p.20
Definitions of Urinary Tract Infections (UTIs)
What is an indwelling balloon catheter?
An indwelling balloon catheter is a type of catheter that is inserted into the bladder and held in place by a balloon that is inflated with sterile water.
p.40
Diagnosis and Culture Techniques for UTIs
What are the basic components of culture work-up for UTIs?
Colony count, identification (ID), and susceptibility testing.
p.36
Collection and Transport of Urine Specimens
What are the key steps in the collection and transport of urine specimens for UTI diagnosis?
The key steps include proper collection techniques to avoid contamination, immediate transport to the laboratory, and maintaining the specimen at the appropriate temperature during transport.
p.32
Collection and Transport of Urine Specimens
Why is urine considered a good growth medium?
Urine can support the growth of organisms, which may multiply if not cultured promptly.
p.49
Diagnosis and Culture Techniques for UTIs
What is a case example of an unexpected organism found in cultures?
An organism usually found in cerebrospinal fluid (CSF) that lives in pigeon poop.
p.22
Definitions of Urinary Tract Infections (UTIs)
What is cystitis?
Cystitis is an infection of the bladder.
p.21
Common Pathogens Associated with UTIs
What pathogens are commonly associated with urethritis in males?
C. trachomatis and N. gonorrhoeae.
p.39
Definitions of Urinary Tract Infections (UTIs)
What is significant bacteriuria in symptomatic women?
> 10^2 coliforms/ml or > 10^5 non-coliforms/ml
p.16
Common Pathogens Associated with UTIs
What percentage of urethritis cases in males is caused by Gram-negative bacilli?
75% of urethritis cases in males are caused by Gram-negative bacilli.
p.37
Collection and Transport of Urine Specimens
What technique is important for using calibrated loops effectively?
Proper dipping and streaking technique is important.
p.37
Collection and Transport of Urine Specimens
What type of streaking is preferred when using calibrated loops?
Quantitative streaking is preferred rather than quadrant streak.
p.3
Collection and Transport of Urine Specimens
What percentage of the total microbiology lab workload is made up of urine cultures?
Up to 50% of the total microbiology lab workload is made up of urine cultures.
p.4
Definitions of Urinary Tract Infections (UTIs)
What are the two ways to get a UTI?
The two ways to get a UTI are ascending (most common) and hematogenous (descending) from bacteremia.
p.11
Microbial Virulence Factors in Uropathogens
What are uropathogens?
Uropathogens are microorganisms that cause urinary tract infections, characterized by their ability to adhere to and invade the urinary tract.
p.9
Definitions of Urinary Tract Infections (UTIs)
What are some examples of normal flora in the central nervous system (CNS)?
Viridans Streptococcus, Lactobacillus, Diphtheroids, Propionibacterium, Cutibacterium, Nonpathogenic Neisseria, Anaerobic cocci, GNR, Mycoplasma, Ureaplasma.
p.10
Definitions of Urinary Tract Infections (UTIs)
What characterizes complicated urinary tract infections?
Complicated infections are associated with structural or functional abnormalities, such as obstruction or reflux, and typically involve upper tract disease.
p.28
Definitions of Urinary Tract Infections (UTIs)
What is a kidney abscess?
A kidney abscess is a localized collection of pus within the kidney, which may not respond to therapy.
p.38
Diagnosis and Culture Techniques for UTIs
What are the types of plating media mentioned for urine cultures?
BA (Blood Agar), MAC (MacConkey Agar), PEA (Phenylethyl Alcohol Agar), or CNA (Colistin-Nalidixic Acid Agar).
p.16
Risk Factors for UTIs by Gender and Age
What is the etiology of urethritis in a 17-year-old male?
Urethritis can be caused by sexually transmitted diseases (STDs) and is influenced by sexual orientation.
p.37
Collection and Transport of Urine Specimens
What should be avoided while plating with calibrated loops?
You should not cut the agar while plating.
p.3
Symptoms and Clinical Presentation of UTIs
How many office visits are attributed to UTIs annually?
