Engidaw Ambelu

1. URINARY TRACT
INFECTION(UTI)
Dr.Wassihun T.

2. Cont…….
• OUTLINE
• Prevalence
• Risk factor
• Clinical presentation
• treatment

3. Prevalence
• 10 million visit/year
• Varies with age and sex
• 1st
year of life M:F 2.8-5.4:1
• Beyond 1year M:F 1:10
• 1%boys
• 3-5%girls

4. ETIOLOGY
Colonic bacteria
• E.coli(75%-90%)
• Klebsilla
• Proteus*
• Entrococcus
• S.saprophyticus
• Viral also may occur adeno virus

5. Pathogenesis and Pathology
1) Ascending infection
2) Hematogenous: rare mostly in neonate

6. RISK factors
• Female gender
• Uncircumcised male
• Vesicoureteral reflux
• Toilet training
• Obstructive uropathy
• voiding dysfunction
• Instrumentation

7. RISK FACTORS
• Wiping from back to front
• Tight under wear
• Neurological bladder
• Sexual activity
• Anatomic abnormalities

8. Contd………Contd………
Three forms of UTI
1.Pyelonephritis
2.Cystitis
3.Asymptomatic bacteriuria

9. Clinical ManifestationClinical Manifestation
Based on age and site of UTI
InfancyInfancy
+/-fever, decreased feeding , FTT, nausea
vomiting, diarrhea and jaundice
In childrenIn children
-cann’t report loin or back pain till 4-5year.

10. pyeloneprits
cystits

11. Asymptomatic Bacteriuria
• No sign and symptom of UTI
• Positive urine culture
• F>M
• No renal injury
• Antibiotic has no benefit

12. cystits
• Cry during micturation
• Urgency
• Frequency
• Supra pubic pain
• Incontinence
• Malodorous urine
• No fever and no renal damage

13. Pyelonephritis
• Temperature often 38 o
c – 38.5o
c
• Pain on under rib, abdomen, flank
• Non specific symptom malaise, vomiting,
diarrhea

14. DiagnosisDiagnosis
Is based on culture of bacteria from urine
How can we collect urine in children?
Toilet trainedToilet trained
Mid stream urine: (retracting prepuce )
No need of cleansing
Dx >100,000 colonies or >10,000 colonies with symptoms
InfantInfant
Adhesive sealed, sterile collecting bag
Collect after cleansing
If Symptom & U/A suggestive + single organism >106
colonies
Dx presumptive UTI.
If this is not met catheterize and repeat culture

15. Contd…..
 Catheterization
Bacteria from uretral meatus may contaminate
Superapupic aspiration (Optimal method)
Delineate bladder by palpation or percussion just 1-
2cm above sympsis pubis 3-4cm depth
Any bacteria from bladder or renal pelvis is
indicative of UTI

16. 1.U/A
U/A is confirmatory rather than diagnostic
-WBC (pyuria)
+/- UTI
Infection can occur without pyuria
Wbc casts – renal origin
RBC usually in cystits
Nitrates and leukocyte estrase are usually positive

17. Contd…..
2. CBC WBC ↑, ESR ↑,CRP ↑
3. Blood culture especially infant and
obstructive uropathy urosepsis

18. IMAGING STUDIES
1) Ultra sound
-R/O renal and perirenal abscesses
-Hydronephrosis
-scaring 30%(disparity in renal size>1cm)
- not useful to see reflux
2) Voiding cystoureterography
 Vesico uretral reflux (in 40%of UTI)
 2-6 weeks after inflammation subside or on discharge
 Contrast VCUG for male and radionuclide for female
Indication:
febrile UTI
UTI in <5 year
abnormal u/s
school aged girl ≥2 UTI
Any male with UTI

19. Contd……
3. Excretory urography
-obstructive malformation
-renal function
- renal scaring

20. TREATMENT
• Cystitis
-If Sever start RX before culture
-Mild UTI or doubtful xwait culture result
-3-5 days
- Trimethoprin –sufamethozazole
-Nitrofurantoin
-Amoxicillin

21. Contd…
Pyelonephritis
Admit if –dehydration
- unable to drink
- less than or equal to1 month
-10-14 day
-Ampicilline and *Aminoglycoside (gentamycine)
-Ceftriaxon
-3rd
generation cephalosprine po

22. Contd…
• Surgery ;renal or perirenal abscess or UTI in
obstructed urinary tract
• Prognosis: excellent if adequate and promote
treatment

23. Complication
• Urosepsis , pyonephrosis and perirenal
abscess
• Urea splitting bacteria will cause
alkalineization of urine → stone
• Renal insufficiency
• Hypertension