Urinary Tract Infections

Indri, dr.
Farah, drg.
Denny, dr.

The Genitourinary System

The organs system of the reproductive organs and urinary system

Grouped together because of their proximity to each other

The genitourinary system is the third of the bodys systems open
to the outside world
Pathogens use this as a portal for entry into the body

Healthcare professionals see many infections in this area

Urinary System Infections

Urine is sterile
Presence of inflammatory cells or pathogens in urine indicate a
urinary tract infection (UTI)
Urinary tract infection is the most common bacterial infection
managed in general medical practice
Accounts for 13% of consultations

Up to 50% of women will have a UTI at some point in their life

Urinary System Infections

Serious problem in
hospitals

Cause morbidity

Pathogens can travel up

the ureters and reach
the kidneys in a small
minority of cases,
causing renal damage
and kidney failure

Majority of infections
are caused by bacteria,
though some are fungal

UTIs Based on Location

Urethra

Urethritis

Bladder

Cystitis

Kidneys

Nephritis

Prostate
(men)

Prostatitis

Definition
It is the presence of microorganisms in the urinary
tract that cannot be accounted for by contamination.
The organisms have the potential to invade the tissues
of the UT and adjacent structures.
A UTI can manifest as several syndromes associated
with an inflammatory response to microbial invasion that
range from asymptomatic bacteriuria to pyelonephritis.

Risk Factors for Urinary Tract

Infection
Incomplete
bladder
emptying:
Foreign
bodies:
Loss of host
defences:

Bladder outflow obstruction

Neurological problems (eg multiple sclerosis, diabetic
neuropathy)
Gynaecological abnormalities (eg uterine prolapse)

Urethral catheters
Ureteric stent

Atrophic urethritis and vaginitis in postmenopausal

women
Diabetes mellitus

Etiology
The microorganism that cause UTIs usually originate
from the bowel flora of the host

Uncomplicated UTI:

Complicated UTIs

E.coli : 85%
S.Saprophyticus : 5-15%
K.pneumoniae, protues sp, Pseudomonas,
and Enterococcus : 5-10%
S.epidermidis if isolated should be
considered a contamination

Occurs because of anatomic, functional,

or pharmacological factors that
predisposes the patient to persistent
infection, recurrent infection, or
treatment failure.
More varied and generally more
resistant
E.coli 50%
K.pneumoniae, protues sp, Pseudomonas,
Enterococcus, Enterobactor sp

Classification
According to anatomic site of
involvement:
Lower tract
infection:

Upper tract
infection:

Cystitis
Urethritis
Prostatitis

Pyelonephritis involving
the kidneys

Classification
According to Degree
Uncomplicated
Occur in individuals who lack structural or
functional abnormalities in the UT that
interfere with the normal flow of urine.
>> healthy females of childbearing age

Complicated
Predisposing lesion of the UT :
congenital abnormality or distortion of the
UT
A stone a catheter
Prostatic hypertrophy (male)
Obstruction
Neurological deficit
Interfere normal flow of urine and urinary
tract defenses.

Recurrent UTIs
Multiple symptomatic infections with
asymptomatic periods
Reinfection: caused by a different organism than originally
isolated and account for the majority of recurrent UTIs.

Relapse: repeated infections with the same initial organism

and usually indicate a persistent infectious source.

Asymptomatic bacteriuria
Common among the elderly
Bacteiruria > 105 bacteria/ml of urine
without symptoms

Symptomatic abacteriuria:
Symptoms of frequency and dysuria in
the absence of significant bacteriuria

Symptoms of UTIs

Lower tract
infection

Upper tract
infection

Dysuria

Flank pain

Urgency

Costovertebral tenderness

Frequency

Abdominal pain

Nocturia

Fever

Suprapubic heaviness

Nausea

Hematuria in women.

Vomiting

No systemic symptoms

Malaise

Typical features of cystitis and

urethritis
Abrupt onset of frequency of micturition (urination)

Scalding pain in the urethra during micturition

(dysuria)

Lower back pain, abdominal pain and tenderness

over bladder

Suprapubic pain during and after voiding

Intense desire to pass more urine after micturition

due to spasm of inflamed bladder (urgency)

Typical features of cystitis and

urethritis
Urine that may appear cloudy
and have an unpleasant smell
Presence of blood in the urine
(haematuria)
Cystitis has more acute onset
and severe symptoms

Symptoms of Prostatitis
Pain in the lower back, perirectal area and testicles
High fever, chills and symptoms similar to bacterial
cystitis
Inflammatory swelling of prostate, which can lead to
urethral obstruction
Urinary retention, which can cause abscess formation or
seminal vesiculitis

Systemic Symptoms Suggestive Of

Pyelonephritis
Fever above 38.3C
Loin pain
May be indication for hospitalisation

Laboratory Findings

Treatment

Treatment
Prevent or treat systemic
consequences of infection
Eradicate the invading organism
Prevent reoccurrence of infection

Treatment

Treatment

Treatment Antibiotic Dose

Non Spesific Treatment

Fluid hydration:
Rapid dilution of bacteria and removal of infection through
increased voiding

Cranberry juice
Increase the antibacterial activity of urine

Urinary analgesics
Phenazopyridine
Has little clinical role in infection because symptoms respond
rapidly to anitmicrobial therapy

Special Consideration in Older

Patient
Prevalence >> with age (40% in women)
Contributing factors include increased prevalence of underlying structural
abnormalities, postmenopausal oestrogen deficiency in women, prostatic
hypertrophy in men
The urinary tract is the most frequent source of bacteraemia in older patients
admitted to hospital
Symptoms may not follow classic patterns seen in younger adults and fever
might not occur
Patients with underlying conditions such as dementia may find it difficult to
explain symptoms
Agitation, change in mental state or other behavioural changes maybe the
only sign of UTI in elderly men and women
Left untreated, UTI can lead to delirium or even death in an elderly patient

Prevention
Keep patients hydrated (Fluid intake of at least 2 litres
per day)
Encourage regular complete emptying of the bladder
Good personal hygiene
For women, avoid feminine hygiene sprays
Encourage front to back cleansing

Prevention
Showers preferable to baths
Cranberry juice maybe effective
Frequently change those who use incontinence pads
Set reminders/timers for those who are memory
impaired to use the bathroom

Thank You