There are 7 million office visits attributed to UTIs annually.
p.26
Risk Factors for UTIs by Gender and Age
What is a significant consequence of urosepsis?
It leads to lots of hospitalizations.
p.43
Diagnosis and Culture Techniques for UTIs
What is the minimal ID for indwelling catheter urine cultures with <100,000 CFU/ml?
Minimal ID for <100,000 CFU/ml.
p.43
Diagnosis and Culture Techniques for UTIs
What is the minimal ID for SPA urine cultures with 100 – 1000 CFU/ml?
Minimal ID for 100 – 1000 CFU/ml.
p.18
Risk Factors for UTIs by Gender and Age
What impact does dehydration have on urinary tract infections?
Dehydration can lead to concentrated urine, which may irritate the bladder and increase the risk of infection.
p.2
Symptoms and Clinical Presentation of UTIs
What are the characteristics of urine in cases of UTI?
Urine in cases of UTI can be cloudy and foul-smelling.
p.30
Diagnosis and Culture Techniques for UTIs
What is the sensitivity of a Gram stain compared to culture?
The sensitivity of a Gram stain is generally lower than that of culture, making culture the gold standard for UTI diagnosis.
p.17
Risk Factors for UTIs by Gender and Age
What are some host factors that can increase the risk of UTIs in males?
Age, hygiene, structural abnormalities, prostate disease, HIV, being uncircumcised, and having sex with an infected partner.
p.41
Contamination and Interpretation of Urine Cultures
What are the exceptions to the colony count rule for N. gonorrhoeae?
Any amount of N. gonorrhoeae is considered an exception to the colony count rule.
p.37
Collection and Transport of Urine Specimens
What are calibrated loops used for in microbiology?
Calibrated loops are used for measuring and transferring specific volumes of liquid, typically for plating microorganisms.
p.28
Antimicrobials Specific to UTI Treatment
What is the treatment for a kidney abscess?
The treatment for a kidney abscess may involve surgically draining or aspirating the fluid.
p.48
Antimicrobials Specific to UTI Treatment
Which drugs are specifically used for treating UTIs?
Nitrofurantoin, Naladixic acid, and Fosfomycin are specifically used for UTIs.
p.38
Diagnosis and Culture Techniques for UTIs
What are the options for plate types in urine cultures?
Single plates or biplates.
p.43
Contamination and Interpretation of Urine Cultures
What should be reported if multiple bacterial morphotypes are present in a urine culture?
Report count + 'Multiple bacterial morphotypes present. Suggest recollection.'
p.4
Diagnosis and Culture Techniques for UTIs
How are many UTIs diagnosed and treated?
Many UTIs are diagnosed and treated without any help from the micro lab.
p.6
Definitions of Urinary Tract Infections (UTIs)
What is a urinary tract infection (UTI)?
A UTI is a disease caused by microbial invasion of the genitourinary tract.
p.18
Symptoms and Clinical Presentation of UTIs
What is a common symptom of urinary tract infections in the elderly?
Disorientation, confusion, and altered mental status are common symptoms in the elderly.
p.12
Common Pathogens Associated with UTIs
What are some common pathogens associated with urinary tract infections?
Escherichia coli, Staphylococcus, Klebsiella, Proteus, Enterobacter, Pseudomonas, Providencia, Serratia, Morganella, Acinetobacter, Candida, Enterococcus, Aerococcus urinae.
p.35
Collection and Transport of Urine Specimens
What should be done if no transport is available for urine specimens?
Refrigerate the specimen.
p.46
Contamination and Interpretation of Urine Cultures
What often ruins urine cultures?
Incorrect transport or delays in testing.
p.28
Definitions of Urinary Tract Infections (UTIs)
What are the types of kidney abscesses?
The types of kidney abscesses include perinephric abscess and intrarenal abscess.
p.7
Definitions of Urinary Tract Infections (UTIs)
What is a symptomatic UTI?
Presence of clinical symptoms associated with the genitourinary tract and bacteriuria.
p.7
Definitions of Urinary Tract Infections (UTIs)
What defines an asymptomatic UTI?
