Urinary Tract Infection Factors and Etiology

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Questions and Answers

What is considered an uncomplicated case for a young healthy woman regarding UTI treatment?

Persistent infections without any treatment

Repeated UTI episodes with structural abnormalities

Sexually inactive and over 40 years old

Single antibiotic dose after symptomatic lower UTI (correct)

Which factor is NOT associated with a predisposition to urinary tract infections?

Diabetes mellitus

High protein diet (correct)

Pregnancy

Neurogenic bladder dysfunction

What should be done routinely in all men with UTI?

Blood work for creatinine

Pyuria assessment

Renal ultrasound

Urine culture testing (correct)

Which of the following is NOT an indication for routine screening of urologic abnormalities?

History of mild dehydration Signup and view all the answers

What is the minimum white blood cell count in urine that indicates pyuria?

10 wbc/mm2 Signup and view all the answers

What is the most common organism responsible for urinary tract infections?

E. coli Signup and view all the answers

Which predisposing factor involves an anatomical issue in the urinary tract?

Vesicourethral reflux Signup and view all the answers

Which of the following bacterial virulence factors is associated with epithelial cell receptors?

S/F/C fimbriae Signup and view all the answers

What is the recommended approach to urine analysis in cases of acute uncomplicated pyelonephritis?

Urinalysis, urine gram stain & culture are recommended Signup and view all the answers

What should be done if symptoms improve but do not completely resolve after initial treatment for a urinary tract infection?

Extend treatment to a 7-day course of the same antimicrobial Signup and view all the answers

Which factor is related to urinary tract instrumentation?

Obstruction Signup and view all the answers

What happens during a rectal examination in cases of acute bacterial prostatitis?

The prostate is tender and swollen Signup and view all the answers

What is the typical first-line antibiotic class used for uncomplicated cystitis treatment?

TMP-SMZ Signup and view all the answers

The presence of what in urine is typically indicative of an infection?

<blockquote> 10 CFU bacteria/ml </blockquote> Signup and view all the answers

What group of individuals is most commonly affected by acute uncomplicated pyelonephritis?

Young women Signup and view all the answers

What is the recommended method for prophylaxis of recurrent acute uncomplicated cystitis?

Continuous low-dose antibiotics Signup and view all the answers

What distinguishes gram-negative bacteria like E. coli in the context of infection?

Presence of lipopolysaccharides Signup and view all the answers

In which scenario should symptoms be managed as if they are complicated urinary tract infections?

Symptoms continue to persist after a 7-day treatment Signup and view all the answers

What is a characteristic of category I prostatitis according to the NIH Consensus Classification?

Acute bacterial prostatitis Signup and view all the answers

What is a common laboratory finding in acute uncomplicated pyelonephritis?

Presence of leukocyte casts in the urine Signup and view all the answers

Which clinical feature is NOT typically suggestive of acute uncomplicated pyelonephritis?

High blood pressure Signup and view all the answers

Which of the following is true about the urine culture thresholds for indicating a UTI?

A culture of ≥100 cfu/ml indicates infection Signup and view all the answers

Which symptom combination indicates the need for diagnostic tests in cases of acute uncomplicated pyelonephritis?

Unusual symptom patterns presenting together Signup and view all the answers

What is the likely cause of chronic prostatitis/chronic pelvic pain syndrome (CPP)?

An unknown etiology Signup and view all the answers

Which medication is indicated for the treatment of acute bacterial prostatitis?

Ciprofloxacin Signup and view all the answers

What factor is NOT indicated for extending treatment to a 7-day course in acute uncomplicated pyelonephritis?

Symptoms have significantly improved Signup and view all the answers

What characterizes chronic bacterial prostatitis?

Recurrent infections by the same organism Signup and view all the answers

Which statement is true regarding chronic prostatitis/chronic pelvic pain syndrome (CPP)?

Symptoms may include pain and voiding complaints Signup and view all the answers

In post-coital prophylaxis for urinary tract infections, which medication is commonly used?

TMP-SMX Signup and view all the answers

Which of these treatments is typically NOT prescribed for chronic bacterial prostatitis?

