Urinary Tract Infection
What four things do antibacterials have to be?
-Ability to reach urine -Adequate absorption and ability to achieve adequate urinary concentrations -Adequate spectrum of activity for likely causative organisms -Well tolerated
What are the ascending routes?
-Infection in women due to the close proximity of the reproductive tract, urinary tract and rectum (urethrea colonized by fecal flora) Spermicides Diaphragms Sexual Intercourse
What ratio of females have a UTI before the age of 25?
1/3
What percentage of females have UTI at some point in their lives?
20%
UTI's are less common in men until age?
65
What is a Complicated UTI's?
A Predisposing lesion of the Urinary Tract
What are two bacterial virulence factors?
Adherence to urinary epithelial cells using fimbriae Biofilms
What are three routes of UTI infection?
Ascending Route Descending Route Lymphatic Pathways
What is asymptomatic bacteriuria?
Bacteria in urine, no symptoms
What does lower tract infection cause?
Cystitis (bladder) Urethritis (urethra) Prostatitis (prostate) Epididymitis (epididymis)
What are the bacterial agents that cause prostatitis in men greater than 30 years old?
E.Coli Klebsiella sp. Proteus sp. P. aeurginosa
A lot of etiological agents cause complicated UTI's but which one is most prevalent?
E.Coli (50%)
What two things are Uncomplicated UTI's caused from?
E.Coli (85%) Staphylococcus Saprophyticus (5-15%)
Which sex has a higher occurence of UTI's?
Females because of close proximity of the reproductive tract, urinary tract and rectum
What is the most common type of bacteria (gram negative or gram positive) that cause UTI's?
Gram Negative
What is fimbrea?
Hairlike appendages on the cell wall
What type of people do Uncomplicated UTI's affect?
Healthy Females age 15-45
What is the descending route?
Hematogenous (the descending of an infection from distant regions)
UTI's are the most common what?
Hospital Acquired Infection or Nosocomial Infection
What is UTI?
Inflammation of the Urinary Epithelium following invasion and colonization by some pathogen within the urinary tract
What is prostatitis?
Inflammation of the prostate
What is an Uncomplicated UTI?
It is when there is a lack of structural or functional abnormalites of the urinary tract that interfere with normal voiding
What do relapse persistant infection UTI's indicate?
Kidney Involvement Structural Problems of the Urinary Tract
What are predisposing factors?
Kidney Stone Indwelling Catheter Pregnancy Mechanical Instruments Spermicides and Diaphragm Use Prostate Enlargement Abnormalities of the Urinary Tract that interfere with normal defense mechanisms
What do bacterialcidal antibiotic do?
Kill the bacteria and eradicate the disease
Who does complicated UTI's affect?
Males and Females
What are three ways to collect urine samples?
Midstream "Clean catch" Catheterization Suprapubic Bladder Aspiration
What are the bacterial agents that cause prostatitis in men younger than 30 years old?
Neisseria gonorrhea Chlamydia trachomatis (Sexually Transmitted Diseases)
What is a relapse persistant infection UTI?
One that has a pesistent infectious source (usually due to infections that have never been cured and become asymptamatic and then flare up again)
What is a Reinfection persistant UTI?
One that is caused by a different organism each time and usually occurs in women
What do bacteriostatic antibiotics do?
Prevents bacteria culture from reproducing and keeps the infection in check but doesn't cure or kill infection.
What is the main cause of UTI's?
Prolonged Urinary Catheters
What does upper tract infection cause?
Pyelonephritis (Kidney)
What are two types of Persistant UTI's?
Reinfection or Relapse
What is the 3rd most common source of UTI's
Sepsis/Severe Sepsis/Shock
What is a Persistant UTI?
UTI that has multiple symptomatic episodes with asymptomatic periods between
What are two laboratory tests?
Urinalysis Urine Culture
What are two methods used to diagnosis UTI's?
Urine Collection Laboratory Tests
What are three host defense mechanisms?
Urine itself - low pH, osmolality, high urea Voiding mechanism Anti adherence mechanisms in bladder
What are signs and sypmptoms of UTI's in elderly?
altered mental status or confusion altered eating habits, GI symptoms
What are signs and sypmptoms of lower UTI?
dysuria, Urgency Frequency Nocturia hematuria
What are biofilms
film of protective mechanism that forms over initial colony of bacteria
What are signs and sypmptoms of upper UTI?
flank pain fever N/V malaise
What are signs and sypmptoms of prostatitis?
pain fever urinary retention problems voiding
What is "Significant Bacteriuria" in Symptomatic females?
≥ 10^2 CFU coliforms/Ml ≥10^3 CFU noncoliforms/mL
What is "Significant Bacteriuria" in Catheterized patients?
≥10^2 CFU bacteria/mL
What is "Significant Bacteriuria" in Symptomatic males?
≥10^3 CFU bacteria/mL
What is "Significant Bacteriuria" in Asymptomatic individuals in 2 consecutive species?
≥10^5 CFU bacteria/mL