Evidence of a local host response to bacteriuria.
p.25
Symptoms and Clinical Presentation of UTIs
What is pyelonephritis?
Pyelonephritis is the inflammation of the kidney, characterized by fever, flank or low back pain, and symptoms of lower UTI, which may include vomiting and other systemic symptoms.
p.24
Diagnosis and Culture Techniques for UTIs
What is the typical urine culture result for acute prostatitis?
Gram-negative rods (GNR) or Enterococci.
p.14
Common Pathogens Associated with UTIs
Which pathogens are commonly involved in recurrent UTIs?
Proteus, Pseudomonas, Klebsiella, Enterobacter, Enterococcus, and Staphylococcus.
p.6
Definitions of Urinary Tract Infections (UTIs)
What is an upper urinary tract infection (U-UTI)?
An upper urinary tract infection involves infection of the kidneys (pyelonephritis) or ureters (ureteritis).
p.11
Microbial Virulence Factors in Uropathogens
What is the significance of toxin production in uropathogens?
Toxin production by uropathogens can damage host tissues and contribute to the severity of urinary tract infections.
p.32
Collection and Transport of Urine Specimens
What happens to urine if there is a delay in culture?
Colony count changes; organisms can either die or multiply, not necessarily the pathogen.
p.46
Contamination and Interpretation of Urine Cultures
What is the most common reason for urine culture contamination?
Poor collection instruction and poor technique.
p.46
Contamination and Interpretation of Urine Cultures
What is referred to as 'the rule of three' in urine culture contamination?
It typically relates to the frequency of contamination issues.
p.41
Contamination and Interpretation of Urine Cultures
What is an exception to the colony count rule for Beta-hemolytic Streptococcus group B?
Any amount of Beta-hemolytic Streptococcus group B in females of childbearing age is considered an exception.
p.33
Collection and Transport of Urine Specimens
Can boric acid tubes be used for urine culture?
No, boric acid tubes cannot be used for urine culture.
p.3
Definitions of Urinary Tract Infections (UTIs)
What are the most frequent bacterial infections in women?
UTIs are the most frequent bacterial infection in women.
p.7
Definitions of Urinary Tract Infections (UTIs)
What is a recurrent UTI?
Usually due to relapse or partial suppression of the original organism.
p.25
Symptoms and Clinical Presentation of UTIs
What percentage of pyelonephritis cases are bacteremic?
40 - 50% of pyelonephritis cases are bacteremic.
p.24
Risk Factors for UTIs by Gender and Age
Who is most commonly affected by chronic prostatitis?
Middle aged to elderly men.
p.6
Definitions of Urinary Tract Infections (UTIs)
What does 'renal' and 'nephro' refer to in medical terminology?
Both 'renal' and 'nephro' refer to the kidney.
p.4
Common Pathogens Associated with UTIs
Which bacteria can cause a hematogenous UTI?
S. aureus can cause a hematogenous UTI from the kidney to the bladder to the urethra.
p.11
Microbial Virulence Factors in Uropathogens
What is the role of capsular polysaccharide in uropathogens?
Capsular polysaccharides help uropathogens evade the host's immune response by forming a protective layer around the bacteria.
p.29
Diagnosis and Culture Techniques for UTIs
What are the key factors in diagnosing a UTI?
Proper collection, proper transport, proper plating, correct enumeration and interpretation, and clear, understandable reporting.
p.5
Diagnosis and Culture Techniques for UTIs
What kind of doctors treat UTIs?
Family practice, ER, minute clinic, Urologist, Ob/Gyn, Nephrologist, Rehab medicine, Geriatrics.
p.15
Risk Factors for UTIs by Gender and Age
What are some host factors that increase the risk of UTIs in females?
Short urethra, sexually active, pregnancy, urethral and vaginal colonization, immune hyper-responsiveness, menopause, low levels of secretory IgA, ABO blood group nonsecretor status.
p.45
Diagnosis and Culture Techniques for UTIs
What billing and compliance issues may arise in reflex testing?
