic

does phenazopyridine do anything to treat infection?

no

adverse effect of phenazopyridine is _____ of body fluids

red-orange color

aminopenicllins have poor activity against _______ so are not used for UTIs

enterobacterales

broad spectrum cephalosporins and FQ both cause collateral damage of ... (2)

- c. diff

- ESBL producing kleb

_____ have drug interactions with warfarin and cations

FQ

are beta lactams active against enterobacterales?

yes, except aminopenicillins

monurol is a ______ used for CYSTITIS/PYLENOPHRITIS

- fosfomycin

- cystitis

______ can cause beta-lactam resistance acinetobacter

broad spectrum cephalosporin use

what are cystitis ONLY drugs (2)

what can be used for cystitis and pylonephritis (3)

- fosfomycin and nitrofurantoin

- trim/sulfa, FQ, beta lactams