Management of uti
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Management of uti

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The principles of management of UTI is described

The principles of management of UTI is described

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Management of uti Management of uti Presentation Transcript

  • Javed Iqbal FCPS, FRCS, Professor Of Surgery Quaid-e-Azam Medical College, &Iqbal Minimal Invasive Surgery Center Bahawalpur www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Urinary tract infections (Complicated) www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • IntroductionMost common type of bacterial infectionsAlthough the urinary tract, unlike the respiratory tract or the gastrointestinal tract, is not exposed to the outside world, and is normally sterile. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • DefinitionUrinary tract infection is diagnosed when bacteria and pus cells are recovered from the urine with or without symptoms. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • UTI Women during the reproductive years Old age Post-operative period www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • “complicated” UTI Long-term foreign bodies such as indwelling urinary catheters and stents. Urinary tract stones. Congenital or anatomic anomalies. Obstructive uropathy Vesicoureteric reflux, or structural urologic abnormalities, including surgically created structural changes, such as ileal loops; Neurogenic bladder disorder Renal transplantation. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Why is the Concept of Complicated UrinaryTract Infections Useful in Practice? www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Complicated UTI More chances of infection with bacteria that are resistant to first-line antibiotics Less likely to respond to a short course (<7 days) of antibiotics; and More likely to require microbiologic laboratory testing, follow-up assessment, and consideration of imaging procedures www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Pre-menopausal Women www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Premenopausal Women Nosocomial pathogens --recent hospitalization Diabetes mellitus Pregnancy Recent instrumentation or surgery Uremia from renal causes Anatomic abnormalities of the urinary tract Urinary tract stones Urinary stents or other foreign bodies Immunocompromised or immunosuppressed, including from the use of immunosuppressive drugs; and a history of renal transplantation. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Why are Women so Prone to Urinary Tract Infections? www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  Short urethra. Close proximity to the anus, vulva and perineal area. In adults the UTIs have been shown to be strongly and independently associated with recent sexual activity www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Pediatric Patients www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • In infants below the age of three months hematogenous spread After this age The route of entry of pathogens is by ascending through the urethra, as in adults www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • The organism mostcommonly associated with UTI in children, as in adults, is E. coli www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  Diagnosis is not always as straightforward as in adults, especially in neonates and very young children; The risk of recurrence is relatively high The risk of complications, or long-term sequela is relatively high, a risk that can be significantly reduced with timely diagnosis and prompt treatment. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  More extensive diagnostic investigations Greater emphasis on prompt and appropriate treatment Longer follow-up after apparent cure www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • What is Required for theDiagnosis of a PediatricUrinary Tract Infection? Urine Culture is must www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Elderly Patients www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Again, women outnumbermen as far as incidence is concerned www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Urinary Tract Infections inthe Elderly should always be Considered Complicated www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • 1 Non-specific, vague, or atypical clinical presentation Decline in mental status www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • 2 The sensitivity of standard urinalysis for leukocyte esterase as a marker of infection is low. Urine cultures www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • 3 Non-first-line antibiotics short-course antibiotic therapy is much less likely to be effective. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • 4 Wide variety of both Gram-negative and Gram-positive bacteria, and polymicrobial infection is relatively common. E. coli accounts for less than 50% of bacterial isolates in the elderly www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Treatment failures andrecurrences, despite what would be considered appropriate and adequate therapy, are common in the elderly www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Why elderly are more prone to UTI Oestrogen Anatomical changes due to gyaenacological surgery Some degree of BOO in male Debilitating diseases resulting in decreased immunity www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Asymptomatic Bacteriuria www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • More than 100,000 colony-forming units (CFU)/mL of voided urine in a person with no symptoms of UTI www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • AsymptomaticBacteriuria in elderlyThe current view is that it should not be treated www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Pregnant Patients1. asymptomatic bacteriuria2. symptomatic lower UTIs 3. pyelonephritis www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Asymptomatic bacteriuria Itshould be treated E-coli is the common bug First line treatment is the choice Duration should be short Recurrence should be monitored www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Patients with Anatomic Abnormalities of the Urinary Tract www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  Patients with congenital developmental or anatomic anomalies; Patients with surgically created anatomic changes in the urinary tract; Patients with any kind of obstructive uropathy; Patients with urinary tract stones; and Patients with long-term foreign bodies in the urinary tract, such as stents or indwelling catheters www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  Infected with a wider range of bacteria They sustain renal damage and scarring as a result of infection They have a high risk of poor response to antibiotic therapy. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Catheter-related Urinary Tract Infection www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Risk Factors longer duration of catheterization female sex poor catheter care inadequate use of antibiotics www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Can Urinary Tract Infection be Prevented in Catheterized Patients? Minimal duration Close system Intermittent cathetrization Supra-pubic cystostomy www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Should Asymptomatic Bacteriuria inCatheterized Patients be Treated? NO www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Chronic (Bacterial) ProstatitisChronic Pelvic Pain Syndrome www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • TREATMENT www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • UTI was first treated with sulfonamides during theSecond World War in 1939by the Nobel Prize Winner Gerhard Domagk www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Non specific therapies Hydration and increased fluid intake; E. coli do not grow in a low osmolar (dilute) urine. Alkalinization of the urine: dissolves urate and oxalates crystals and less growth of E.coli Urination after intercourse. Analgesia. www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Antibiotics www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • General Considerations Concentration in the urine Concentration in vaginal secretions Spectrum of activity against infecting organisms Half-life Safety and adverse effect profile Cost www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Traditional First-line Agents for Uncomplicated Urinary Tract Infections Amoxicillin Ampicillin Trimethoprim Trimethoprim–sulfamethoxazole www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • First-line Agents No role in Complicated UTI Very little role when the isolate is E-Coli www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Oral Cephalosporins www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Extended-spectrum Agents www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Aminoglycosides www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Nitrofurantoin www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Fluoroquinolones www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  •  Classification of Fluoroquinolones Whatis the Anti-bacterial Activity of the Fluoroquinolones? www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Which Fluoroquinolonesare Suitable as First-lineAgents for Treatment of Complicated Urinary Tract Infections? www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • Antipyretic Therapy www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com
  • THANK YOU VERY MUCH www.facebook.com/surgeonjaved e-mail: surgeonjaved@hotmail.com