Topic for BAMS

2. Contents
• Introduction
• Epidemiology
• Etiology
• Classification of UTI
• Pathogenesis
• Risk factors
• Clinical presentation
• Diagnosis
• Conclusion
• References

3. INTRODUCTION
• A urinary tract infection (UTI) is an
infection in any part of urinary system
— kidneys, ureters , bladder and
urethra. Most infections involve the
lower urinary tract — the bladder and
the urethra.

4. Epidemiology
• Seen in all age groups
• Infants up to 6 months – 2/1000
Women – at greater risk than men;
prevalence 40-50% in women and 0.04% in
men.
• 10% women have recurrent UTI in their life
• 7 million new cases of lower UTI / year
• 1 million hospitalizations / year
• Incidence of UTI increases in old age; 10%
of men and 20% of women are infected.

6. Etiology
• Acute uncomplicated UTI:
• Escherichia coli – cause about 80% of UTI
• 20% of UTI caused by-
1. Gram negative enteric bacteria – Klebsiella,
Proteus
2. Gram positive cocci – Streptococcus Faecalis
Staphylococcus saprophyticus
• S.saprophyticus – restricted to infections in
young sexually active women.

8. CLASSIFICATION OF UTI
Site of Infection
Upper
•Acute pyleonephritis
•Chronic pyleonephriitis
•Interstitial pyleonephritis
•Renal abscess
•Perirenal abscess
•Both upper & lower UTI are further divided
into complicated and uncomplicated.
Lower
•Cystitis
•Prostatitis
•Urethritis

9. 2. UTI
1. Community aquired (non catheter
associated)- uncomplicated
2. Nosocomial uti (catheter associated) –
complicated

10. 3. UTI
Uncomplicated UTIs Complicated UTIs
• Infection involving Presence of metabolic,
normal urinary tract. Functional and anatomical
• Healthy non pregnant abnormalities.
1.Women
2.Pregnancy
3.Catheterization
4.Diabetes
5.Infecton stone

11. Pathogenesis
• 4 routes of bacterial entry to urinary
tract.
1) Ascending infection
2) Blood borne spread
3) Lymphatogenous spread
4) Direct extension from other organs

12. Ascending Infection
 Most common route.
 Organisms ascend through urethra into
bladder.
Organism
Colonize in perineal , periurethral areas
Ascend to bladder and kidney
UTI

13. Hematogenous spread:
• Blood borne spread to kidneys.
• Occurs in bacteraemia.

14. • Lympathogenous spread
• Men- through rectal and colonic
lymphatic vessels to prostrate and
bladder.
• Women- through periuterine lymphatics
to urinary tract.
Direct extension from other
organs:
• Pelvic inflammatory diseases
• Genito-urinary tract fistulas

15. RISK FACTORS
1. Aging: diabetes mellitus
• urine retention
• impaired immune system
2. Females: shorter urethra
• sexual intercourse
• contraceptives
• incomplete bladder emptying with age
3. Males: prostatic hypertrophy
• bacterial prostatis
• age

16. UTI-CLINICAL
PRESENTATION
• Clinical manifestations depending on site of
infection
• Clinical manifestations depending on age of
patient

17. Clinical manifestations
depending on site of infection
 Urethritis:
• Discomfort in voiding
• Dysuria
• Urgency
• frequency
• pyuria

18. Cystitis:
• Dysuria, urgency and frequent urination
• Pelvic discomfort
• Suprapubic pain
• Abdominal pain
• Pyuria
• Urine is cloudy,
Malodorous and bloody

19. Pyelonephritis
• Invasive nature
• Suprapubic tenderness
• Fever and chills
• White blood cell casts in urine
• Back pain
• Nausea ,vomiting and diarrhea.
• Complications include sepsis, septic shock
and death.

20. Clinical manifestations depending on age
 Babies and infants:
1. Failure to thrive
2. Fever
3. Apathy
4. Diarrhoea
 Children:
1. Dysuria, urgency, frequency
2. Haematuria
3. Acute abdominal pain
4. Vomiting

21.  Adults:
1. Lower UTI- frequency, urgency ,
dysuria, haematuria
2. Upper UTI- fever, rigor and loin pain
and symptoms of lower UTI.
 Elderly patients:
• Mostly asymptomatic
• Not diagnostic as the symptoms are
common with age.

22. INVESTIGATION
• Microscopic examination of urine
• Urinalysis
• Urine culture
• Imaging techniques – CT scan and
MRI

23. Laboratory findings
Normal finding
• pH - 4.6 – 8.0
• Appearance- clear
• Color – pale to amber
yellow
• Odor – aromatic
• Blood – none
• Leukocyte esterase –
none
• WBC- absent
• Bacteria- absent
Abnormal finding
• •pH – Alkaline
(increases)
• Appearance – cloudy
• Color - deep amber
• Odor – foul smelling
• Blood – maybe present
• Leukocyte esterase -
present
• WBC- present
• Bacteria- present

24. Urinalysis :
• Presence of pus, white blood cells, red
blood cells
• Bacterial count > 105 /ml – significant
bacteriuria
• Leukocyte esterase dipstick test – WBC in
urine
• Nitrite dipstick test- pink colour

25. Urine culture
• For pyelonephritis
• Not a rapid diagnostic tool >105 bacteria
/ml
• Differential leukocyte count increased
neutrophills.

26. UTI - management
• Symptomatic UTI- antibiotic therapy
• Asymptomatic UTI- no treatment
required
except in special situations.
• Non- specific therapy:
1. more water intake.
2. Maintaining acidity of urine by fluids
like canberry juice.

27. TREATMENT
PATHOGEN SPECIFIC TREATMENT

28. Conclusion
• Urinary tract infections are the 2nd most
common bacterial infections.
• Women are the most infected subjects in the
population.
• Development of resistance to antibiotics by
the bacteria result in problems during the
treatment and lead to relapse or recurrence.
• Recent advances such as development of
immunologicals like intranasal vaccines may
result in life time cure of the infection in
future.