Causes of COMMUNITY-ACQUIRED PNEUMONIA:
Streptococcus Pneumoniae
Causes of NEONATAL (less than 3 months old) MENINGITIS and SEPSIS: In order
Group-B Strep
Escherichia Coli
Causes of INFANTILE (infants 6 - 24 months) MENINGITIS and SEPSIS: In order
Haemophilus Influenzae (Hib)
Neisseria Meningitidis
Causes of UTI's: In order
E. Coli
Proteus Vulgaris / Mirabilis:
10-15% of hospital acquired UTI's.
Pseudomonas Aeruginosa
ENTEROBACTERIACEAE: Cause Gastroenteritis, UTI's, Pneumonia, and Bacteremia.
GASTROENTERITIS: STRICTLY LUMINAL
Enteropathogenic E. Coli (EPEC)
Enterotoxigenic E. Coli (ETEC)
Vibrio Cholerae
Vibrio Parahaemolyticus (mechanism uncertain)
GASTROENTERITIS: INVASIVE (DYSENTERY)
Enteroinvasive E. Coli (EIEC)
Shigellosis
Salmonella Enterica
Campylobacter Jejuni
BACTEREMIA
Entero hemolytic E. Coli (EHEC)
Salmonella Typhi
Salmonella Choleraesuis
URINARY TRACT INFECTION
E. Coli
Proteus
Pseudomonas
Klebsiella
PNEUMONIA
Pseudomonas Aeruginosa
Klebsiella Pneumoniae
ENTEROBACTERIACEAE ANTIGENIC MARKERS:
O-Antigen: Carbohydrate in the cell wall.
K-Antigen: Capsular antigen, when present.
H-Antigen: Flagellar antigen, when present:
Campylobacter, Helicobacter, Escherichia.
F-Antigen: Pili antigen.
UTI COLLECTION METHODS:
Midstream clean catch
Catheterization
Risk of introducing infection
Technique must be aseptic
Indwelling Catheter
Infection always results.
Suprapubic Aspiration -- done only in males
UTI DIAGNOSTIC GUIDELINES:
Asymptomatic Bacteriuria (Female): Greater than 105 bacteria / mL of a single isolate.
Collection: Clean-catch midstream
Symptoms: asymptomatic
Uncomplicated Acute UTI: Greater than 103 bacteria / mL of a single isolate.
Collection: Clean-catch midstream
The diagnostic amount is smaller because polyuria is a symptom of UTI's, thus less bugs would tend to be in the urine.
Symptoms: Dysuria, frequency, urgency
Uncomplicated Acute Pyelonephritis: Greater than 105 bacteria / mL of a single isolate
Collection: Clean-catch midstream, or catheter
Symptoms:
Fever, chills
Back pain, flank pain, tenderness of costovertebral angle
Dysuria, frequency, urgency
Primary UTI (Male): Greater than 105 bacteria / mL of a single isolate
Collection: Clean-catch midstream, or suprapubic aspiration
Cause: Often prostatitis or an enlarged prostate.
Complicated UTI: Greater than 102 - 103 (100 - 1000) bacteria / mL of polymicrobic bacteria -- any bugs count.
Collection: Catheter
Diagnostic amount is less because of greater risk-factors and the patient's inability to concentrate the urine.
Risk-Factors:
Anatomic Abnormalities
Obstructive Uropathy
Indwelling Catheters