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Rods
R: GNR
L: GPR (UTI (Risk factors (Women, Recent intercourse, Hx of…
Rods
R: GNR
L: GPR
Microbiology
Stains Pink, thin peptidoglycan layer with outer membrane and thus does not hold stain
Porin
Passage of small molecules, mutation can cause resistance
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Peptidoglycan Layer
Thinner, decolorize in presence of acetone)
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Biofilms
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Increase resistance to antibiotics and immune system
e.g. pseudomonas aeruginosa -> remove foreign body if possible
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Classification
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Enterobacteriaceae
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Found in soil, water, vegetation, normal intestinal flora
Major cause of UTI, hospital acquired pneumonia and blood stream infx, intraabdominal infx
Pseudomonas
Found in soil, WATER, plants
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LPS, many endo/exotoxins, proteases, other virulence factors
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Clinical associations
Burns, wound infx, neutropenia
Swimmers ear, malignant otitis
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Anaerobes
impt flora in oropharynx, GI and GU tract
Bacteroides fragilis
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Often present in polymicrobial infx (intestinal perforation, abdominal abscess)
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UTI
Lower
Cystitis, URethritis, asymptomatic bacteriuria (not an infx)
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Pathogenesis
- Colonization with uropathogens (attach to urinary epithelium with fecal flora) near urethra
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- Continue up ureters into kidneys
- pyelo can also result from bacterial seeding of kidneys during bacteremia
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Clinical manisfestations
Cystitis
Urinary freq, dysuria, hematuria, suprapubic pain
Pyelo
Fever, Costovertebral angle tenderness, vomiting, flank pain
Diagnosis
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Urinalysis
pyuria (WBC in urine) is most sensitive test, though not specific
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e.g. E. Coli > 100000 cfu/ml (more likely to be true UTI vs 1000-100000, where it is sometimes associated with UTI in community acquired among young women)
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Treatment
3 first line antibiotics
Nitrofurantoin
contraindicated in GFR < 60, upper uti
Trimethoprim-sulfamethoxazole
rash, renal failure
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