UTI

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Urinary Tract Infection

Or (UTI) exists when pathogenic microorganisms are detected in the urine, urethra, bladder, kidney, or prostate, Any infection in the lower or upper urinary tract

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catheter-associated (or nosocomial) infections and non-catheter-associated (or communityacquired) infections. Complicated UTI vs Uncomplicated UTI symptomatic or asymptomatic

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Epidemiology

Female > male women between 20 and 50 acute symptomatic UTIs - first year of life of males

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Etiology

most common agents are the gram-negative bacilli Escherichia coli causes ~80% of acute infections Proteus, Klebsiella spp.and Enterobacter spp. major role play a

Serratia spp. & Pseudomonas spp

nosocomial, catheterassociated infections

in

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Conditions affecting Pathogenesis

Gender and Sexual Activity Pregnancy Obstruction Neurogenic Bladder Dysfunction Vesicoureteral Reflux Bacterial Virulence Factors Genetic Factors

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Gender & Sexual activity

female urethra prone to colonization by gram (-) bacteria

proximity to the anus, its short length (~4 cm), and its termination beneath the labia

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Gender & Sexual activity cont

Sexual intercourse causes the introduction of bacteria into the bladder Use of spermicidal compounds with a diaphragm or cervical cap or use of spermicidecoated condoms Uncommon in male patients <50 years old and no history of heterosexual or homosexual insertive rectal intercourse urethral obstruction due to prostatic hypertrophy common cause of UTI in males

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Pregnancy
Predisposing Factors

decreased ureteral tone decreased ureteral peristalsis temporary incompetence of the vesicoureteral valves Bladder catheterization during or after delivery

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Obstruction
Any impediment to the free flow of urine:

Tumor Stricture Stone prostatic hypertrophy

..results in hydronephrosis and a greatly increased frequency of UTI.

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Neurogenic Bladder Dysfunction

Interference with bladder enervation:

spinal cord injury tabes dorsalis etc initiated by the use of catheters for bladder drainage prolonged stasis of urine in the bladder

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Vesicoureteral Reflux

reflux of urine from the bladder cavity up to he upper urinary tract impaired vesicoureteral junction facilitates reflux of bacteria and thus upper tract infection

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Pathogenesis
UTI results from interplay of: Host Etiologic Agent

Ascending route Hematogenous spread Lymphatic spread

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Asymptomatic bacteriuria per presence of more than 100,000 organisms

mL in 2 consecutive urine samples in the absence of declared symptoms

bacteriuria in a woman with no symptoms

Acute Cystitis

It is an inflammation of the bladder due to bacterial or non-bacterial causes (ie. Radiation, viral) Infection limited to the lower urinary tract

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Urethritis

It should be suspected in patients with acute cystitis and a negative urine culture

Acute Pyelonephritis

Infection of the renal parenchyma and pelvicaliceal system accompanied by significant bacteriuria

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Clinical Presentation
ACUTE CYSTITIS

dysuria, particularly at the end of the urination, Urgency & frequency occasionally gross or microscopic hematuria urine culture (+) for bacterial growth with at least 100 colonies/mL Associated with pyuria and bacteriuria Usually uncomplicated but infection may ascend and involve upper urinary tract

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Acute Pyelonephritis

Symptoms generally develop rapidly over a few hours or a day fever, shaking chills, nausea, vomiting, abdominal pain, and diarrhea. Symptoms of cystitis are sometimes present fever, tachycardia, and generalized muscle tenderness, PE reveals marked tenderness on deep pressure in one or both CVA or on deep abdominal palpation. Leukocyte casts - pathognomonic
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Hematuria - during the acute phase

Urethritis

acute dysuria, frequency, and pyuria, ~30% have midstream urine cultures with either no growth or insignificant bacterial growth Clinically, cannot always be readily distinguished from cystitis sexually transmitted pathogens VS low-count E. coli or S. saprophyticus infection Chlamydial or gonococcal infection - gradual onset of illness, no hematuria, no suprapubic pain, and >7 days of symptoms E. coli UTI - Gross hematuria, suprapubic pain, an abrupt onset of illness, a duration of illness of <3 days, and a history of UTIs
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Catheter-Associated UTIs

develops in at least 1015% of hospitalized patients with short-term indwelling urethral catheters. The risk of infection is ~35% per day of catheterization. E. coli, Proteus, Pseudomonas, Klebsiella, Serratia, staphylococci, enterococci, and Candida

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Factors associated

female sex prolonged catheterization severe underlying illness disconnection of the catheter and drainage tube other types of faulty catheter care, and lack of systemic antimicrobial therapy.

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Infection occurs by one of two routes:

migration through the column of urine in the catheter lumen (intraluminal route) or up the mucous sheath outside the catheter (periurethral route).

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DIAGNOSIS

Urine cultures, U/A, CBC In symptomatic patients, bacteria present in large numbers (105/mL) midstream catch In asymptomatic patients, two consecutive urine specimens should be examined before therapy is instituted 105 bacteria of a single species per milliliter should be demonstrable in both specimens colony counts of 102104/mL - suprapubic aspiration & indwelling catheter

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Therapeutics
Treat for 3 days

Cephalexin 500mg 1 cap QID Or C-Trimoxazole 1 tab BID PO Or Norfloxacin 400 mg 1 tab BID Or Ciprofloxacin 250-500mg 1 tab BID Or Co-Amoxiclav 375mg 1 tab TID PO Or Nitrofurantoin 100mg 1 cap QID PO x 7 days

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Prognosis
Good!!!

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Prevention

avoid spermicide use void soon after intercourse Postmenopausal women not taking oral estrogen replacement therapy - intravaginal estrogen cream Increase OFI Change foley caths every 2 weeks All pregnant women should be screened for bacteriuria in the first trimester

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THANK YOU!!!

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