Management of uti


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The principles of management of UTI is described

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Management of uti

  1. 1. Javed Iqbal FCPS, FRCS, Professor Of Surgery Quaid-e-Azam Medical College, &Iqbal Minimal Invasive Surgery Center Bahawalpur e-mail:
  2. 2. Urinary tract infections (Complicated) e-mail:
  3. 3. 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. e-mail:
  4. 4. DefinitionUrinary tract infection is diagnosed when bacteria and pus cells are recovered from the urine with or without symptoms. e-mail:
  5. 5. UTI Women during the reproductive years Old age Post-operative period e-mail:
  6. 6. “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. e-mail:
  7. 7. Why is the Concept of Complicated UrinaryTract Infections Useful in Practice? e-mail:
  8. 8. 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 e-mail:
  9. 9. Pre-menopausal Women e-mail:
  10. 10. 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. e-mail:
  11. 11. Why are Women so Prone to Urinary Tract Infections? e-mail:
  12. 12.  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 e-mail:
  13. 13. Pediatric Patients e-mail:
  14. 14. 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 e-mail:
  15. 15. The organism mostcommonly associated with UTI in children, as in adults, is E. coli e-mail:
  16. 16.  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. e-mail:
  17. 17.  More extensive diagnostic investigations Greater emphasis on prompt and appropriate treatment Longer follow-up after apparent cure e-mail:
  18. 18. What is Required for theDiagnosis of a PediatricUrinary Tract Infection? Urine Culture is must e-mail:
  19. 19. Elderly Patients e-mail:
  20. 20. Again, women outnumbermen as far as incidence is concerned e-mail:
  21. 21. Urinary Tract Infections inthe Elderly should always be Considered Complicated e-mail:
  22. 22. 1 Non-specific, vague, or atypical clinical presentation Decline in mental status e-mail:
  23. 23. 2 The sensitivity of standard urinalysis for leukocyte esterase as a marker of infection is low. Urine cultures e-mail:
  24. 24. 3 Non-first-line antibiotics short-course antibiotic therapy is much less likely to be effective. e-mail:
  25. 25. 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 e-mail:
  26. 26. Treatment failures andrecurrences, despite what would be considered appropriate and adequate therapy, are common in the elderly e-mail:
  27. 27. 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 e-mail:
  28. 28. Asymptomatic Bacteriuria e-mail:
  29. 29. More than 100,000 colony-forming units (CFU)/mL of voided urine in a person with no symptoms of UTI e-mail:
  30. 30. AsymptomaticBacteriuria in elderlyThe current view is that it should not be treated e-mail:
  31. 31. Pregnant Patients1. asymptomatic bacteriuria2. symptomatic lower UTIs 3. pyelonephritis e-mail:
  32. 32. 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 e-mail:
  33. 33. Patients with Anatomic Abnormalities of the Urinary Tract e-mail:
  34. 34.  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 e-mail:
  35. 35.  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. e-mail:
  36. 36. Catheter-related Urinary Tract Infection e-mail:
  37. 37. Risk Factors longer duration of catheterization female sex poor catheter care inadequate use of antibiotics e-mail:
  38. 38. Can Urinary Tract Infection be Prevented in Catheterized Patients? Minimal duration Close system Intermittent cathetrization Supra-pubic cystostomy e-mail:
  39. 39. Should Asymptomatic Bacteriuria inCatheterized Patients be Treated? NO e-mail:
  40. 40. Chronic (Bacterial) ProstatitisChronic Pelvic Pain Syndrome e-mail:
  41. 41. TREATMENT e-mail:
  42. 42. UTI was first treated with sulfonamides during theSecond World War in 1939by the Nobel Prize Winner Gerhard Domagk e-mail:
  43. 43. 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. e-mail:
  44. 44. Antibiotics e-mail:
  45. 45. General Considerations Concentration in the urine Concentration in vaginal secretions Spectrum of activity against infecting organisms Half-life Safety and adverse effect profile Cost e-mail:
  46. 46. Traditional First-line Agents for Uncomplicated Urinary Tract Infections Amoxicillin Ampicillin Trimethoprim Trimethoprim–sulfamethoxazole e-mail:
  47. 47. First-line Agents No role in Complicated UTI Very little role when the isolate is E-Coli e-mail:
  48. 48. Oral Cephalosporins e-mail:
  49. 49. Extended-spectrum Agents e-mail:
  50. 50. Aminoglycosides e-mail:
  51. 51. Nitrofurantoin e-mail:
  52. 52. Fluoroquinolones e-mail:
  53. 53.  Classification of Fluoroquinolones Whatis the Anti-bacterial Activity of the Fluoroquinolones? e-mail:
  54. 54. Which Fluoroquinolonesare Suitable as First-lineAgents for Treatment of Complicated Urinary Tract Infections? e-mail:
  55. 55. Antipyretic Therapy e-mail:
  56. 56. THANK YOU VERY MUCH e-mail: