2. Objectives:
Definition of Urinary tract inection.
Distinguish Types of UTI including (Cystitis, Urethritis, prostatitis, and
pyelonephritis).
Describe the pathophysiology Related to UTI.
Most common risk factor of UTI .
Signs & symptoms of UTI.
Diagnostic methods for UTI.
Complications of UTI.
Treatment of UTI.
3. Urinary tract infection:
Is an infection in any part of the Urinary system, including( Kidneys,
ureters, bladder and urethra).Most infections involve the lower
urinary tract (bladder and urethra).
In males most common types of UTI are Prostatitis and urethritis.
In females of same age group the MC types are (cystitis, urethritis).
4. Epidemiology:
Common disorder, especially in females .
33% to 50% of all women experience UTI in their lifetime.
In males, UTI is uncommon, except in the first year of life and in men
over 60 years.
The incidence of UTI increases in Pt>50 Yrs, but the female: male ratio
decreases.
10. Pathophysiology of UTI:
The bacteria that cause urinary tract infections typically enter the bladder
via the urethra.
However, infection may also occur via the blood, lymph or direct extinction
from other organs.
It is believed that the bacteria are usually transmitted to the urethra from
the bowel flora, with females at greater risk due to their short urethra.
After gaining entry to the bladder, E. Coli are able to attach to the bladder
wall and form a biofilm that resists the body's immune response.
11.
12. Clinical Features of UTI:
Depending on the site of infection !
Most typical symptoms of cystitis and urethritis
(lower) include:
Frequency of micturition.
Dysuria.
Suprapubic pain and tenderness.
Hematuria (mainly visible)& pyuria .
Urgency and Strangury.
Smelly urine (unpleasant)
13. Systemic symptoms are usually slight or absent.
Infection in the lower urinary tract can spread to
cause acute pyelonephritis, thus systemic symptoms appear, such as:
lion pain, fever, tenderness, chills, night sweats, rigors, vomiting, and hypotension.
Prostatitis is suggested by:
perineal or suprapubic pain, pain on ejaculation and prostatic tenderness on
rectal examination
16. Diagnosis of UTI:
1-Dipstick urinalysis:
A urine dipstick positive for hematuria or proteinuria .
-Positive urine leukocyte esterase test (reflect pyuria).
-positive nitrate test for presence of bacteria (gram negative), (sensitive and
specific for enterobacteriaccea).
-combining the above two tests yields a sensitivity of 85% and specificity of 75%.•
Most urinary pathogens can reduce nitrate to nitrite, and neutrophils and nitrites
can usually be detected in symptomatic infections by urine dipstick tests for
leucocyte esterase and nitrite, respectively.
17. 2-Urinalysis (clean-catch mid stream specimen).
adequacy of collection.
Presence of epithelial cells indicate valvar or urethral contamination.
(perform straight Cath of the bladder)
Presence of pus, WBCs and RBCs.
Bacteruria>1 organism per oil immersion field
Bacteruria without WBC reflect contamination and not reliable Indicator of
infection.• Pyuria is the most valuable finding for diagnosis
>= 10 leukocyte/micro L is abnormal
Other findings: hematuria, mild proteinuria.
23. Management of UTI:
Antibiotics : recommended in all cases of proven UTI (symptomatic).
Treatment may be started while awaiting the result of urine culture.
Asymptomatic: no treatment required except in special situations.
Treatment duration:
Single dose therapy.
3 day course(the norm, less likely to induce significant alterations in bowel flora
compared with 7 day course).
7 day course.
10-14 day course
24. Trimethoprim or nitrofurantoin:
is the usual first choice of drug for initial treatment.
Between 10% and 40% of organisms causing UTI are resistant to trimethoprim.
Quinolone antibiotics:
such as ciprofloxacin and norfloxacin, and cefalexin are also generally
effective.
(alternative)
25. Co-amoxiclav amoxicillin:
are no longer recommended as blind therapy, as up to 30%
of organisms are resistant.
Penicillin and cephalosporin:
are safe to use in pregnancy but trimethoprim, sulphonamides, quinolones
and tetracycline should be avoided.
Also, drugs of choice for UTI with Renal failure.
26. In more severe infection, antibiotics should be continued for 7–14 days.
Seriously ill patients may require intravenous therapy with gentamicin for a few
days later.
Recurrent infection:
If relapse occurs within 2 weeks of cessation of treatment , continue treatment for
2 more weeks and obtain urine culture.
Urinary analgesic:
Phenazopyridine (1 to 3 days for dysuria).
27. Non specific therapy:
More water intake.
Maintaining acidity of urine by fluids like cranberry juice.
Summary of medications used