Billing and compliance issues can include incorrect coding and lack of adherence to regulations.
p.31
Collection and Transport of Urine Specimens
What are the appropriate specimens for urine analysis?
Clean catch, catheterized, suprapubic aspirate (bladder tap), renal/surgical/aspirate/fluid specimens, nephrostomy urine.
p.48
Antimicrobials Specific to UTI Treatment
What is an important characteristic of antimicrobials used for UTIs?
Antimicrobials should be excreted in urine in active form and ideally concentrate to achieve levels higher than serum levels.
p.48
Antimicrobials Specific to UTI Treatment
What is the significance of achieving higher drug levels in urine compared to serum levels?
Even if the Minimum Inhibitory Concentration (MIC) is resistant, the drug might still work if urine levels are higher than serum levels.
p.3
Risk Factors for UTIs by Gender and Age
What is the estimated annual cost associated with UTIs?
The estimated annual cost associated with UTIs is 1.6 billion dollars.
p.24
Symptoms and Clinical Presentation of UTIs
What are the symptoms of chronic prostatitis?
Chronic intermittent dysuria, increased frequency of urination, pelvic pain, and enlarged prostate.
p.18
Risk Factors for UTIs by Gender and Age
How can catheterization contribute to urinary tract infections?
Catheterization can introduce bacteria into the urinary tract, leading to infection.
p.11
Microbial Virulence Factors in Uropathogens
What role does motility play in uropathogens?
Motility allows uropathogens to swim upstream in the urinary tract, facilitating their movement towards the bladder and kidneys.
p.50
Definitions of Urinary Tract Infections (UTIs)
Is bladder urine really sterile?
Bladder urine is generally considered sterile in healthy individuals, but it can become contaminated with bacteria from the urethra or external environment during collection or due to underlying health conditions.
p.10
Definitions of Urinary Tract Infections (UTIs)
What are uncomplicated infections in the context of urinary tract infections?
Uncomplicated infections occur in individuals with normal anatomy and can affect both the upper and lower urinary tract.
p.45
Diagnosis and Culture Techniques for UTIs
What are the types of indices used in reflex testing?
Chemical indices and microscopic indices.
p.44
Diagnosis and Culture Techniques for UTIs
Which UA indices may indicate UTI?
Increased protein and WBC casts may indicate UTI, particularly in pyelonephritis.
p.28
Diagnosis and Culture Techniques for UTIs
How can a kidney abscess be diagnosed?
A kidney abscess can be diagnosed by CT scan or ultrasound.
p.8
Definitions of Urinary Tract Infections (UTIs)
What is acute urethral syndrome?
A condition characterized by dysuria and pyuria along with leukocytes.
p.8
Definitions of Urinary Tract Infections (UTIs)
What are the symptoms of prostatitis?
Swelling of the prostate accompanied by fever.
p.16
Common Pathogens Associated with UTIs
What percentage of urethritis cases in males is caused by Gram-positive cocci?
20% of urethritis cases in males are caused by Gram-positive cocci.
p.48
Antimicrobials Specific to UTI Treatment
Which antimicrobials are often used empirically for UTIs?
Ciprofloxacin, Nitrofurantoin, and SXT are often used empirically for UTIs.
p.25
Common Pathogens Associated with UTIs
How do bacteria enter the bloodstream in cases of pyelonephritis?
Bacteria can enter the bloodstream through the urinary tract, especially in cases of severe infection.
p.4
Types of UTIs: Upper vs Lower
What is the most common route for UTIs?
The most common route for UTIs is ascending.
p.11
Microbial Virulence Factors in Uropathogens
How do uropathogens adhere to host tissues?
Uropathogens use bacterial adhesions, pili, and fimbrae to stick to the urinary tract tissues.
p.34
Collection and Transport of Urine Specimens
What happens when multiple tubes are given for urine collection?
It can lead to confusion and potential contamination of samples, resulting in inaccurate test results.
p.20
Risk Factors for UTIs by Gender and Age
How does male anatomy differ from female anatomy in relation to urinary tract infections?
