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Causative Agents
Clinical Features
1. Asymptomatic infection or covert bacteriuria is associated with active disease process in kidney.
Hence, if left untreated, it can develop cystitis and might go to renal failure.
2. Symptomatic Infection
In this, UTI is associated with symptoms as:
• Cystitis-characterized by dysuria, frequency of micturition, fever, urgency, supra pubic pain and
sometimes haematuria.
• More common in females because of short urethra
• Acute urethral syndrome-characterized by dysuria and frequency, seen in young, sexually active
women
• Pyelonephritis-characterized by loin pain, tenderness, high fever and rigors.
• Chronic pyelonephritis causes general ill health and malaise with nocturia
• Pyelitis-a mild form of pyelonephritis with pyuria but minimal involvement of renal tissue
Complications
• Septicaemia-particularly in elderly
• Chronic renal failure-due to renal scarring because of persistent or recurrent UTI in the young
Laboratory methods
A. Microscopy
1. Direct microscopic examination of centrifuged deposits is useful for detection of pus cells,
epithelial cells, bacteria, urinary casts, red cells, tubular epithelial cells or atypical cells.
2. Gram stained film may reveal white cells and bacteria that may have come from genital or urinary
tract
Wherever possible, detailed biochemical tests should be put up to confirm the identity of the isolate.
B. Culture
Blood agar and MacConkey agar are inoculated with predetermined quantity of urine. This helps in
expressing the bacterial count in uniform term of per ml. A standardized loop should be used for
inoculation. A loop which delivers 0.05 ml of urine is most convenient. One ml of urine shall contain 200
loopfuls. The number of colonies that are obtained after overnight incubation of inoculated plates is
multiplied with 200 to get viable bacterial count per ml of urine. Thus, if the number of colonies on a
bacteriological medium is 500, the viable bacterial count per ml of urine shall be 500 x 200 = 100,000.
Kass gave a criterion of active bacterial infection of urinary tract according to which a count exceeding
100,000 bacteria per ml denotes significant bacteriuria and is indicative of active UTI. This count is,
however, not applicable to tuberculosis of urinary tract because of slow rate of multiplication of
mycobacteria.
Ampicillin Kanamycin
Nalidixic acid Nitrofurantoin
Norfloxacin Sulphonamides
Tobramvcin Amoxycillin
Augmentin Cotrimoxazole
Carbenicillin Cephalexin
Cephaloridine Ciprofloxacin
Gentamicin
The cultures of screened positive urine samples are identified by using standard biochemical and/or
serological tests.
Treatment:
Treatment for urinary tract infections should be guided by susceptibility report as multiple resistances to
drugs may occur in uropathogen. Sometimes, a combination of drugs is required.