Propranolol Signup and view all the answers

When are blood cultures recommended in the management of urinary tract infections?

In cases of suspected sepsis syndrome Signup and view all the answers

What is a characteristic symptom of acute bacterial prostatitis?

Fever and chills Signup and view all the answers

Which pathogen is commonly associated with catheter-associated urinary tract infections (UTIs)?

E. coli Signup and view all the answers

What is one of the symptoms relief methods mentioned for chronic bacterial prostatitis?

Prostatic massage Signup and view all the answers

Which of the following is recommended for long-term therapy in patients who do not respond to full-dose treatment?

Long-term low-dose suppressive therapy Signup and view all the answers

What is the recommended duration of treatment for a patient using Ciprofloxacin for complicated UTI?

28 days Signup and view all the answers

What treatment is recommended for men with recalcitrant chronic bacterial prostatitis?

TURP or total prostatectomy Signup and view all the answers

What type of treatment is described as having a duration of only 1 week for symptomatic relief?

Short-term anti-inflammatory agents Signup and view all the answers

Which of these antibiotics is prescribed at a dose of TMP-SMX 80/400 mg for chronic therapy?

160/800 mg Signup and view all the answers

What is the percentage of Klebsiella pneumonia identified in UTI associated with anatomical abnormalities?

37% Signup and view all the answers

Study Notes

Factors Predisposing to UTI

Presence of Microorganisms in the kidney and urinary tract
Host Biological and Behavioral Factors:
- Gender and Sexual Activity
- Pregnancy
- Obstruction
- Neurogenic Bladder Dysfunction
- Vesicourethral Reflux
- Urinary Tract Instrumentation
- Diabetes Mellitus
- Immunosuppression
- Urinary Tract Abnormalities

Bacterial Virulence Factors

Adhesins/Epithelial Cell Receptors:
- P fimbriae (MR): glycospingolipid globoseries, gal-a 1-4 (P blood group antigens)
- Type I fimbriae (MS): glucoproteins, uroplakin I and II
- S/F/C fimbriae (MR): Sialyl a 2-3 galactoside
- Type I C (MR):
- G fimbriae (MR): terminal N acetyl D

Bacterial Etiology of Urinary Tract Infection

Gram-negative bacteria:
- E.Coli: 70-95% of UTIs in women, 21-54% of UTIs in men
- Proteus Mirabilis: 1-2% of UTIs in women, 1-10% of UTIs in men
- Klebsiella Spp: 1-2% of UTIs in women, 2-17% of UTIs in men
- Citrobacter Spp./= 10 CFU bacteria/ ml:

Acute Uncomplicated Pyelonephritis

Criteria for Young Women:
- /= 10 CFU bacteria/ml on 2 consecutive urine specimens
- Symptoms improved but not completely resolved after 7 days of antimicrobial treatment
- Symptoms fail to resolve after 7 days of antimicrobial treatment

Acute Uncomplicated Pyelonephritis in Women

Symptoms:
- Fever (> 38C)
- Chills, nausea, flank pain
- CVA tenderness
Laboratory Findings:
- Significant pyuria
- Bacteriuria of > 10,000 cfu/ml
- Leukocyte casts
- Leukocytosis

Diagnosis of UTI

Urine cultures are not necessary in cases with significant pyuria:
- 8 pus cells/mm3 uncentrifuged urine
- 5 pus cells/mm3 centrifuged urine
- (+) LE and nitrite test
Diagnostic test needed in those with unusual combination of symptoms
Diagnostic Tests:
- Urinalysis
- Urine gram stain & culture
- Blood cultures (not routinely recommended)

Uncomplicated UTI in Young Women

A single dose of antibiotics after sexual intercourse is considered an uncomplicated treatment for a single episode of symptomatic lower UTI in young (15 to 40 y/o) healthy, sexually active women without history of structural or functional urologic abnormalities.