Male anatomy has a longer urethra, which may provide some protection against UTIs, while female anatomy has a shorter urethra, making them more susceptible to infections.
p.21
Symptoms and Clinical Presentation of UTIs
What are the common causes of urethritis in females?
Low urine colony counts, STDs, HSV, confusion with vaginitis, and acute urethral syndrome.
p.37
Collection and Transport of Urine Specimens
What are the common volumes for calibrated loops?
Calibrated loops typically measure 0.01 or 0.001 mL.
p.37
Collection and Transport of Urine Specimens
What materials can calibrated loops be made from?
Calibrated loops can be made from plastic (disposable) or metal (reusable).
p.24
Symptoms and Clinical Presentation of UTIs
What are the symptoms of acute prostatitis?
Fever, chills, dysuria, increased frequency of urination, low back or pelvic pain, and pyuria.
p.16
Common Pathogens Associated with UTIs
Is S. saprophyticus a common cause of urethritis in males?
S. saprophyticus is rarely a cause of urethritis in males.
p.43
Diagnosis and Culture Techniques for UTIs
What action should be taken for symptomatic cases with the same results as 2 pathogens?
Minimal ID and save – contact lab for further ID.
p.18
Risk Factors for UTIs by Gender and Age
What role do diaphragms and spermicides play in urinary tract infections?
Diaphragms and spermicides can disrupt normal vaginal flora and increase the risk of UTIs.
p.11
Microbial Virulence Factors in Uropathogens
What are lipopolysaccharides and their relevance to uropathogens?
Lipopolysaccharides are components of the outer membrane of Gram-negative bacteria (GNR) that can trigger inflammatory responses in the host.
p.13
Risk Factors for UTIs by Gender and Age
What are some pediatric host factors that can increase the risk of UTIs?
Poor hygiene practices, being uncircumcised, low birth weight, and occasional structural/anatomical problems.
p.49
Diagnosis and Culture Techniques for UTIs
What are some examples of unusual or special cultures in microbiology?
Salmonella infections, Shigella infections, Neisseria gonorrhoeae (male or female), AFB culture, fungus culture, and virus culture.
p.40
Diagnosis and Culture Techniques for UTIs
Why is it important to perform culture work-up quickly in UTI cases?
Patients are often already on empiric therapy, so timely results are crucial.
p.22
Symptoms and Clinical Presentation of UTIs
What are common symptoms of cystitis?
Common symptoms include dysuria, frequency, urgency, tenderness and pain over the bladder, and bloody and/or cloudy or foul-smelling urine.
p.26
Definitions of Urinary Tract Infections (UTIs)
What is urosepsis?
Sepsis resulting from leaking of urine from damaged or clogged kidney into the bloodstream.
p.26
Symptoms and Clinical Presentation of UTIs
What causes systemic symptoms in urosepsis?
Pus and bacteria get into the blood, causing systemic symptoms (bacteremia).
p.14
Common Pathogens Associated with UTIs
What is the most common pathogen associated with uncomplicated UTIs in females?
E. coli, responsible for 80-90% of uncomplicated UTIs.
p.14
Common Pathogens Associated with UTIs
Which pathogen is associated with UTIs in young sexually active females?
S. saprophyticus, which accounts for 2-15% of cases.
p.25
Symptoms and Clinical Presentation of UTIs
What are the symptoms associated with pyelonephritis?
Symptoms may include fever, flank or low back pain, symptoms of lower UTI, vomiting, and other systemic symptoms.
p.4
Contamination and Interpretation of Urine Cultures
Is normal urine sterile?
Normal urine is considered sterile, but it can be contaminated as it passes through an unsterile opening.
p.6
Definitions of Urinary Tract Infections (UTIs)
What symptoms may accompany an upper urinary tract infection?
An upper urinary tract infection may be accompanied by a lower urinary tract infection (L-UTI) and fever.
p.11
Microbial Virulence Factors in Uropathogens
What are hemolysins and their function in uropathogens?
