UNCOMPLICATED

URINARY TRACT
INFECTION

Ketut Suwitra

Division of Nephrology Department of Internal

Medicine
Faculty of Medicine Udayana University / Sanglah
Hospital
Denpasar
Definition
Urinary Tract Inferction (UTI) is, a
condition in which there are a growth
of microorganism in urinary tract.
In normal condition urine and
urinary tract are sterile
Classification of Urinary Tract
Infection (UTI) according to the
Clinical Condition :
Uncomplicate
d / simple UTI

Urinary Tract
Infection
(UTI)
Complicated UTI
Uncomplicated / simple UTI is :
UTI in normal status of Urinary Tract
:
no structural damage /
abnormality
normal kidney function
no other concomitant disease of
UT
no immunocompromized
condition
Low risk for complication
Complicated UTI is :
UTI with several abnormality in
UT :
structural damage/abnormality
reduce of kidney function
other concomitant disease
immonocompromize
High risk for complication or
treatment failure
Classification of UTI according to
the population affected:
1. UTI in young women :
1.a acute uncomplicated cystitis
1.b. acute uncomplicated
pyelonephritis
1.c. recurrent cystitis
2. UTI in adult with acute cyctitis or
prostatitis (in man)
3. Complicated UTI
4. Asymptomatic bacteriuria
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Nephrology, 2010
Pathogenesis
In healthy woman :
Uropathogens (typically
Escherichia coli) present in the
rectal flora enter the bladder
through the urethra

In male :
Colonizing uropathogens may
also come from a sex partners
vagina or rectum
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Nephrology, 2010
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Nephrology, 2010
Definitive diagnosis of UTI
requires the presence of
significant bacteriuria.
Traditional standard : 105 colonies or
more/m3 uropathogens of voided
midstream urine
The Infectious Diseases Society of
America consensus : 103 colonies
(80% sensitivity, 90% specificity)
Route of infection
Ascending from the urethra
most common
Hematogenous /
lymphatogenous
less common
Clinical Syndrome
Acute Uncomplicated
Cystitis in Young Woman
Dysuria
Frequency
Urgency
Suprapubic pain
Pyuria
Hematuria
Urine culture :
Generally not in women with
uncomplicated cystitis because :
the causative organisms are
predictable
the culture results become
available only after therapeutic
decisions have been made
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Nephrology, 2010
Hooton T, Urinary Tract Infection in Adults.
In : Floege J, Johnson RJ, Feehally J,
editors. Comprehensive Clinical
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Acute Uncomplicated
Pyelonephritis in Women
Symptom & Sign
fever
chills
flank pain
nausea / vomiting
costovertebral angel
tenderness
symptoms of cystitis
Laboratory Finding:
leucocytosis
pyuria / leucosuria
leucocyte casts

Urine Culture & Sensitivity test :

Should be perform will have
104 /ml or more
athologic Finding

Acute pyelonephritis. Renal tissue shows a dilated

tubule with neutrophils enmeshed in proteinaceous debris (pus
casts,
arrow) with adjacent interstitial inflammation. (Courtesy C. Alpers,
University
Hooton T, Urinary Tract Infection in Adults. In : Floege J,
of Washington, Seattle, Washington,
Johnson RJ, USA.)
Feehally J, editors. Comprehensive Clinical
Imaging studies

Acute pyelonephritis. Contrast-enhanced CT scan

shows areas of lower density due to infection and edema (arrows).
(Courtesy W. Bush, University of Washington, Seattle, Washington, USA.)
Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Indication for hospital
admission :
In ability to maintain oral
hydration or to take
medications
Uncertainty about diagnosis
Severe illness / severe
leucocytosis
Immunocompromize patients
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
 Hooton T, Urinary Tract Infection in Adults. In : Floege J,
Johnson RJ, Feehally J, editors. Comprehensive Clinical
Nephrology, 2010
Thank You