Hormonal Treatment in Postmenopausal Women

Intravaginal estriol cream at night for 2 weeks - 2x a week for 8 months

Indications for Screening Urologic Abnormalities

Routine screening is not recommended unless:
- Gross hematuria during episodes of UTI
- Obstructive symptoms
- Clinical impression of persistent infection
- Infection of urea-splitting bacteria
- History of pyelonephritis
- History or symptoms suggestive of urolithiasis
- History of childhood UTI
- Elevated serum creatinine

Prophylaxis for Recurrent Acute Uncomplicated Cystitis

Continuous Prophylaxis:
- TMP-SMX: 40/200 mg daily or thrice weekly
- Trimethoprim: 100 mg daily
- Nitrofurantoin: 50/100 mg daily
- Cefaclor: 250 mg daily
- Cefalexin: 125/250 mg daily
- Norfloxacin (or other likely effective drug): 200 mg daily
Post-Coital Prophylaxis:
- TMP-SMX: 40/200 mg or 80/400 mg
- Nitrofurantoin: 250 mg
- Ciprofloxacin: 125 mg
- Norfloxacin: 200 mg

NIH Consensus Classification of Prostatitis

Category I (Acute Bacterial Prostatitis):
- Acute infection of the prostate gland characterized by fever, chills, low back pain, and perineal pain.
- Irritative voiding symptoms are characteristic (dysuria, frequency, urgency, nocturia).
- Rectal examination reveals a markedly tender, swollen prostate.
- Treatment with fluoroquinolones is recommended.
Category II (Chronic Bacterial Prostatitis):
- Recurrent infection of the prostate caused by persistence of the same organism despite treatment.
- Symptoms are irritative voiding and pain of varying degrees.
- Rectal examination reveals no characteristic finding.
- Treatment with Trimethoprim 50/ 100 is recommended.
Category III (Chronic Prostatitis/CPP):
- Chronic Pelvic Pain Syndrome (CPPS)
- No demonstrable infection; primarily pain complaints, plus voiding complaints and sexual dysfunction affecting men of all ages.
- Usually cause is unknown.
- Treatment: Oloxacin 100 mg

Chronic Prostatitis/ CPPS Treatment

IIIA. Modification according to results of 1st line treatment:
- Quinolone for 28 days:
  - Ciprofloxacin 500mg BID
  - Ofloxacin 200mg BID
  - Norfloxacin 400mg BID
  - Doxycycline 100mg BID
  - Minocycline 100mg BID
  - Trimethoprim 200mg BID
  - TMP-SMX 160/800 mg BID
Men with recalcitrant chronic bacterial prostatitis:
- TURP or total prostatectomy
- Symptomatic relief: anti-inflammatory agents and prostatic massage
- Long term, low dose suppressive therapy may be recommended
TMP-SMX 80/400mg OD is recommended for 4 to 6 weeks.

Complicated Urinary Tract Infections

Pathogens Identified in Complicated UTIs:
- Catheter-associated UTI: E coli, P aeruginosa, Proteus mirabilis, enterbacter, Providencia stuartii, Morganella morgagni, Citrobacter, Enterococcus, Candida sp
- Short term (1 week) UTI: E coli, P aeruginosa, Proteus mirabilis, enterbacter, Providencia stuartii, Morganella morgagni, Citrobacter, Enterococcus, Candida sp.
- Anatomic Abnormalities UTI: E.Coli, Klebsiella pneumonia(37%), P.aeruginosa, Proteus mirabilis
- UTI in Diabetes: E.Coli, Klebsiella pneumonia(37%), P.aeruginosa, Proteus mirabilis, Enterobacter, Enterococcus, Candida
- Renal Transplant UTI: E.Coli, Klebsiella pneumonia, Candida albicans, Pseudomonas aeruginosa
Duration of Treatment is 7 days
Post-treatment urine culture: 1-2 weeks after completion of medication

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Description

This quiz covers the various factors predisposing individuals to urinary tract infections (UTIs), including biological, behavioral, and bacterial virulence factors. Additionally, it explores the bacterial etiology and the role of gram-negative bacteria in UTI occurrences. Test your knowledge on this important topic in microbiology and urology.