Hemolysins are toxins produced by some uropathogens that can lyse red blood cells, aiding in nutrient acquisition and tissue damage.
p.30
Diagnosis and Culture Techniques for UTIs
Can we potentially diagnose UTI with a quick Gram stain?
Yes, a quick Gram stain can be used as a preliminary diagnostic tool for UTIs.
p.35
Contamination and Interpretation of Urine Cultures
What can sometimes precipitate in refrigerated urine specimens?
Crystals or amorphous solids.
p.45
Diagnosis and Culture Techniques for UTIs
What are some common issues faced in interdepartmental workflows?
Interdepartmental workflow issues can include communication breakdowns and delays in processing.
p.33
Collection and Transport of Urine Specimens
Can boric acid tubes be used for urine analysis (UA) as a preservative for automated instruments?
No, boric acid tubes cannot be used for urine analysis (UA) as a preservative for automated instruments.
p.38
Diagnosis and Culture Techniques for UTIs
What is the minimum incubation time for urine culture plates?
Minimum 24 hour incubation, without CO2.
p.31
Collection and Transport of Urine Specimens
Is it common to submit multiple urine specimens?
Yes, sometimes two specimens are submitted, one for UA and one for culture.
p.43
Diagnosis and Culture Techniques for UTIs
What is the minimal identification (ID) threshold for voided midstream urine with ≥10,000 CFU/ml?
ID & AST for ≥10,000 CFU/ml.
p.7
Definitions of Urinary Tract Infections (UTIs)
What is asymptomatic bacteriuria?
A condition where bacteria are present in the urine without causing symptoms.
p.8
Definitions of Urinary Tract Infections (UTIs)
What does bacteriuria indicate?
The presence of detectable bacteria in the urine.
p.24
Diagnosis and Culture Techniques for UTIs
What indicates a positive culture in chronic prostatitis?
Positive culture of prostatic secretions or voided urine.
p.6
Definitions of Urinary Tract Infections (UTIs)
What is a lower urinary tract infection (L-UTI)?
A lower urinary tract infection involves infection of the urethra (urethritis), bladder (cystitis), or prostate (prostatitis).
p.11
Microbial Virulence Factors in Uropathogens
What is the connection between uropathogens and calculi formation?
Some uropathogens can contribute to the formation of kidney stones (calculi), which can obstruct the urinary tract and lead to further complications.
p.44
Diagnosis and Culture Techniques for UTIs
What UA indices are associated with cystitis versus pyelonephritis?
Increased protein is associated with pyelonephritis, while WBC casts are also increased in pyelonephritis.
p.31
Collection and Transport of Urine Specimens
How are most urine specimens processed?
Most specimens are shared, with urinalysis (UA) performed first, followed by culture.
p.38
Diagnosis and Culture Techniques for UTIs
What type of media may some labs use for urine cultures?
Some labs use chromogenic media.
p.26
Diagnosis and Culture Techniques for UTIs
What is the correlation in urosepsis diagnosis?
There is a correlation of blood culture and urine culture results.
p.8
Definitions of Urinary Tract Infections (UTIs)
What is cervicitis?
Inflammation of the cervix, which can be acute or chronic.
p.14
Common Pathogens Associated with UTIs
What pathogens are associated with urethral syndrome?
E. coli and C. trachomatis.
p.18
Risk Factors for UTIs by Gender and Age
What are some extrarenal obstructions that can lead to urinary stasis?
Congenital abnormalities, calculi, malignancies, vesicoureteral reflux, prostatic hypertrophy, neurogenic bladder, and pregnancy.
p.18
Risk Factors for UTIs by Gender and Age
How does immunocompromised status, such as in diabetes, affect the risk of UTIs?
Immunocompromised individuals have a reduced ability to fight infections, increasing their risk of UTIs.
p.11
Microbial Virulence Factors in Uropathogens
How does biofilm formation contribute to uropathogen virulence?
Biofilm formation allows uropathogens to adhere to surfaces and resist antimicrobial treatments, making infections harder to eradicate.
