Urinary tract infection management

1. Urinary Tract
Infection
Dr. Iqra Muzaffar

2. Definition
Symptomatic prescence of
microorganisms within the
urinary tract i-e kidneys ,
ureters, bladder and urethra .

3. Terminologies
– Uncomplicated : UTI without underlying renal and neurological disease.
– Complicated : UTI with underlying structural , medical or neurological disease.
– Recurrent : Greater than 3 symptomatic UTI within 12 months following clinical
therapy
– Re-Infection : Recurrent UTI caused by a different pathogen at any time.
– Relapse: Recurrent UTI caused by same species causing original UTI within 2
weeks after therapy.

4. Classification
Upper
• Acute pyelonephritis
• Chronic pyelonephritis
• Interstitial pyelonephritis
• Renal Abscess
• Peri-renal Abscess
Lower
• Cystitis
• Prostatitis
• Urethritis

5. – Both Upper and lower UTI are further divided into complicated and
uncomplicated.

6. Epidemiology
– Seen in all age groups.
– Infants upto 6 months (2/1000)
– More common in boys than girls.
– WOMEN
are at greater risk than men (40-50% prevelance in women ,
0.04% in men)
Incidence of UTI increases in old Age (10 % men & 20% women are infected )

7. ETIOLOGY
– ACUTE UNCOMPLICATED UTI :
E. Coli – 80%
20% of UTI caused by
Gram negative enteric Bacteria – Klebsiella , Proteus
Gram Positive Cocci – Streptococcus feacalis
Staphylococcus Saprophyticus – restricted to infections in
young sexually active women .

8. – COMPLICATED UTI
– Pseudomonas aeruginosa, Enterobacter & Serratia .
– Hospital Acquired

9. Pathogenesis
– Routes of infection
– Ascending ( most common route )
– Blood borne ( S. Aureus)
– Lymphatogenous ( in men through rectal and colonic
lymphatic vessels to prostate and bladder ; in women through periuterine
lymphatics to urinary tract )
– Direct extension from organs
( Pelvic Inflammatory disease,
Genitourinary fistulas )

10. Risk Factors
– Aging
Diabetes ,
Urine retention,
Impaired immune system
– Females
shorter urethra
sexual intercourse
contraceptives
– Males
Prostatic hypertrophy
Bacterial prostatitis

11. UTI CLINICAL
PRESENTATION
– Depends on site of infection
& Age of the patient

12. Signs & Symptoms
Mostly
asymptomatic
Elderly
Frequency
Urgency
Dysuria
Hematuria
Fever e rigors
Loin pain
AdultsChildren
Failure to
thrive
Fever
Apathy
Diarrhea
Infants
Dysuria
Frequency
Urgency
Vomiting
Acute
Abdominal
Pain

13. Diagnosis
– Microscopic Examination of Urine
– Urinanalysis
– Urine Culture
– Imaging Techniques – CT Scan , MRI

14. Laboratory Examination
– Uncontaminated , MSU
– Methods of urine Collection
– Sticks on bag
– catherization
– Supra-pubic Aspriation 9 Gold Standard)

15. Diagnostic Tests for
RECURRENT UTI in ADULTS
– IVP
– Excretory
– Voiding Cystourethrography
– Cystoscopy
– Manual Pelvic and prostatic Examination

16. MANAGEMENT
Non specific
Therapy
Asymptomatic –
No Antibiotics
Symptomatic –
Antibioyic
therapy

17. Goals of therapy
– Elimination of infection
– Relief of acute symptoms
– Prevention of recurrent and long term complications.

18. Ideal ANTIBIOTIC for UTI
– Adequate coverage over E.coli
– Concentration in urine
– Duration of therapy
– Low resistance
– Cost effective
– Low adverse effect profile

19. Single dose therapy
(Uncomplicated UTI)
– Trimethoprim-Sulfamethoxazole (160+800 mg )
– Amoxicillin-culvulnate 500mg
– Amoxicillin 3G
– Ciprofloxacin 500mg
– Norfloxacin 400mg

20. 3 Day therapy
(Complicated UTI)
– Extended release ciprofloxacin
– 500mg for uncomlicated
– 1000mg for complicated

21. 7 DAY THERAPY
– Recurrent cases
– Pregnancy
– UTI with other risk factors

22. 14 DAYS THERAPY
– For complicated UTI
– High risk of mortality and morbidity